Genicular Nerve Radiofrequency Research Articles

Ultrasound-guided thermal radiofrequency ablation of the genicular nerves after total knee replacement

The rate of refractory chronic pain after total knee replacement (TKR) is 20–25%, with no identifiable etiology in 6% of cases. Without an etiologic diagnosis, the surgeon is unlikely to consider revision, but pain poses a therapeutic challenge for achieving satisfaction and an acceptable quality of life. Genicular nerve radiofrequency ablation (GNRFA) was recently developed as a non-drug analgesic option. It is minimally invasive and safe, with few adverse effects, opening a new perspective for management of refractory chronic pain after TKR. Level of evidenceIV.

Complications and opioid-prescribing patterns following genicular nerve radiofrequency ablation versus intra-articular injection: a matched cohort study.

Genicular nerve radiofrequency ablation (GNRFA) is an emerging procedure used to relieve pain from severe knee osteoarthritis. While there have been rare reports of significant complications, their incidence has not been well established. The objective of this study was to examine complication rates at 30 and 90 days post treatment as well as characterize opioid-prescribing patterns before and after treatment. A large national database was queried to identify patients undergoing GNRFA from 2015 to 2022 and matched to control cohorts composed of patients receiving either intra-articular corticosteroid (CSI) or hyaluronic acid injection (HAI) of the knee. Complication rates at 30 and 90 days were analyzed. Opioid utilization was assessed in the 6 months before and after treatment. Rates of infection (0.1%, CI 0.02% to 0.5% vs 0.2%, CI 0.05% to 0.6%), septic arthritis (<0.1%, CI 0.003% to 0.4% vs 0.1%, CI 0.02% to 0.5%), deep vein thrombosis (2.0%, CI 1.3% to 2.7% vs 1.6%, CI 1.0% to 2.2%), pulmonary embolism (1.2%, CI 0.6% to 1.7% vs 1.3%, CI 1.1% to 2.5%), bleeding (<0.1%, CI 0.003% to 0.4% vs 0%, CI 0% to 0.3%), seroma (<0.1%, CI 0.003% to 0.4% vs 0.2%, CI 0.05% to 0.6%), nerve injury (0%, CI 0% to 0.3% vs 0%, CI 0% to 0.3%) and thermal injury (0%, CI 0% to 0.3% vs 0%, CI 0% to 0.3%) were not different between CSI and GNRFA cohorts at 30 days. Rate of swelling was significantly greater in the GNRFA cohort (9.4%, CI 7.6% to 10.4% vs 6.4%, CI 4.8% to 7.2%, p=0.003) at 30 days. At 90 days, rates of septic arthritis (0.1%, CI 0.02% to 0.5% vs 0.3%, CI 0.08% to 0.7%), deep vein thrombosis (3.1%, CI 2.1% to 3.8% vs 3.1%, CI 2.2% to 3.9%), pulmonary embolism (1.5%, CI 0.9% to 2.1% vs 1.8%, CI 1.2% to 2.5%), and nerve injury (0%, CI 0% to 0.3% vs <0.1%, CI 0.003% to 0.4%) were not significantly different.Between HAI versus GNRFA cohorts, no significant differences were seen in rates of infection (0.3%, CI 0.08% to 0.07% vs 0.7%, CI 0.3% to 1.2%), septic arthritis (0.2%, CI 0.05% to 0.6% vs 0.4%, CI 0.2% to 0.9%), deep vein thrombosis (2.0%, CI 1.3% to 2.7% vs 1.9%, CI 1.2% to 2.7%), pulmonary embolism (1.5%, CI 0.9% to 2.2% vs 1.7%, CI 1.1% to 2.5%), bleeding (0.1%, CI 0.02% to 0.5% vs 0.2%, CI 0.05% to 0.6%), seroma (<0.1%, CI 0.03% to 0.4% vs 0%, CI 0% to 0.3%), nerve injury (0%, CI 0% to 0.3% vs 0%, CI 0% to 0.3%), swelling (14.0%, CI 11.6% to 15.1% vs 12.0%, CI 10.3% to 13.6%), and thermal injury (<0.1%, CI 0.03% to 0.4% vs <0.01%, CI 0.3% to 0.4%) at 30 days. Rates of infection (0.7%, CI 0.3% to 1.2% vs 1.4%, CI 0.9% to 2.1%), septic arthritis (0.3%, CI 0.1% to 0.8% vs 0.5%, CI 0.2% to 1.1%), deep vein thrombosis (3.6%, CI 2.6% to 4.4% vs 3.1%, CI 2.2% to 4.0%), pulmonary embolism (2.3%, CI 1.5% to 3.0% vs 2.1%, CI 1.4% to 3.0%) and nerve injury (0%, CI 0% to 0.3% vs 0.1%, CI 0.02% to 0.5%) were not significantly different at 90 days.There were no significant differences in level of pretreatment opioid utilization although overall consumption in mean daily morphine equivalents was greater in the GNRFA cohort. Opioid utilization significantly increased in the first 30 days after ablation in patients with no prior opioid use compared to controls. In patients with some and chronic prior opioid use, opioid requirements were generally decreased in all treatment groups at 6 months with no clearly superior treatment in reducing opioid consumption. Our study demonstrated that GNRFA possesses a safety profile similar to that of intra-articular injections although significant adverse events such as venous thromboembolism and septic arthritis may occur rarely. Although opioid utilization generally increased in the 30 days after ablation compared with intra-articular injection, similar reduction in opioid consumption at 6 months was seen in patients with prior opioid use in the ablation and control cohorts.

