Radiofrequency ablation of the genicular nerves using ultrasound is safe and effective for treating intractable knee osteoarthritis pain by using either monopolar or bipolar radiofrequency ablation. This technique is based on anatomical studies demonstrating that genicular nerves are accompanied by genicular arteries. Ultrasound-guided RF genicular ablation yielded both significant reductions in knee pain and improvements in functional capacity.
The aim of this study is to compare between ultrasound guided monopolar and bipolar radiofrequency ablation in chronic knee osteoarthritis. Osteoarthritis of knee joint is one of the most common disease conditions with advanced age and leads to considerable morbidity in terms of pain, stiffness, limitation in functions, disturbance in sleep and psychological disturbance A diagnostic genicular nerve block (GNB) with local anesthetic is performed before RF genicular ablation, and a successful response to GNB is considered to indicate the need for RF genicular ablation
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
50
a radiofrequency cannula is advanced under USG guidance towards the nerve. The final position will be confirmed by using nerve stimulator with elicitation of paraesthesia along the area of knee joint supplied by that respected genicular nerve by stimulation at 50 Hz current of \<0.5 mV. The motor stimulation will be negative at all instances. For each genicular nerve, two conventional RF lesions are done for 120s at 80° of temperature using the Neurotherm 1100 RF generator.
Two radiofrequency cannula are advanced under USG guidance towards the nerve. The final position will be confirmed by using nerve stimulator with elicitation of paraesthesia by stimulation at 50 Hz current of \<0.5 mV. The motor stimulation will be negative at all instances. For each genicular nerve, two conventional RF lesions are done for 120s at 80° of temperature using the Neurotherm 1100 RF generator.
Mansoura University
Al Mansurah, DK, Egypt
RECRUITINGOsteoarthritis pain
The mean changes from baseline levels of osteoarthritis pain using visual analogue scale used to measure pain intensity. It is 10 cm scale where 0 cm represent no pain and 10 cm represent the worst pain ever
Time frame: basal value, at 1, 4, 12, 24 weeks post procedure
Oxford Knee Score
A specific score to assess the functional changes in the knee using Oxford Knee Score (OKS). The scores are 12-item questionnaires ranging from 12-60, with 12 representing the optimal outcome.
Time frame: basal value, at 1, 4, 12, 24 weeks post procedure
The procedure time
The procedure time taken by each mode of radiofrequency from the start of advancement of the cannula under US guidance to the end of the procedure.
Time frame: from the start of advancement of the cannula to end of procedure.
Patient satisfaction score
Patient satisfaction score with treatment which is scored from 1 to 10. A score of 1-4 was considered "dissatisfied," 5-8 was "satisfied," and 9 or 10 was "very satisfied
Time frame: up to 24 weeks post procedure
Changes in doses of rescue analgesics
Time frame: up to 24 weeks post procedure
The incidence of numbness
Time frame: up to 24 weeks post procedure
The incidence of paresthesia
Time frame: up to 24 weeks post procedure
The incidence of motor weakness
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Time frame: up to 24 weeks post procedure
the proportion of successful responders
the proportion of successful responders with a reduction of at least 50% of median VAS score and no increase from baseline OKS
Time frame: up to 24 weeks post procedure