Radiofrequency neuroablation as a treatment method for pain syndrome in conservative treatment of knee osteoarthritis
Pain syndrome is one of the most frequent reasons for visiting a doctor of elderly patients with knee osteoarthritis. Pain caused by knee osteoarthritis is nociceptive; therefore, in the treatment of the knee osteoarthritis, it is rational to provide a targeted impact on the structures that produce the pain. Radiofrequency neuroablation (RFNA) allows induce the nociceptive mechanism in the structures conducting pain impulses.
Objective: to evaluate the effectiveness of radiofrequency neuroablation in the treatment of pain syndrome in patients with knee osteoarthritis.
Methods: the open controlled randomized study included treatment results analysis of 44 patients with knee osteoarthritis of the third stage with predominance of pain in one of the knee joints. Patients were divided into two groups: the study group (n = 22) and the comparison group (n = 22). Patients of both groups for the treatment of knee joint pain received osteoarthritis basis therapy. Patients in the study group additionally had RFNA of the genicular nerves. The intensity of the pain syndrome was measured with visual analog scale (VAS) and the functional status and quality of life of patients was analyzed using the WOMAC questionnaire in terms of 2 weeks, 1 and 3 months after the beginning of the treatment.
Results: this study revealed that the functional activity of the patients of both groups was decreased in affected with intensive pain syndrome — the total WOMAC index was 87.0 points in middle range. Positive changes were revealed in both groups of patients. More pronounced and lasting effect of the treatment was obtained in a group of patients undergoing RFNA procedure in combination with basis conservative treatment: decreasing values regard to the VAS to 4.0 points and the total WOMAC index to 33.0 points). In comparison group was admitted the scores reduction of the VAS to 5.5 points and the total WOMAC index to 61.0 points.
Conclusion: RFNA of the genicular nerves, as an additional method of pain treatment, along with conservative therapy in patients with knee osteoarthritis is an effective way of the pain syndrome reducing which improves functional activity and quality of life.
Full Text:PDF (Українська)
Neogi, T. (2013). The epidemiology and impact of pain in osteoarthritis. Osteoarthritis and Cartilage, 21 (9), 1145–1153. doi:10.1016/j.joca.2013.03.018
Bakalyuk, T.G., Misula, I.R., Sirant, H.O., Zawidniuk, Y.V. & Zyatkovskaya, O.Y. (2018). Joint pain in primary gonarthrosis in the elderly: ways to improve rehabilitation efficiency. Achievements of clinical and experimental medicine, 2, 29–33. (in Ukrainian)
Srikanth, V. K., Fryer, J. L., Zhai, G., Winzenberg, T. M., Hosmer, D., & Jones, G. (2005). A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthritis and Cartilage, 13 (9), 769–781. doi:10.1016/j.joca.2005.04.014
Gwilym, S. E., Keltner, J. R., Warnaby, C. E., Carr, A. J., Chizh, B., Chessell, I., & Tracey, I. (2009). Psychophysical and functional imaging evidence supporting the presence of central sensitization in a cohort of osteoarthritis patients. Arthritis & Rheumatism, 61 (9), 1226–1234. doi:10.1002/art.24837
Slobodin, T. M., & Maslova, I. H. (2018). Pathogenesis and the modern comprehensive approach to the treatment of pain syndromes in neurology. International Neurological Journal, 6 (100), 17–22. doi: 10.22141/2224-0722.214.171.1248.146453. (in Russian)
Podhajsky, R. J., Sekiguchi, Y., Kikuchi, S., & Myers, R. R. (2005). The histologic effects of pulsed and continuous radiofrequency lesions at 42°C to rat dorsal root ganglion and sciatic nerve. Spine, 30 (9), 1008–1013. doi:10.1097/01.brs.0000161005.31398.58
Howes, L. G. (2007). Selective COX-2 inhibitors, NSAIDs and cardiovascular events — is celecoxib the safest choice? Therapeutics and clinical risk management, 3 (5), 831–845.
Franco, C. D., Buvanendran, A., Petersohn, J. D., Menzies, R. D., & Menzies, L. P. (2015). Innervation of the anterior capsule of the human knee. Regional Anesthesia and Pain Medicine, 40 (4), 363–368. doi:10.1097/aap.0000000000000269
Rojhani, S., Qureshi, Z., & Chhatre, A. (2017). Water-cooled radiofrequency provides pain relief, decreases disability, and improves quality of life in chronic knee osteoarthritis. American Journal of Physical Medicine & Rehabilitation, 96 (1), e5–e8. doi:10.1097/phm.0000000000000549
Kesikburun, S., Yaşar, E., Uran, A., Adigüzel, E., & Yilmaz, B. (2016). Ultrasound-guided genicular nerve pulsed radiofrequency Treatment for painful knee osteoarthritis: A preliminary report. Pain Physician, 19 (5), E751–E759.
Ahmed, A., & Arora, D. (2018). Ultrasound-guided radiofrequency ablation of genicular nerves of knee for relief of intractable pain from knee osteoarthritis: a case series. British Journal of Pain, 12 (3), 145–154. doi:10.1177/2049463717730433
Roy, I. V., Fishchenko, Ya. V., & Kudrin, A. P. (2017). Radiofrequency ablation of the sacroiliac joint in the pain treatment. Trauma, 18, 2, 95–99. doi: 10.22141/1608-1706.2.18.2017.102565. (in Russian)
Povoroznyuk, V., Pryimych, U., & Chebotarev, D. (2016). Identification of neuropathic pain component in patients OF various age with knee osteoarthritis. Osteoarthritis and Cartilage, 24, Suppl. 1, S450–S451. doi: 10.1016/j.joca.2016.01.820.
Masala, S., Fiori, R., Raguso, M., Morini, M., Calabria, E., & Simonetti, G. (2014). Pulse-dose radiofrequency for knee osteoartrithis. CardioVascular and Interventional Radiology, 37 (2), 482–487. doi:10.1007/s00270-013-0694-z
Choi, W., Hwang, S., Song, J., Leem, J., Kang, Y., Park, P., & Shin, J. (2011). Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial. Pain, 152 (3), 481–487. doi:10.1016/j.pain.2010.09.029
Copyright (c) 2019 Maksim Golovakha, Yevhen Bilykh
This work is licensed under a Creative Commons Attribution 4.0 International License.