The Effectiveness and Safety of Genicular Nerve Radiofrequency Ablation for the Treatment of Recalcitrant Knee Pain Due to Osteoarthritis: a Comprehensive Literature Review

Abstract

Purpose of Review: Review the effectiveness and safety of current treatment protocols for fluoroscopically guided genicular nerve radiofrequency ablation (RFA) used for recalcitrant knee pain secondary to osteoarthritis (OA). Recent Findings: Randomized controlled trials and cohort studies of fluoroscopically guided RFA of the genicular nerves demonstrate variability in responder rates from 59% at 3 months to as high as 74% at 6 month follow-up. Studies that investigated the prognostic value of genicular nerve blocks to select patients for RFA demonstrate no difference in outcomes with current treatment protocols. Other factors that may influence the success rate of this procedure include radiologic severity of osteoarthritis, longer duration of knee pain, smoking, and bilateral knee pain. Relative safety of this procedure has been shown with no adverse events reported in reviewed trials, but several case reports demonstrate there are risks associated with this procedure. Recent neuroanatomical studies show additional genicular nerves that could likely be safely targeted by RFA, yet are not included in current treatment protocols. Summary: RFA provides an effective treatment option for patients with recalcitrant chronic knee pain secondary to OA with up to 74% of patients experiencing greater than 50% pain relief at 6 months. The procedure is relatively safe, but risks should be weighed against potential benefits. Further research is needed to determine need for prognostic blocks, determine prognostic radiologic factors, and determine changes in effectiveness with updated treatment protocols that target more genicular nerves.