How I do it: implementing virtual reality for genicular nerve radiofrequency ablation

How I do it: implementing virtual reality for genicular nerve radiofrequency ablation

Reply to Letter to the Editor regarding "Ultrasound-guided genicular nerve radiofrequency treatment: prospective randomized comparative trial of a 3-nerve protocol versus a 5-nerve protocol".

Reply to Letter to the Editor regarding "Ultrasound-guided genicular nerve radiofrequency treatment: prospective randomized comparative trial of a 3-nerve protocol versus a 5-nerve protocol".

Comments on: Ultrasound-guided genicular nerve radiofrequency treatment: prospective randomized comparative trial of a 3-nerve protocol versus a 5-nerve protocol.

Comments on: Ultrasound-guided genicular nerve radiofrequency treatment: prospective randomized comparative trial of a 3-nerve protocol versus a 5-nerve protocol.

Comparison of the efficacy of genicular nerve phenol neurolysis and radiofrequency ablation for pain management in patients with knee osteoarthritis.

: Genicular nerve neurolysis with phenol and radiofrequency ablation (RFA) are two interventional techniques for treating chronic refractory knee osteoarthritis (KOA) pain. This study aimed to compare the efficacy and adverse effects of both techniques. : Sixty-four patients responding to diagnostic blockade of the superior medial, superior lateral, and inferior medial genicular nerve under ultrasound guidance were randomly divided into two groups: Group P (2 mL phenol for each genicular nerve) and Group R (RFA 80°C for 60 seconds for each genicular nerve). The numeric rating scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate the effectiveness of the interventions. : RFA and phenol neurolysis of the genicular nerves provided effective analgesia within groups at 1 week, 1 month, and 3 months compared to baseline. There was no significant difference between the groups in terms of NRS and WOMAC scores at all measurement times. At the 3rd month follow-up, 50% or more pain relief was observed in 53.1% of patients in Group P and 50% of patients in Group R. The rate of transient paresthesia was 34.4% in Group P and 6.3% in Group R, and this was significantly higher in Group P. : Neurolysis of the genicular nerves with both RFA and phenol is effective in the management of KOA pain. Phenol may be a good alternative to RFA. Further studies are needed on issues such as dose adjustment to prevent transient paresthesia response.

Ultrasound vs. fluoroscopic guidance in genicular nerve radiofrequency thermocoagulation for chronic knee pain: which one is the future?

