The purpose of this study is to assess how clinically useful and safe genicular nerve radiofrequency ablation is in people with chronic pain after total knee arthroplasty performed for osteoarthritis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
14
Genicular nerve RFA is a standard outpatient procedure using fluoroscopic guidance to ensure accurate placement of the radiofrequency cannula. After placement of the radiofrequency cannula, nerve stimulation is performed to confirm proper position and ensure that the cannula is not too close to motor fibers. One mL of 2% lidocaine is placed at each of the cannulas. The RFA treatment is then proceeded by rhizotomizing each genicular nerve at 80°C for 90 seconds with a 15-second ramp-up.
Is performed identically to the active treatment but without the application of the RFA current
University of Massachusetts Chan Medical School
Worcester, Massachusetts, United States
Acceptability by actively treated participants Outcome
Our a priori decision rule for acceptability of RFA will be that 50% of the actively treated participants respond affirmatively at the 3-month visit: "Would you recommend the treatment used in this study to someone in a similar situation with knee pain after a knee replacement?"
Time frame: 3 months
Safety Outcome
\<2 serious adverse events among 20 actively treated participants. After enrollment, participants will complete training regarding the daily notification for daily adverse event monitoring. During the study, participants will be automatically prompted daily to report adverse events on their mobile device or home computer. If a participant does not complete adverse event monitoring daily, a member of the study team will contact them to troubleshoot. Additionally, a more thorough examination of patient safety will be conducted during the clinical exam in the 1-, 3-, and 6-month follow-up visits. Prosthesis safety will be assessed with skyline, lateral, and anteroposterior radiographs (e.g. aseptic loosening, osteolysis) at baseline and 6 months69. Serious adverse events will be consistent with our institution's IRB definitions and with a definition of serious adverse drug experience in FDA 21 CFR 312.32(a).
Time frame: 6 months
Efficacy Outcome
\<5 number needed to treat to achieve a patient-acceptable symptom state. Patient acceptable symptom state will be defined with the following question: "Think about all consequences of your arthroplasty in the last week. If you were to remain for the rest of your life as you were last week, would the current state be acceptable or unacceptable for you?"61 Primary efficacy measure will be whether a participant considers themselves in an acceptable symptom state at the 3-month visit after the intervention. A \<5 number is needed to treat to achieve a patient-acceptable symptom state.
Time frame: 3 months
Pain Number Rating Score (NRS)
Change from baseline in daily pain number rating scale (NRS) scores via text or online platform until study completion. Min= 0, Max=10. Larger change in scores mean a better outcome.
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Time frame: 6 months
Knee Injury and Osteoarthritis Outcome Score (KOOS)
Change from baseline in the Knee Injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living subscales at 1-, 3-, and 6-month visits. Questions measured from 0-4. Min = 0 (none), Max= 4 (extreme). Larger change in scores mean a better outcome.
Time frame: 1-, 3-, and 6-month visits
Physical Activity Scale for the Elderly (PASE)
Change from baseline in the Physical Activity Scale for the Elderly (PASE) at 1-, 3-, and 6-month visits. Measured based on frequency 0 (never)- 3 (often). Larger change in score means better outcome.
Time frame: 1-, 3-, and 6-month visits
Quality of Life Measured using Knee Injury and Osteoarthritis Outcome Score Quality of Life (KOOS QOL)
Change from baseline in the KOOS Quality of Life subscale at 1-, 3-, and 6-month visits. not at all- extreme. Larger change in score means better outcome.
Time frame: 1-, 3-, and 6-month visits
Quality of Life Measured using Patient Reported Outcome Measurement Information System (PROMIS) Global 10
Change from baseline in the PROMIS Global 10 at 1-, 3-, and 6-month visits.
Time frame: 1-, 3-, and 6-month visits
Walk Test
Change from baseline in 20-meter walk test time at 1-, 3-, and 6 month visits
Time frame: 1-, 3-, and 6-month visits
Chair Stand Test
Change from baseline in chair stand speed at 1-, 3-, and 6- month visits
Time frame: 1-, 3-, and 6-month visits
Daily Step Count
Change from baseline in daily step count via Wearable Activity Monitor (i.e. Fitbit) averaged over the one week following 1-, 3-, and 6- month visits
Time frame: 1-, 3-, and 6-month visits
Incidence of Pain Medication use
Change from baseline in usage of pain medication for target knee pain at 1-, 3-, and 6- month visits. Measured using questionnaire.
Time frame: 1-, 3-, and 6-month visits
Gait Analysis
An optional sub-study will assess change from baseline in spatiotemporal metrics of gait at the 3 month visit. . Data collected will include knee kinematics and kinetics using optical motion capture and spatiotemporal gait parameters using wearable inertial sensors. Larger change from baseline means better outcome.
Time frame: 3 months