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Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up
  1. David Walega1,
  2. Zachary McCormick2,
  3. David Manning1 and
  4. Michael Avram1
  1. 1 Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2 Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
  1. Correspondence to Dr David Walega, Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; d-walega{at}northwestern.edu

Abstract

Background and objectives Refractory chronic knee pain from osteoarthritis (OA) is commonly treated with total knee arthroplasty (TKA). TKA can be associated with severe postoperative pain and persistent postsurgical knee pain. Poorly controlled postoperative pain can negatively effect functional outcomes following TKA, and effective opioid-sparing analgesia is key to the ideal recovery. Genicular nerve radiofrequency ablation (GN-RFA) has been shown in several trials to be clinically effective in patients with severe refractory knee pain from OA. We aimed to assess if preoperative GN-RFA would improve postoperative pain outcomes following TKA.

Methods This was a sham-control prospective clinical trial in which blinded participants were randomized to image-guided GN-RFA or a simulated sham procedure 2-6 weeks prior to elective TKA. Outcomes were assessed at 48 hours and 1, 3 and 6 months following TKA.

Results Seventy participants enrolled in this study. As compared with sham controls, GN-RFA had no treatment effect on postoperative opioid consumption, pain or functional measures at any time point.

Conclusions Cooled RFA of the superior lateral, superior medial and inferomedial genicular nerves, when performed 2–6 weeks prior to elective TKA as part of a multimodal postoperative pain management regime, had no measurable effect on postoperative opioid use, analgesia use or function in the 48 hours following surgery. In addition, we found no longer term effect on outcome measures 1, 3 and 6 months after TKA.

Trial registration number NCT02746874.

  • radiofrequency ablation
  • knee osteoarthritis
  • knee pain
  • genicular nerve ablation
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Footnotes

  • Presented at Interim data from this work were presented at the American Society of Regional Anesthesia and Pain Medicine in New York City, 19–22 April 2018 and the World Institute of Pain Meeting in Dublin, Ireland, 9–12 May 2018.

  • Contributors DW was instrumental in the design, plan and conduct of this study; he lead the team who acquired the data, interpreted results and wrote the manuscript. DW received investigator-initiated research support (funding and disposable equipment) from Halyard Health to conduct this study. ZM assisted in the study design and plan, interpretation of results and manuscript production and editing. DM assisted in the study design, plan and study conduct, in addition to the interpretation of results and manuscript production and editing. MA assisted in the study design, statistical plan and analysis, the interpretation of results and manuscript editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DW has received investigator initiated research funding and honoraria from Halyard Health; he receives funding from the National Institute on Aging (R01AG049924-01) for an unrelated research study in women. He receives royalties from UptoDate for a chapter on an unrelated topic. The other authors claim no other conflicts of interest.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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