Fluoroscopic guiding is commonly utilized for interventional pain management procedures. However, ultrasonography has started to be used more widely in interventional pain procedures. It has become even more popular with its advantages. The clinician who performs the pain procedure and the patient are not exposed to radiation. Vascular structures can be directly visualized. Ultrasonography is more accessible and portable than fluoroscopy. For all these reasons, its use will increase. So, in this study, we aimed to compare the efficacy of the genicular nerve radiofrequency thermocoagulation application under ultrasound guidance and fluoroscopy guidance. Patients with stage 2 and 3 osteoarthritis, according to the Kellgren-Lawrence classification, were included in our study (n=180). Seventy percent of patients were women. Sixty patients received medical treatment only. Genicular nerve radiofrequency thermocoagulation was performed with fluoroscopy in sixty patients and with ultrasonography guidance in sixty other patients. Visual Analogue Scale at 1 month (VAS1) and Western Ontario and McMaster Universities Arthritis (WOMAC1) were recorded before the procedure, while VAS2 and WOMAC2 were recorded at 3 months. In the ultrasound and fluoroscopy group, a statistically significant difference was found between VAS1 and VAS2, WOMAC1 and WOMAC2 (p<0.05). VAS1 of the patients in the fluoroscopy group was 6.65±0.93, and it was 5.88±0.92 in the ultrasonography group, which was similar (p<0.0001). VAS2 was 2.26±1.16 in the ultrasonography group and 3.83±1.66 in the fluoroscopy group (p<0.0001). The reduction rate in pain severity in patients undergoing the procedure under ultrasonography guidance was more marked than that in the fluoroscopy group (p<0.0001). For the radiofrequency thermocoagulation of the genicular nerve, both imaging approaches are available. Ultrasonography guidance appears to be better than fluoroscopy guidance in this technique because of the lower radiation dose and the ability to detect the target location and neighboring tissues more precisely under ultrasonography guidance.

Genicular nerve radiofrequency ablation for the treatment of chronic knee joint pain: a real-world cohort study with evaluation of prognostic factors.

Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for chronic knee pain. However, there has been minimal investigation of real-world, long-term outcomes and factors that predict treatment success after GNRFA. To evaluate the effectiveness of GNRFA for chronic knee pain in a real-world population and identify predictive factors. Consecutive patients who underwent GNRFA at a tertiary academic center were identified. Demographic, clinical, and procedural characteristics were collected from the medical record. Outcome data were numeric rating scale (NRS) pain reduction and Patient Global Impression of Change (PGIC). Data were collected by standardized telephone survey. Predictors of success were evaluated with logistic and Poisson regression analyses. Of the 226 total patients identified, 134 (65.6 ± 12.7; 59.7% female) were successfully contacted and analyzed, with a mean follow-up time of 23.3 ± 11.0 months. Of those, 47.8% (n = 64; 95%CI: 39.5%-56.2%) and 61.2% (n = 82; 95%CI: 52.7%-69.0%) reported ≥50% NRS score reduction and ≥2-point NRS score reduction, respectively, and 59.0% (n = 79; 95%CI: 50.5%-66.9%) reported "much improved" on the PGIC questionnaire. Factors associated with a greater likelihood of treatment success (P < .05) were higher Kellgren-Lawrence osteoarthritis grade (2-4 vs 0-1); no baseline opioid, antidepressant, or anxiolytic medication use; and >3 nerves targeted. In this real-world cohort, approximately half of the participants experienced clinically meaningful improvements in knee pain after GNRFA at an average follow-up time of nearly 2 years. Factors associated with higher likelihood of treatment success were more advanced osteoarthritis (Kellgren-Lawrence Grade 2-4); no opioid, antidepressant, or anxiolytic medication use; and >3 nerves targeted.

Long-term Efficacy of Genicular Nerve Ablation for Chronic Osteoarthritic Knee Pain: A Prospective Observational Longitudinal Study

Objective: When patients with chronic osteoarthritis (OA) knee pain do not respond to conservative treatment and are not suitable for knee arthroplasty, radiofrequency ablation (RFA) of the genicular nerve is probably an alternative treatment. This study aimed to evaluate the efficacy and safety of genicular nerve ablation in severe osteoarthritic knee pain patients. Materials and Methods: Patients with severe chronic OA knee pain were recruited and performed a genicular nerve block (GNB). The patients’ demographic data, numerical rating scale (NRS) at rest and on movement, Thai Oxford knee score (Thai OKS), Thai knee injury and osteoarthritis outcome score physical function short form (Thai KOOS-PS), timed up and go test, brief pain inventory, fall evaluation, and EuroQol 5D-5L were recorded. For the positive block patients (≥50% pain relief for 24 hours), genicular nerve RFA was performed under fluoroscopic or ultrasound guidance. All patients were followed up at the 1st, 3rd, 6th, 9th and 12th months. Results: 21 patients were included in the study, but only 17 were completely followed up for 12 months. At the 12th month, genicular nerve RFA reduced the mean NRS on movement from 7.9±1.6 to 4.0±2.6 (p=0.005), improved knee function (Thai OKS from 18.8±5.3 to 28.5±10.1; p=0.006), but did not significantly improve quality of life (EuroQol-5D-5L from 0.43±0.20 to 0.69±0.33; p=0.130). No adverse events were observed. Conclusion: Genicular nerve radiofrequency ablation in severe chronic OA knee patients demonstrated significant pain relief and functional improvement for up to 12 months without serious adverse events.

