Nnake Chidebelum O, El-Othmani Mouhanad M, Cooper H John, Shah Roshan P, Geller Jeffrey A, Neuwirth Alexander L
Division of Hip and Knee Reconstruction, Columba University Medical Center, New York-Presbyterian Hospital, 622 West 168t Street, PH 11- Center, New York, NY, 10032, USA.
Knee Surg Relat Res. 2024 May 19;36(1):18. doi: 10.1186/s43019-024-00222-9.
Total knee arthroplasty (TKA) is a successful treatment for end-stage osteoarthritis, yet some patients still experience postoperative pain. Genicular nerve radiofrequency ablation (GNRFA) has become a potential modality to address pain in TKA. This systematic review aims to critically analyze the applicability of GNRFA in perioperative pain control prior to TKA, as well as a treatment modality for chronic painful well-appearing TKA.
PubMed, Medline, EMBASE, Google Scholar, Scopus, and COCHRANE databases, as well as the ClinicalTrials.gov register, were reviewed. The search included randomized controlled trials and cohort studies. The sample population focused on two cohorts; those who underwent TKA and utilized intentional GNRFA as a perioperative pain control modality, and those utilizing the treatment modality for chronic pain in well-appearing TKA. GNRFA was the intervention studied, and postoperative outcomes were compared with the control group, which consisted of those not receiving GNRFA.
Eight total publications were identified as relevant to this search. Among the pre-TKA studies, there was variability in results; these inconsistencies were attributed to a lack of standardization, especially with regard to type, timing, and targeted nerves with ablation. Likewise, while the results were improved among the population with chronic painful TKA receiving GNRFA, these inconsistencies still existed.
Current evidence suggests GNRFA as a possible pre-TKA intervention to potentially minimize opioid consumption, patient-reported pain, length of stay, and increased range of motion and activity. However, the short-lived duration in the setting of chronically painful well-appearing TKA represents a major barrier that warrants further investigation. Limitations include small sample size, heterogeneity, lack of standardization of techniques among studies, and lack of direct comparison and meta-analysis. Further research should focus on the standardization of technique as well as analyzing various patient and health-system-related factors that correlate with sustained positive outcomes.
全膝关节置换术（TKA）是治疗终末期骨关节炎的一种成功方法，但仍有一些患者术后会经历疼痛。膝神经射频消融术（GNRFA）已成为解决TKA疼痛的一种潜在方式。本系统评价旨在严格分析GNRFA在TKA术前围手术期疼痛控制中的适用性，以及作为慢性疼痛但外观良好的TKA的一种治疗方式的适用性。
检索了PubMed、Medline、EMBASE、谷歌学术、Scopus和COCHRANE数据库以及ClinicalTrials.gov注册库。检索包括随机对照试验和队列研究。样本人群集中在两个队列；那些接受TKA并将有意的GNRFA作为围手术期疼痛控制方式的人群，以及那些将该治疗方式用于慢性疼痛但外观良好的TKA的人群。GNRFA是研究的干预措施，并将术后结果与未接受GNRFA的对照组进行比较。
共确定了8篇与该检索相关的出版物。在TKA术前研究中，结果存在差异；这些不一致归因于缺乏标准化，特别是在消融的类型、时机和靶向神经方面。同样，虽然接受GNRFA的慢性疼痛TKA人群的结果有所改善，但这些不一致仍然存在。
目前的证据表明，GNRFA作为一种可能的TKA术前干预措施，有可能减少阿片类药物的使用、患者报告的疼痛、住院时间，并增加活动范围和活动量。然而，在慢性疼痛但外观良好的TKA情况下，其持续时间较短是一个主要障碍，值得进一步研究。局限性包括样本量小、异质性、研究间技术缺乏标准化，以及缺乏直接比较和荟萃分析。进一步的研究应侧重于技术标准化，以及分析与持续积极结果相关的各种患者和卫生系统相关因素。
