IMPORTANCE: Knee osteoarthritis (OA) is a prevalent and disabling condition, especially in older adults. For patients who are not candidates for total knee arthroplasty (TKA) due to comorbidities or limited access to care, minimally invasive pain-relief options are critically needed.
OBJECTIVE: To assess the efficacy and safety of ultrasound-guided chemical neurolysis using 95% ethanol targeting four genicular nerves in patients with symptomatic knee OA who have not responded to conservative management.
DESIGN: Double-blind, randomized, sham-controlled clinical trial.
PARTICIPANTS: A total of 100 adults with symptomatic knee OA, confirmed radiographically and unresponsive to conservative treatment, were enrolled and randomized.
INTERVENTIONS: Patients were randomized to receive ultrasound-guided chemical neurolysis of the superomedial, superolateral, recurrent tibial, and inferomedial genicular nerves with 95% ethanol (treatment group) or a sham procedure (control group).
MAIN OUTCOMES AND MEASURES: The primary outcome was pain intensity measured by the Numerical Rating Scale (NRS) at 7 days, 30 days, 3 months, and 6 months post-procedure. Secondary outcomes included opioid consumption and health-related quality of life measured by the EQ-5D-5L questionnaire. Safety outcomes focused on the occurrence of neurological complications. Analyses were conducted using an intention-to-treat approach with appropriate handling of missing data.
RESULTS: Patients in the ethanol neurolysis group experienced significantly greater reductions in NRS scores at all follow-up points compared to the sham group (P < .0001). Opioid consumption was also significantly reduced in the neurolysis group throughout the 6-month period (P < .0001). Quality of life, as assessed by EQ-5D-5L, improved significantly in the treatment group (P < .0001). No neurological deficits or serious adverse events were reported in either group.
CONCLUSIONS AND RELEVANCE: Ultrasound-guided chemical neurolysis of the SMGN, SLGN, RTGN, and IMGN with 95% ethanol is a safe and effective minimally invasive treatment for patients with refractory knee OA pain. It significantly reduces pain and opioid use while improving quality of life, making it a valuable therapeutic option for individuals ineligible for surgical intervention.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
A variant of techniques already in use. Feasible.
Physician rater
Interesting study looking at the efficacy for OA knee pain relief using ethanol given under US to target relevant knee sensory nerve innervation. Sustained pain relief was achieved in the intervention group versus sham placebo.
, McMaster University