The safety and efficacy of genicular nerve radiofrequency ablation for pain in inferolateral quadrant of the knee

BackgroundGenicular nerve radiofrequency ablation (RFA) is an effective procedure to alleviate knee pain. This procedure has been proven to be safe, except in the inferior lateral quadrant (ILQ) due to its innervation being near the common fibular nerve (CFN). Given the complexity of this approach, pain physicians do not routinely perform RFA in the ILQ, leading to inadequate pain relief in this region. MethodsThis is a retrospective study of 54 patients who had undergone genicular nerve RFA. Thirty patients had genicular nerve RFA of the knee joint including the ILQ innervated by the inferolateral genicular and recurrent fibular nerves, while 24 patients had RFA of the knee joint without involvement of the ILQ. We compared the outcomes (pain relief, function, and complications) in the patients with and without ILQ RFA at 3 months and 6 months after RFA. ResultsThere was no significant difference in initial pain and functional level before RFA between these two groups. After RFA, the two groups had comparable pain relief at 3 months (p ​= ​0.06) and 6 months (p ​= ​0.20), and similar functionality at 3 months (p ​= ​0.29) and 6 months (p ​= ​0.12). There were no reported complications after RFA with or without ILQ RFA. ConclusionsRFA of the innervation to the ILQ of the knee is as safe and effective as all other anterior quadrants.

Ultrasound-guided Genicular Nerve Radiofrequency Treatment-Three- versus Five-Nerve Protocol: Prospective Randomized Comparative Trial.

Genicular nerve radiofrequency (RF) procedure is increasingly being performed to treat chronic pain due to knee osteoarthritis (OA). Targeting additional sensory nerves and improving target identification by using ultrasound (US) guidance may improve treatment success. The aim of this study was to compare the effectiveness of traditional genicular nerves versus two additional sensory nerves to traditional genicular nerves for US-guided genicular nerve RF procedures in patients with chronic knee OA. A total of 80 patients were randomized into two groups. Patients in the three-nerve targeted (TNT) group received a genicular RF with traditional genicular nerves; superior lateral, superior medial, and inferior medial nerves, and the five-nerve targeted (FNT) group received a genicular RF with recurrent fibular and infrapatellar branch of the saphenous nerve in addition to the traditional genicular nerves. Numerical Rating Scale (NRS), Short Form-36 (SF-36), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Quantitative analgesic questionnaire (QAQ) and patient satisfaction were evaluated at pretreatment, at week 1, months 1,3,6. Both techniques provided significant pain reduction and functional improvement up to six months post-procedure (p < 0.05). The FNT group showed significant improvement with respect to the NRS, WOMAC total and SF-36 score compared to the TNT group at each follow-up point. No differences in QAQ or patient satisfaction scores were observed between both groups. The US-guided five-nerve targeted technique is a safe method, and a more effective therapeutic procedure than the traditional three-nerve targeted technique for chronic knee OA. US National Library of Medicine https://clinicaltrials.gov/ct2/show/NCT05073887?term=Selin+Guven+kose&draw=4&rank=5.

Abstract No. 120 Genicular Nerve Radiofrequency Ablation: Is There a Predictor of Outcomes?

Abstract No. 120 Genicular Nerve Radiofrequency Ablation: Is There a Predictor of Outcomes?

The Role of Genicular Radiofrequency Ablation in the Management of Persistent Pain after Total Knee Arthroplasty.

