PMID- 32701684
OWN - NLM
STAT- MEDLINE
DCOM- 20210728
LR  - 20230714
IS  - 1940-5480 (Electronic)
IS  - 1067-151X (Linking)
VI  - 29
IP  - 9
DP  - 2021 May 1
TI  - Thermal Nerve Radiofrequency Ablation for the Nonsurgical Treatment of Knee 
      Osteoarthritis: A Systematic Literature Review.
PG  - 387-396
LID - 10.5435/JAAOS-D-20-00522 [doi]
AB  - BACKGROUND: There are roughly 14 million adults in the United States presenting 
      with symptomatic osteoarthritis (OA) of the knee. Nerve radiofrequency ablation 
      (RFA) is a nonsurgical procedure for the management of knee OA symptoms, and no 
      previous systematic review has been performed comparing geniculate nerve RFA to 
      other nonsurgical treatments. QUESTIONS/PURPOSES: (1) How does geniculate nerve 
      RFA compare with other nonsurgical modalities for patients with knee OA about 
      pain, function, quality of life, and composite scores? and (2) How does 
      geniculate nerve RFA compare with other nonsurgical modalities for patients with 
      knee OA about adverse events (AEs)? METHODS: A systematic literature review was 
      conducted within PubMed, EMBASE, and Cochrane Central Register of Controlled 
      Trials to identify all studies from 1966 to 2019 evaluating the relative 
      effectiveness of geniculate nerve thermal (heated or cooled) RFA compared with 
      other nonsurgical treatments for knee OA. Two independent abstractors reviewed 
      and analyzed the literature including comparators such as intra-articular (IA) 
      corticosteroids, IA hyaluronic acid, NSAIDs, acetaminophen (paracetamol), and 
      control/sham procedures. Inclusion was based on the following criteria: English 
      language, human subjects, symptomatic knee OA, and patient-reported outcomes. 
      RESULTS: Five high-quality and two moderate-quality randomized controlled trials 
      (RCTs) met the inclusion criteria for this review. The results showed consistent 
      agreement across all RCTs in favor of geniculate nerve thermal RFA use for 
      nonsurgical treatment of knee OA. One high-quality RCT and one moderate-quality 
      RCT found geniculate nerve RFA to provide statistically significant outcome 
      improvement compared with control or sham procedures regarding pain, function, 
      quality of life, and composite scores. When compared with IA corticosteroids and 
      hyaluronic acid, geniculate nerve RFA also provided notable improvement in pain, 
      function, and composite scores (visual analog scale, Western Ontario, and 
      McMaster Universities Arthritis Index, and Oxford Knee Score). RFA was markedly 
      favored for all pain and composite outcomes (Western Ontario and McMaster 
      Universities Arthritis Index and visual analog scale). The included RCTs did not 
      report any serious AEs related to geniculate nerve RFA. DISCUSSION: These results 
      demonstrate geniculate nerve thermal RFA to be a superior nonsurgical treatment 
      of knee OA compared with NSAIDs and IA corticosteroid injections. None of the 
      RCTs reported any serious AEs with geniculate nerve thermal RFA, as opposed to 
      known cardiovascular, gastrointestinal, and renal AEs for NSAIDs and accelerated 
      cartilage loss and periprosthetic infection risk for IA corticosteroid 
      injections. LEVEL OF EVIDENCE: Level I.
CI  - Copyright (c) 2020 by the American Academy of Orthopaedic Surgeons.
FAU - Chen, Antonia F
AU  - Chen AF
AUID- ORCID: 0000-0003-2040-8188
AD  - From the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard 
      Medical School, Boston, MA (Dr. Chen), the American Academy of Orthopaedic 
      Surgeons, Rosemont, IL (Mr. Mullen, Mr. Casambre, and Ms. Visvabharathy), and the 
      CHI St. Alexius Health, Williston, ND (Dr. Brown).
FAU - Mullen, Kyle
AU  - Mullen K
AUID- ORCID: 0000-0003-3545-1066
FAU - Casambre, Francisco
AU  - Casambre F
AUID- ORCID: 0000-0001-9602-002
FAU - Visvabharathy, Vidya
AU  - Visvabharathy V
FAU - Brown, Gregory A
AU  - Brown GA
AUID- ORCID: 0000-0002-8797-4101
LA  - eng
PT  - Journal Article
PT  - Systematic Review
PL  - United States
TA  - J Am Acad Orthop Surg
JT  - The Journal of the American Academy of Orthopaedic Surgeons
JID - 9417468
RN  - 9004-61-9 (Hyaluronic Acid)
SB  - IM
MH  - Adult
MH  - Humans
MH  - Hyaluronic Acid/therapeutic use
MH  - Injections, Intra-Articular
MH  - Knee Joint
MH  - *Osteoarthritis, Knee/drug therapy
MH  - *Radiofrequency Ablation
MH  - Treatment Outcome
EDAT- 2020/07/24 06:00
MHDA- 2021/07/29 06:00
CRDT- 2020/07/24 06:00
PHST- 2020/05/07 00:00 [received]
PHST- 2020/06/12 00:00 [accepted]
PHST- 2020/07/24 06:00 [pubmed]
PHST- 2021/07/29 06:00 [medline]
PHST- 2020/07/24 06:00 [entrez]
AID - 00124635-202105010-00007 [pii]
AID - 10.5435/JAAOS-D-20-00522 [doi]
PST - ppublish
SO  - J Am Acad Orthop Surg. 2021 May 1;29(9):387-396. doi: 10.5435/JAAOS-D-20-00522.