03:18 PM Abstract No. 298 Safety and efficacy of image-guided radiofrequency ablation of the genicular nerve for pain management in patients with moderate to severe osteoarthritis of the knee: an initial single-institution experience

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To analyze the safety and efficacy of image-guided genicular nerve radiofrequency ablation (RFA) for the treatment of pain in non-surgical candidates with moderate to severe knee osteoarthritis (OA). In an IRB-approved prospective study, consecutive patients with pain from moderate to severe knee OA refractory to anti-inflammatory analgesia and multiple intraarticular lidocaine-steroid injections who underwent radiofrequency ablation of genicular nerves were included. All patients initially underwent anesthetic blocks of the superior medial and lateral and inferior medial genicular nerve branches and experienced great short-term pain relief of >6 points out a 10 scale. Radiofrequency ablation of the same nerve branches were performed 1-2 weeks after nerve block. Follow up at 1 month after the procedure was done to asses for any procedure related complications such as bleeding or infection. Efficacy of the treatment was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to assess overall symptoms, stiffness, pain, and functional daily living pre block/ablation and at 3 months post treatment. A total of ten knees were treated in 8 patients. The average age of the patients was 70.9 years. Mean follow-up time was 3.5 months. No procedure related complication was identified. The mean total WOMAC score (out of 100) improved significantly from baseline score of 47 to 65.9 at 3 months post treatment (p=0.019). Subanalysis of the overall symptoms component of the WOMAC questionnaire demonstrated significant decrease in mean overall symptoms score from 11.4 to 7.3 (p=0.046). Mean stiffness score decreased from 6.2 to 3.5 (p=0.003) and mean pain score decreased from 22.5 to 13.3 (p=0.026). There was also significant improvement in the functional daily living limitations with mean baseline score of 30.2 and 3 month post therapy score of 20.3 (p=0.037). Imaged-guided radiofrequency ablation of genicular nerves is a safe treatment option with good short-term outcome in patients that do not qualify for TKA because of comorbidities with moderate to severe OA of the knee refractory to conservation treatments.