Persistent pain is one of the most frequent complications following total knee arthroplasty (TKA) and can be devastating for the patient's quality of life. The use of genicular nerve radiofrequency ablation (GNRFA) is prevalent regarding non-surgical treatment of knee osteoarthritis. However, it is controversial when employed for the management of residual pain after TKA. This study aims to evaluate the efficacy of GNRFA for the treatment of post-TKA chronic pain and to assess the potential benefits of its use. Twelve patients sustaining chronic pain after TKA underwent GNRFA treatment. The intervention included the superior medial genicular nerve, the superior lateral genicular nerve and the inferior medial genicular nerve. Visual analog scale (VAS) system was utilized for pain assessment at 1-week, 6-month, and 1-year follow-ups. Patients experiencing chronic knee pain derived from other or unspecified causes were excluded. Mean VAS score before the treatment was 8.3, while it ended up 2.3, 5.7, and 7.9 at the 1-week, 6-month, and 1-year follow-up, respectively. Some patients reported residual pain that they regarded more bearable than before the procedure at the 1-week evaluation, with no significant alterations in the 6-month reassessment. In 2 cases results at the 1-week follow-up were dissatisfying, however, this aided us in distinguishing the cause of the persistent pain. We were not able to conclude that GNRFA used for the treatment of chronic pain after TKA is as efficacious as in knee osteoarthritis pain. However, in some cases, it proved to be beneficial regarding discerning the etiology of the pain.

The Therapeutic Effect of Genicular Nerve Radiofrequency for Chronic Knee Pain After a Total Knee Arthroplasty: A Systematic Review

The Therapeutic Effect of Genicular Nerve Radiofrequency for Chronic Knee Pain After a Total Knee Arthroplasty: A Systematic Review

Long-Term Treatment Outcomes and Predictors of Treatment Success following Genicular Nerve Radiofrequency Neurotomy for Chronic Knee Pain; a Cross-Sectional Cohort Study

Long-Term Treatment Outcomes and Predictors of Treatment Success following Genicular Nerve Radiofrequency Neurotomy for Chronic Knee Pain; a Cross-Sectional Cohort Study

Predictive factors associated with successful response to utrasound guided genicular radiofrequency ablation.

BackgroundUltrasound-guided genicular nerve radiofrequency (RF) procedures are of interest in the management of chronic knee pain. A wide variety of demographic, clinical, and procedural characteristics can affect treatment success. This study aimed to determine predictive factors to provide superior treatment outcomes.MethodsThe demographic, clinical, and technical data of patients who received genicular nerve RF for knee pain between September 2016 and September 2021 were evaluated. A positive outcome was defined as at least 50% pain relief on a pain score for at least 6 months. Logistic regression analysis was performed to determine the factors associated with a successful response to genicular RF.ResultsAmong 206 patients who underwent genicular RF, 62% of the patients reported successful outcomes at 6 months. In the multivariate model, targeting 5 nerves (odds ratio [OR], 6.184; 95% confidence interval [CI], 2.291–16.690; P < 0.001) was the most significant predictor of successful outcomes. Multivariable logistic regression analysis showed that prognostic genicular nerve block with a 50% cut-off value (OR, 2.109; 95% CI, 1.038–4.287; P = 0.039), no opioid use (OR, 2.753; 95% CI, 1.405–5.393; P = 0.003), and depression (OR, 0.297; 95% CI, 0.124–0.713; P = 0.007) were the predictive factors significantly associated with response to genicular RF.ConclusionsClinical and technical factors associated with better treatment outcomes were ultimately targeting more nerves, performing prognostic block, no opioid use, and no depression. These results are expected to be considered when selecting patients for genicular RF.

Total Knee Arthroplasty After Genicular Nerve Radiofrequency Ablation: Reduction in Prolonged Opioid Use Without Increased Postsurgical Complications.

Introduction:Genicular nerve radiofrequency ablation (GNRFA) is an increasingly used nonsurgical treatment modality for patients with advanced knee osteoarthritis. Previous studies have demonstrated this to be an effective and safe method to decrease pain and increase functionality in this patient population. The purpose of this study was to compare 2-year postoperative complication rates and rates of prolonged postoperative opioid usage between patients undergoing total knee arthroplasty (TKA) after previous GNRFA and those undergoing TKA alone.Methods:Patients who underwent primary TKA after prior GNRFA (GNRFA-TKA) of the ipsilateral knee were identified in a national all-payer claims database from 2010 to 2019. Univariate and multivariable analyses were conducted comparing those with prior GNRFA and those without. Outcomes of interest included prolonged postoperative opioid usage, 2-year revision rates, and 90-day medical complications. Statistical analysis was conducted using R software provided by the PearlDiver Database.Results:In total, 675 patients in the GNRFA-TKA cohort were compared with a control cohort of 255,351 patients. Genicular nerve radiofrequency ablation-total knee arthroplasty patientshad lower odds of prolonged opioid use postoperatively (OR: 0.478; 95%: 0.409 to 0.559; P < 0.001). No notable difference was observed in the 2-year surgical outcomes between cohorts. Patients in the GNRFA-TKA cohort had lower odds of requiring a blood transfusion and having postoperative anemia, all arrhythmias, and urinary infections compared with primary TKA control patients.Conclusion:Preoperative GNRFA leads to a lower rate of prolonged postoperative opioid use in patients undergoing TKA, without an increased risk of complications. Future prospective studies are needed to validate the findings of this database study.

