From the Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences (Dr. Stake, Agarwal, Dr. Campbell); the Department of Orthopaedic Surgery, Howard University Hospital (Dr. Coombs), Washington, DC; the Department of Orthopaedic Surgery, Penn Medicine, Philadelphia, PA (Dr. Cohen); the Department of Orthopaedic Surgery, VCU Health, Richmond, VA (Dr. Golladay); and the Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, Columbia, MD (Dr. Thakkar).
J Am Acad Orthop Surg Glob Res Rev. 2022 Aug 12;6(8). doi: 10.5435/JAAOSGlobal-D-22-00125. eCollection 2022 Aug 1.
Genicular nerve radiofrequency ablation (GNRFA) is an increasingly used nonsurgical treatment modality for patients with advanced knee osteoarthritis. Previous studies have demonstrated this to be an effective and safe method to decrease pain and increase functionality in this patient population. The purpose of this study was to compare 2-year postoperative complication rates and rates of prolonged postoperative opioid usage between patients undergoing total knee arthroplasty (TKA) after previous GNRFA and those undergoing TKA alone.
Patients who underwent primary TKA after prior GNRFA (GNRFA-TKA) of the ipsilateral knee were identified in a national all-payer claims database from 2010 to 2019. Univariate and multivariable analyses were conducted comparing those with prior GNRFA and those without. Outcomes of interest included prolonged postoperative opioid usage, 2-year revision rates, and 90-day medical complications. Statistical analysis was conducted using R software provided by the PearlDiver Database.
In total, 675 patients in the GNRFA-TKA cohort were compared with a control cohort of 255,351 patients. Genicular nerve radiofrequency ablation-total knee arthroplasty patientshad lower odds of prolonged opioid use postoperatively (OR: 0.478; 95%: 0.409 to 0.559; P < 0.001). No notable difference was observed in the 2-year surgical outcomes between cohorts. Patients in the GNRFA-TKA cohort had lower odds of requiring a blood transfusion and having postoperative anemia, all arrhythmias, and urinary infections compared with primary TKA control patients.
Preoperative GNRFA leads to a lower rate of prolonged postoperative opioid use in patients undergoing TKA, without an increased risk of complications. Future prospective studies are needed to validate the findings of this database study.
膝关节神经射频消融术（GNRFA）是一种越来越被用于治疗晚期膝骨关节炎的非手术治疗方法。先前的研究表明，这种方法可以有效且安全地减轻疼痛并提高患者的功能。本研究旨在比较接受过 GNRFA 治疗的患者和未接受过 GNRFA 治疗的患者行初次全膝关节置换术（TKA）后的 2 年术后并发症发生率和术后延长使用阿片类药物的发生率。
在 2010 年至 2019 年期间，我们在一个全国性的支付者索赔数据库中确定了单侧膝关节行初次 TKA 且既往行 GNRFA（GNRFA-TKA）的患者。通过单变量和多变量分析比较了接受 GNRFA 治疗和未接受 GNRFA 治疗的患者。主要观察结果包括术后延长使用阿片类药物、2 年翻修率和 90 天内的医疗并发症。统计分析使用 PearlDiver 数据库提供的 R 软件进行。
在 GNRFA-TKA 队列中，共有 675 例患者与对照组（255351 例患者）进行了比较。GNRFA-TKA 患者术后延长使用阿片类药物的可能性较低（OR：0.478；95%：0.409 至 0.559；P<0.001）。两组之间 2 年手术结果没有明显差异。与原发性 TKA 对照组相比，GNRFA-TKA 组的患者输血需求较低，术后贫血、所有心律失常和尿路感染的发生率也较低。
术前 GNRFA 可降低行 TKA 患者术后延长使用阿片类药物的比率，且不增加并发症的风险。需要进一步前瞻性研究来验证本数据库研究的结果。
