Abstract
BackgroundThe clinical utility of radiofrequency (RF) in patients with knee osteoarthritis (OA) remains unclear. We conducted a meta-analysis to systematically evaluate the efficacy and safety of RF treatment in patients with knee OA.MethodsSearches of the PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data databases were performed through August 30, 2021. The major outcomes from published randomized controlled trials (RCTs) involving patients with knee OA were compared between RF and control groups, including Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Global Perceived Effect (GPE) scale, and adverse effects at available follow-up times.ResultsFifteen RCTs involving 1009 patients were included in this meta-analysis, and the results demonstrated that RF treatment correlated with improvements in pain relief (VAS/NRS score, all P < 0.001) and knee function (WOMAC, all P < 0.001) at 1–2, 4, 12, and 24 weeks after treatment as well as patients’ degree of satisfaction with treatment effectiveness (GPE scale, 12 weeks, P < 0.001). OKSs did not differ significantly between the two groups. Moreover, treatment with RF did not significantly increase adverse effects. Subgroup analysis of knee pain indicated that the efficacy of RF treatment targeting the genicular nerve was significantly better than intra-articular RF at 12 weeks after treatment (P = 0.03).ConclusionsThis meta-analysis showed that RF is an efficacious and safe treatment for relieving knee pain and improving knee function in patients with knee OA.
Highlights
The clinical utility of radiofrequency (RF) in patients with knee osteoarthritis (OA) remains unclear
RFA, radiofrequency ablation; PRF, pulsed radiofrequency ablation; CRF, cooled radiofrequency ablation; CRMRF, capacitive resistive monopolar radiofrequency; NSAIDs, nonsteroidal anti-inflammatory drugs; GN, genicular nerve; IA, intra-articular; VAS, Visual Analogue Scale; GPE, Global Perceived Effect; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Western Ontario and McMaster Universities; OKS, Oxford Knee Scores; NA, not applicable significant difference at 4 weeks after treatment and a significant difference at 12 weeks between the two groups (4 weeks, Weighted mean difference (WMD) = − 0.63, 95% confidence interval (CI) − 0.15 to 1.42, P = 0.12; 12 weeks, WMD = 1.12, 95% CI 0.61 to 1.63, P < 0.001)
The data at 1–2 weeks after treatment showed that RF mode (RFA, WMD = − 1.76, 95% CI − 2.30 to − 1.22, P < 0.001), location (Asia, WMD = − 1.63, 95% CI − 2.07 to − 1.20, P < 0.001), site of radiofrequency, diagnosed nerve block (DNB), sex ratio (≥ 2, WMD = − 1.59, 95% CI − 2.15 to − 1.02, P < 0.001), and body mass index (BMI) (< 30 kg/m2, WMD = − 1.80, 95% CI − 3.29 to − 0.31, P = 0.02) were potential sources of heterogeneity
Summary
The clinical utility of radiofrequency (RF) in patients with knee osteoarthritis (OA) remains unclear. Knee osteoarthritis (OA), a degenerative joint disease of the knee, typically results in progressive loss of articular cartilage elasticity and erosion of the articular surface [1, 2]. Knee pain is the main clinical symptom of knee OA and causes functional limitations, fatigue, depressed mood, and loss of independence, which worsens over time and eventually leads to disability [5]. As the candidate treatment regimen for end-stage knee OA, arthroscopic surgery or total knee arthroplasty (TKA). Persistent pain is not relieved effectively in approximately 20–53% of the patients undergoing arthroscopic surgery or TKA [7, 8]. Some patients have contraindications or are not good candidates for surgery due to age or severe comorbidities
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