Radiofrequency Ablation of the Infrapatellar Branch of the Saphenous Nerve for the Treatment of Chronic Anterior Inferomedial Knee Pain.

Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for chronic knee pain related to osteoarthritis. It is often utilized when conservative management has failed and patients wish to avoid arthroplasty, are poor surgical candidates due to comorbid medical conditions, or in those suffering from persistent pain after arthroplasty. The classic targets for GNRFA include the superior lateral genicular nerve, superior medial genicular nerve, and inferior medial genicular nerve but multiple anatomic studies have demonstrated additional sensory innervation to the knee. In this research article, we propose an image-guided technique that can safely target the infrapatellar branch of the saphenous nerve which also provides sensory innervation to the anterior capsule. The proposed technique includes variations for conventional bipolar radiofrequency ablation, cooled radiofrequency ablation, dual-tined bipolar radiofrequency ablation, and monopolar radiofrequency ablation using a long axis approach. The described technique is based on updated anatomic studies and takes into account safety concerns such as thermal risk to the skin and/or pes anserine tendons and breaching of the synovial cavity. Future clinical research should be performed to confirm the safety and effectiveness of this specific approach.

Genicular nerve radiofrequency ablation for pain control following anterior cruciate ligament reconstruction - A case report

Adequate postoperative pain control is an essential factor for the success of rehabilitation programs after anterior cruciate ligament reconstruction (ACLR). The genicular nerve radiofrequency ablation (GNRF) is a recently developed method.This study aimed to evaluate the use of GNRF in patients who underwent ACLR.We performed GNRF guided by ultrasonography for patients who underwent ACLR with aggravated pain. GNRF was performed following ACLR a day after surgery. The pain was evaluated using the Visual Analogue Scale (VAS), and the Euroqol-5 Dimension (EQ-5D) measured the quality of life on the day of one, three, and seven after surgery.ResultsIn this study, two patients participated. In the postoperative days first, third, and seventh, the mean VAS was decreased after providing the intervention (from 8 to 5, 2, and 1, respectively). The mean EQ5D improved from 0.48 to 0.52, 0.56, 0.66, respectively.We concluded that GNRF is an adequate and safe procedure for managing postoperative pain after ACLR. It may enhance the postoperative rehabilitation program.

Effectiveness of the Thermal Genicular Nerve Radiofrequency Ablation Therapy Under Fluoroscopy in Patients with Non-operative Advanced Stage Knee Osteoarthritis: 1-Year Follow-Up Results.

In this study, our aim was to present the 1-year results of the effect of thermal genicular nerve radiofrequency ablation (GNRFA) therapy on pain and functional outcomes in patients with advanced knee osteoarthritis. After retrospectively examining the hospital records, 49 knees of 35 patients who had undergone thermal RFA of the superior medial, superior lateral, and inferior medial branches of the genicular nerve under fluoroscopic guidance between July 2019 and December 2020 were included in the study. The visual analog scale (VAS) scores of the patients were recorded before RFA, on the day of RFA, and at the first, sixth, and 12th months postoperatively, as well as their Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores before RFA and at the 12th month postoperatively. Complications developed after the procedure and during the follow-up period were screened. Twenty-five of the patients were females and 10 males, with a mean age of 77.3 ± 7.9years (range 61-92years). The mean VAS score was 8.4 ± 0.9 before RFA, and as 1.7 ± 1.0 right after the procedure, 2.4 ± 1.7 at the first month, 3.4 ± 1.8 at the sixth month, and 4.4 ± 1.9 at the 12th month (p < 0.01). In terms of the WOMAC score, the average value was 69.7 ± 6.4 before the treatment and 36.1 ± 11.8 at the final follow-up at the 12th month (p < 0.01). No complications were observed in any patient during the treatment or the follow-up period. Non-surgical thermal GNRFA therapy of knee osteoarthritis provides significant outcomes in terms of pain and functionality, with no significant systemic or local side effects. Therefore, the technique can be considered as an alternative to other methods when treating advanced osteoarthritis.