Effectiveness of genicular nerve radiofrequency ablation in osteoarthritis and post-surgical knee pain: systematic review

Abstract Objective To evaluate the effectiveness of genicular nerve radiofrequency ablation (GnRFA) for chronic knee pain due to osteoarthritis or persistent post-surgical knee pain (PPSP). Methods Population: Adults ≥ 18 years with chronic knee pain due to osteoarthritis (OA) or PPSP. Intervention: GnRFA. Comparison: Sham, placebo, active treatments, or no comparator. Outcomes: Proportion of individuals with pain score reductions of ≥50% or ≥2 points or ≥30% improvement in functional measures at 1, 3, 6, 12, 18, and 24 months. Search strategy and risk of bias assessment: Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched through April 2024 (PROSPERO ID CRD42024552068). Cochrane Risk of Bias 2, Risk of Bias In Non-Randomized Studies-of Interventions and National Heart, Lung, and Blood Institute quality assessment tools were used accordingly. Results The search identified 1849 records, with 226 full-texts reviewed and 28 studies included (11 randomized controlled trials and 17 observational studies, totaling 2218 participants). Pooled success rates for ≥50% pain reduction in both OA and PPSP were 51% (95% CI: 49%-54%) at 6 months, 43% (95% CI: 40%-47%) at 12 months, and 58% (95% CI: 48%-67%) at 24 months. Large lesions showed higher pooled success rates compared to small lesions at 12 months (55% (95%CI: 51%-59%) vs 34% (95%CI: 26%-43%)). Conclusions GnRFA is effective in reducing knee pain in the majority of patients with osteoarthritis when large lesion techniques are used with moderate-certainty evidence, according to GRADE. Alternatively, there is low quality evidence that GnRFA results in treatment benefit for individuals with PPSP. These conclusions, however, are limited by small subgroup sample sizes and the lack of a meta-analysis.