Effectiveness comparison of genicular nerve ablation for knee osteoarthritic versus post-total knee arthroplasty pain

Abstract

Background: Genicular nerve radiofrequency ablation (GNRFA) is a popular and effective procedure to treat arthritic knee pain. For refractory arthritic pain that fails conservative treatment, total knee arthroplasty (TKA) has been an excellent option. Unfortunately, 15-30% of people who undergo a TKA continue to experience pain and stiffness in the knee. The treatment options for post-TKA knee pain are limited. Pain providers have been trialing GNRFA on this pain condition. However, convincing evidence of its efficacy in treating post-TKA pain is still lacking.

Methods: This is a retrospective study of 73 patients who had undergone genicular nerve RFA, 46 (63.01%) with osteoarthritic pain, and 27 (36.99%) with post-TKA pain. We compared the outcomes (pain relief, function, and complications) between these two groups at 3 months and 6 months after RFA.

Results: Before RFA, there was no significant difference in initial pain and functional level between these two groups. After RFA, the two groups had comparable pain relief at 3 months (p = 0.68) and 6 months (p = 0.53), and similar functionality at 3 months (p = 0.36) and 6 months (p = 0.65).The overall success rate (≥50% pain relief after RFA) was 80.82%, 95% CI: 70.34%-88.22% (osteoarthritic group 80.43%, 95% CI: 66.83%-89.35%, post-TKA 81.48%, 95% CI: 63.30%-91.82%, P = 0.91) at 3-month follow-up and 56.16%, 95% CI: 44.76%-66.95% (osteoarthritic group 56.52%, 95% CI: 42.25%-69.79%, post-TKA 55.56%, 95% CI: 37.31%-72.41%, P = 0.94) at 6-month follow-up.There were no reported complications in either group.

Conclusions: Genicular Nerve Radiofrequency Ablation (GNRFA) holds the potential to be equally effective for both post-TKA knee pain and osteoarthritic knee pain.

Keywords: Efficacy; Knee pain; Osteoarthritis; Post-total knee arthroplasty; Radiofrequency ablation.

Fig. 1

On the anterior-posterior view, four cannulas are targeting the superolateral genicular nerve (SLGN), inferolateral genicular nerve (ILGN), recurrent fibular nerve (RFN), and infrapatellar branch of the saphenous nerve (IMGN). The tibial plateau is lower and at the level of the fibular head tip after total knee arthroplasty (TKA). To target the ILGN, the fibular head tip is used as a reference point to ensure the cannula is placed just medial to the tip of the fibular head. This precise placement is crucial to avoid incidental intra-articular involvement and prevent subsequent infection.