Abstract
Background Knee osteoarthritis (KOA) is a common degenerative disease associated with joint dysfunction and pain. Ultrasound-guided radiofrequency (RF) may be a promising therapy in the treatment of chronic pain for KOA patients. Objective To evaluate the efficacy and safety of ultrasound-guided RF treatment for chronic pain in patients with KOA. Design A systematic review was conducted, and a meta-analysis was carried out when possible. Setting. We examined the studies evaluating the clinical efficiency of ultrasound-guided RF on chronic pain in KOA population. Method A systematic review for the efficacy and safety of ultrasound-guided RF treatment for pain management of KOA patients was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Wanfang Data, and China National Knowledge Infrastructure (CNKI) from the date of inception to February 2020, and a meta-analysis was conducted. The primary outcomes of pain intensity (visual analogue scale or numerical rating scale) and knee function [the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)] were evaluated from baseline to various follow-up times by random-effects model. Heterogeneity was assessed by I2 statistic and the potential sources of heterogeneity by subgroup and metaregression analyses, respectively. Results Eight publications with 256 patients were included in the meta-analysis. RF could relieve pain with −4.196 of pooled mean difference and improve knee function by decreasing 23.155 points in WOMAC. Three patients had ecchymosis, two with hypoesthesia and one with numbness after the procedure, and improved within 6 months. Furthermore, study design and treatment target were the sources of heterogeneity by subgroup and metaregression analyses, accounting for 37% and 74% of variances, respectively. Target of genicular nerve achieved better pain relief than intra-articular or sciatic nerve. Sensitivity analysis showed that removal of any single study was unlikely to overturn the findings. Limitations. There were some limitations in the study. Firstly, the small number of relevant studies limited the confidence level of the meta-analysis. Also, the significant heterogeneity may not be explained due to the limited data. Secondly, the direct comparison of two different guidance methods (ultrasound vs. fluoroscopy) for RF therapy is lacking. In addition, the outcomes were blindly assessed in the meta-analysis from all studies according to evaluation of bias, which could affect the reality of the data. Finally, most of the studies only provided short follow-up times, so we could not analyze the long-term effectiveness of ultrasound-guided RF in the treatment of patients with KOA. Conclusions Ultrasonography is an effective, safe, nonradiative, and easily applicable guidance method for RF in pain relief and functional improvement in KOA patients.
Highlights
Knee osteoarthritis (KOA) is a very common joint disease and associated with diverse factors including age, obesity, metabolic bone diseases, acute or chronic joint injuries, etc. [1]. e prevalence of KOA ranges from 4.2% to 15.5% and gradually increases with age
Eighty-four irrelevant studies were removed through screening the titles and abstracts of publications, and 25 additional studies were excluded by exclusion criteria via full-text screening
WOMAC and Lysholm scores were available to evaluate the functional improvement from baseline to various follow-up times in 7 studies. e most of follow-up times were up to half year (0, 4, 12, and 24 weeks), and only one study was followed up to one year (0, 4, 12, 24, and 48 weeks). e ultrasound transducer parameter, complication or adverse effect, conclusion and limitation of studies are presented in Tables 2 and 3
Summary
Knee osteoarthritis (KOA) is a very common joint disease and associated with diverse factors including age, obesity, metabolic bone diseases, acute or chronic joint injuries, etc. [1]. e prevalence of KOA ranges from 4.2% to 15.5% and gradually increases with age. To evaluate the efficacy and safety of ultrasound-guided RF treatment for chronic pain in patients with KOA. We examined the studies evaluating the clinical efficiency of ultrasound-guided RF on chronic pain in KOA population. A systematic review for the efficacy and safety of ultrasound-guided RF treatment for pain management of KOA patients was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Wanfang Data, and China National Knowledge Infrastructure (CNKI) from the date of inception to February 2020, and a meta-analysis was conducted. Study design and treatment target were the sources of heterogeneity by subgroup and metaregression analyses, accounting for 37% and 74% of variances, respectively. Ultrasonography is an effective, safe, nonradiative, and applicable guidance method for RF in pain relief and functional improvement in KOA patients
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