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. 2024 Aug 19;3(3):100432.
doi: 10.1016/j.inpm.2024.100432. eCollection 2024 Sep.

Genicular nerve radiofrequency ablation practice patterns: A survey study of the International Pain and Spine Interventional Society

Reza Ehsanian  1 , Shawn Fernandez  2 , Amanda Cooper  3 , Daniel M Cushman  3 , Aaron Conger  3 , Taylor Burnham  3 , Alexandra E Fogarty  4 , Rohit Aiyer  5 , Katie Smolinski  3 , Zachary L McCormick  3
Affiliations

Genicular nerve radiofrequency ablation practice patterns: A survey study of the International Pain and Spine Interventional Society

Reza Ehsanian et al. Interv Pain Med. .

Abstract

Introduction: Chronic knee pain often results from degenerative conditions such as knee osteoarthritis (OA) and can worsen after surgical interventions like total knee arthroplasty (TKA). Knee OA affects approximately 86 million individuals globally, leading to decreased function, mobility limitations, and disability. While TKA is a common surgical treatment for refractory knee OA, though up to 20 % of patients experience chronic post-operative knee pain worse than their pre-operative pain. Genicular nerve radiofrequency ablation (GnRFA) has emerged as a promising intervention for knee OA pain unresponsive to conservative management and for chronic post-TKA pain. GnRFA is an evidence-based technique supported by multiple prospective cohort studies and randomized controlled trials (RCTs). However, practice patterns and GnRFA techniques vary, and no peer-reviewed publication has yet quantified these variations in real-world clinical practice.

Objective: This study aims to understand the practice patterns of interventional pain physicians regarding patient selection, use of prognostic blocks, imaging, nerve targets, GnRFA types, and GnRFA techniques in treating knee pain secondary to OA or persistent post-TKA pain.

Methods: An anonymous 29-question survey was distributed via electronic mail to members of the International Pain and Spine Intervention Society (IPSIS) from January 16, 2024, to February 29, 2024. The survey assessed practice patterns related to patient selection, prognostic block use, and GnRFA techniques. Data were collected and stored using REDCap software, with descriptive statistics calculated.

Results: A total of 150 completed surveys were analyzed, representing a completion rate of 2.0 % of surveys sent, 3.5 % of emails opened, and 56.8 % of those who clicked on the survey link. Respondents generally use common selection protocols regarding OA grade (Kelgren-Lawrence 3 and 4), duration of failed conservative care (3-6 months), a single anesthetic block paradigm, and use of fluoroscopic guidance for the GnRFA procedure. More variability was reported between respondents regarding the volume of anesthetic used during prognostic blocks, the threshold to consider a prognostic block "positive," the technology used, and nerves targeted during the GnRFA procedure.

Conclusion: The study provides valuable insights into the current practice patterns of GnRFA among interventional pain physicians. While there is consensus on some aspects of patient selection and procedural techniques, significant variability exists in prognostic block protocols and nerve targets for GnRFA. These findings highlight the need for further research to explore the long-term efficacy and safety of GnRFA and to standardize techniques and protocols across different practice settings, ultimately improving patient outcomes and quality of life. The low response rate may limit generalizability, and the survey did not include data on active tip sizes used for ablation or whether other procedures should be exhausted before resorting to GnRFA. Additionally, a survey to IPSIS membership only may not fully represent a diverse cohort of pain management specialists, potentially introducing sampling bias. Future studies should include members from a broader range of professional organizations to enhance representativeness.

Keywords: Chronic knee pain; GnRFA; Interventional pain; Knee OA; Post-TKA pain.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Co-Authors: 1) Taylor Burnham, DO MS receives research grant funding from DIROS technology (paid directly to the University of Utah) and does consulting work with AVANOS Medical. 2) Zachary L. McCormick, MD serves on the Board of Directors of the International Pain and Spine Intervention Society (IPSIS), has research grants from Avanos Medical, Boston Scientific, Relievant Medsystems, Saol Therapeutics, Spine Biopharma, SPR Therapeutics, Stratus Medical (paid directly to the University of Utah), and also consultancies with Avanos Medical, Saol Therapetuics, Stryker, and OrthoSon.If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

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Standardized anonymous survey.
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Standardized anonymous survey.
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Standardized anonymous survey.
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Standardized anonymous survey.
See this image and copyright information in PMC

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References

    1. Cui A., Li H., Wang D., Zhong J., Chen Y., Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 2020;29–30 doi: 10.1016/j.eclinm.2020.100587. - DOI - PMC - PubMed
    1. Linsell L., Dawson J., Zondervan K., Rose P., Carr A., Randall T., et al. Population survey comparing older adults with hip versus knee pain in primary care. Br J Gen Pract J R Coll Gen Pract. 2005;55:192–198. - PMC - PubMed
    1. Garstang S.V., Stitik T.P. Osteoarthritis: epidemiology, risk factors, and pathophysiology. Am J Phys Med Rehabil. 2006;85:S2–S11. doi: 10.1097/01.phm.0000245568.69434.1a. quiz S12-14. - DOI - PubMed
    1. Murphy L., Schwartz T.A., Helmick C.G., Renner J.B., Tudor G., Koch G., et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59:1207–1213. doi: 10.1002/art.24021. - DOI - PMC - PubMed
    1. Gaught A.M., Carneiro K.A. Evidence for determining the exercise prescription in patients with osteoarthritis. Physician Sportsmed. 2013;41:58–65. doi: 10.3810/psm.2013.02.2000. - DOI - PubMed

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