Purpose
To evaluate various radiofrequency ablation (RFA) treatments for knee osteoarthritis
(OA) and determine the best modality, target, number of electrodes, and image guidance
for improving knee pain and function.
Methods
Electronic databases were searched for randomized controlled trials (RCTs) comparing
the efficacy of RFA treatments for knee OA from inception up to September 30, 2021.
The primary outcome was the visual analog scale (VAS), and the secondary outcome was
the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Bayesian
network meta-analysis was performed to synthesize the mean difference (MD) and rank
the comparative effectiveness of treatments.
Results
A total of 21 eligible RCTs (from 2011 to 2021, involving 1,818 patients) with 8 RFA
treatments, 6 intra-articular injections, NSAIDS, exercise, and placebo were assessed.
Conventional bipolar genicular nerve RFA (GNRFA) had the greatest net benefit on the
VAS at 6 months (MD, −5.5; 95% confidence interval [CI], −4.3 to −6.7; SUCRA, .98).
And cooled monopolar GNRFA had the greatest net benefit on the WOMAC at 6 months (MD, −33;
95% CI, −37 to −29; SUCRA, .99). In conventional and pulsed modalities, bipolar RFA
was associated with a significant decrease in VAS and WOMAC than monopolar RFA. Combining
pulsed intra-articular RFA and platelet-rich plasma injection had no additional positive
effects on VAS or WOMAC at 3 months.
Conclusions
RFA is effective in improving both knee pain and function in patients with OA, at
least in the short term (6 months). Patients respond better to the cooled modality
than the conventional and pulsed modalities. Bipolar is more effective than monopolar
for improving pain and function in conventional and pulsed modalities. Fluoroscopy
and ultrasound guidance showed no differences in improving pain and function. The
effectiveness of RFA in cooled modality using bipolar or in combination with various
intra-articular injections remains to be compared.
Level of Evidence
II, systematic review and meta-analysis of Level I and II studies.
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Article info
Publication history
Published online: February 11, 2022
Accepted:
January 30,
2022
Received:
March 12,
2021
Footnotes
See commentary on page 2303
The authors report the following potential conflicts of interest or sources of funding: This study was supported through grants from the National Natural Science Foundation of China (81802210 and 81672219), the Key Project of Sichuan Science & Technology Department (2018SZ0223 and 2018SZ0250), the National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (Z20191008 and Z2018B20). Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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