Knee Joint Osteo Arthritis: Role of Radiofrequency in Managing Pain

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Knee Joint Osteo Arthritis: Role of Radiofrequency in Managing Pain

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Photo by Jasmin Schreiber on Unsplash

Photo by Jasmin Schreiber on Unsplash

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Background: Pain due to knee joint osteo arthritis is one of most common health problems in old age and many treatment options have been used to control pain but none of them is completely effective and also have their side effects. The knee joint is supplied by genicular nerves which convey the sensory input to higher centers. The aim of present study was to evaluate the effectiveness of radio frequency ablation of genicular nerves in controlling pain due to knee joint osteo arthritis and to compare the pain relief and effect on analgesic intake with control group at 1st, 4th, 8th and 12th week of post procedure period. Materials and Methods: Fifty, American Society of Anaesthesiologist, grade 1 and 2 adult patients in age group of 40 to 70 years and suffering from knee joint osteoarthritis and on regular analgesic drug intake were randomly divided into two groups. 22G Radiofrequency cannula with 100 mm length and 10mm active tip and radio frequency machine G4 Cosman was used for sensory and motor stimulation for locating and ablation of genicular nerves. In Group I (Control group), the radiofrequency needles were placed extra articularly around knee joint under C­Arm guidance and genicular nerves were located with sensory and motor stimulation and one ml of 1%xylocaine was given at each needle site. No thermal or pulsed RF was given. In Group II (Study group), the RF needles were placed extra articularly at specified genicular nerves and after sensory and motor stimulation one ml of 1% xylocaine was given at each needle site. Radio frequency was given with target temperature of 70°c for three cycles, each of 1.5 minutes duration. Post procedure observations were made by an independent anesthetist not associated with procedure team. The post procedure VAS scores and analgesic intake were noted at 1st, 4th, 8th and 12th week in both groups. Statistical Analysis Used – SPSS version 14.0 (SPSS Inc., Chicago, IL), Chi square test, student’s t test. p­Value < 0.05 was taken as statistically significant. Results: The VAS score in Gp I, in immediate post procedure period was 0.80±0.500 as compared to base line score of 6.80±0.645 9 (p< 0.001). The VAS at 1st, 4th, 8th and 12th week follow up was 6.56±0.651, 6.88±0.666, 6.92±0.640 and 6.92± 0.572 and change was statistically insignificant (p >0.05). In immediate post procedure period the VAS score in Gp II, was 0.92±0.572 as compared to pre procedure VAS of 7.0±0.707 (p <0.001). The VAS at 1st, 4th, 8th and 12th week follow up was 1.84±0.987, 1.96±0.978, 2.36±1.075 and 2.60±1.041 respectively and the change in VAS was highly significant (p <0.01). The mean consumption of capsule Raceclo per week in pre procedure period in Gp I & II was 6.44±0.917 and 6.44±0.961 showing no significant intergroup difference statistically (p >0.05).In Gp I, the mean weekly consumption of capsule Raceclo at 1st, 4th, 8th and 12th week follow up was 5.52±0.823, 6.161 ±0.746, 6.28±0.737 and 6.68±0.690 respectively and the change was statistically insignificant(p >0.05). The mean post procedure weekly consumption of capsule Raceclo in Gp II, at 1st, 4th, 8th and 12th week was 0.60±1.190, 0.56±1.356, 0.96±1.567 and 1.52±1.447 respectively and the decrease in analgesic consumption was statistically highly significant on intra group and inter group comparison. All the Gp II patients except one were relieved of pain. Two patients in Gp II reported pain relief in other knee also. No complications such as infection hemorrhage; thermal injury and sensory or motor weakness/loss were reported.

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