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Cooled and traditional thermal radiofrequency ablation of genicular nerves in patients with chronic knee pain: a comparative outcomes analysis
  1. Bernie P Wu1,
  2. Daniel Grits1,
  3. Victor Foorsov2,
  4. Jijun Xu3,
  5. Pavan Tankha4 and
  6. Robert B Bolash5
  1. 1 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
  2. 2 Department of Orthopedic Surgery/Regional Medical Group, Northwestern Medicine, Chicago, Illinois, USA
  3. 3 Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4 Center for Comprehensive Pain Recovery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5 Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to Mr Bernie P Wu, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio 44195, USA; wup{at}


Introduction Genicular nerve radiofrequency ablation (GNRFA) is a minimally invasive intervention for patients with chronic knee pain (CKP) not responding to conservative treatments. Few investigations have compared treatment outcomes of cooled-RFA (c-RFA) and thermal-RFA (t-RFA), two common approaches of GNRFA. This study aims to investigate and compare outcomes, including probability of treatment success, between c-RFA and t-RFA in patients with CKP.

Methods This retrospective cohort study analyzed a total of 208 propensity score matched patients, including 104 patients who received c-RFA and 104 patients who received t-RFA. The primary outcome was probability of pain relief after the procedure, defined as reduction in Numeric Rating Scale (NRS) pain score of 2 or greater. The secondary outcomes were degree of NRS pain score reductions, duration of relief, and the probability of patients receiving TKA within 1 year of treatment.

Results T-RFA was associated with a higher probability of pain relief within 1, 3, and 6 months after procedure when compared with c-RFA. Probabilities of pain relief from t-RFA and c-RFA were 62% (95% CI 51% to 71%) and 43% (95% CI 34% to 53%; p=0.01) within 1 month, 78% (95% CI 68% to 85%) and 55% (95% CI 45% to 64%; p<0.001) within 3 months, and 79% (95% CI 70% to 86%) and 59% (95% CI 49% to 68%; p<0.01) within 6 months, respectively. t-RFA was also associated with greater mean NRS pain score reduction at 1 month after procedure: −4.71 (95% CI −5.3 to −4.1) when compared with −3.59 (95% CI −4.3 to −2.9; p=0.02) from c-RFA. T-RFA and c-RFA were comparable in pain score reduction at 3, 6, 9 and 12 months after procedure. Both groups demonstrated comparable duration of relief and probability of patients receiving TKA within 1 year.

Discussion Both t-RFA and c-RFA effectively reduced NRS pain scores in most patients with CKP within the 1 year follow-up period. Genicular nerve t-RFA was associated with a higher probability of treatment success and a greater degree of pain relief at 1 month after the procedure when compared with c-RFA in propensity score matched patients with CKP.

  • pain management
  • lower extremity
  • chronic pain
  • outcomes
  • technology

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors BPW contributed to the study design, collected data, monitored data analysis, and drafted as well as revised the manuscript. He is the guarantor. DG wrote the statistical analysis plan, analyzed the data, and revised the manuscript. VF led the initiation and proposal of the project, contributed substantially to the study design, constructed data collection tools, and revised the manuscript. JX provided guidance throughout the project and revised the manuscript. PT provided guidance throughout the project revised the manuscript. RBB provided guidance throughout the project, contributed to the study design, monitored data collection and analysis, provided logistical support, and revised the manuscript.

  • Funding JX received research funding from NIH (K08 CA228039) and Nevro (to institution). RBB received research funding from Abbott and Boston Scientific (to institution).

  • Competing interests The authors have no conflict of interest related to this manuscript. JX is a consultant for Genentech. RBB is a consultant for Medtronic, Agnovos, and Pfizer.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.