Comprehensive genicular nerve radiofrequency ablation for refractory knee pain using a dual-tined electrode: A
Hasan Sen1, Audrey Adler1, Amanda N Cooper1
1Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, United States.
Background:
Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for refractory knee pain. However, refinements of GNRFA protocols are ongoing as new technologies emerge amidst accumulating evidence supporting expanded lesioning strategies.
Objectives:
Describe a novel, comprehensive GNRFA protocol utilizing dual-tined electrodes to target six genicular nerves and report clinical outcomes in a cross-sectional cohort. This technique incorporates both bipolar and monopolar ablation for precise, effective lesioning.
Methods:
Consecutive patients who underwent GNRFA with the described protocol at a tertiary academic center were contacted for follow-up. Baseline demographic and clinical data were collected from electronic medical records, and outcomes were assessed via standardized telephone survey. The primary outcome was the proportion of participants with ≥50 % numerical rating scale (NRS) pain score reduction. Secondary outcomes included the respective proportions of participants with ≥2-point NRS reduction and Patient Global Impression of Change (PGIC) scores ≥6, reflecting a "much improved" or better status.
Results:
Fourteen patients (16 GNRFA procedures) were included. At a mean follow-up of 9.0 ± 1.5 months, 50.0 % (95 %CI:28.0-72.0 %) of participants reported ≥50 % NRS reduction, 62.5 % (95 %CI:38.6-81.5 %) experienced ≥2-point NRS reduction, and 56.3 % (95 %CI:33.2-76.9 %) reported PGIC scores ≥6. No new opioid use, arthroplasties, or procedural complications were reported at follow-up.
Conclusion:
Our expanded, 6-nerve GNRFA protocol using dual-tined electrodes provided clinically significant pain relief in most patients with no associated complications. This technique shows promise as a safe, effective treatment option for refractory knee pain due to knee osteoarthritis in patients selected by single genicular nerve blocks requiring ≥50 % pain relief. Larger prospective studies with longer follow-up are needed to confirm these findings.
