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Ajrawat P, Radomski L, Bhatia A, et al. Radiofrequency Procedures for the Treatment of Symptomatic Knee Osteoarthritis: A Systematic Review. Pain Med. 2019 Sep 17. pii: 5580377. doi: 10.1093/pm/pnz241. (Systematic review)
Abstract

OBJECTIVE: To evaluate the effectiveness and safety of radiofrequency (RF) ablation and neuromodulation modalities for knee osteoarthritis (OA).

METHODS: The Pubmed, Medline, Embase, and Cochrane Library databases were searched from inception to August 2018. All comparative and noncomparative studies that reported clinical outcome measures and adverse events related to RF modalities for knee OA were included. Pain scores, physical function measures, quality of life (QOL), patient satisfaction, and adverse events for three months and beyond of postprocedure follow-up were analyzed qualitatively.

RESULTS: Thirty-three studies, including 13 randomized controlled trials (RCTs), two nonrandomized comparative studies, and 18 noncomparative cohort studies, were identified, with 1,512 patients (mean age = 64.3 years, 32.5% males). All 33 studies were considered to be of moderate or high methodological quality. All 33/33 (100%) studies reported alleviation of OA-related knee pain from baseline until three to 12 months with RF modalities, with six comparative studies reporting 194/296 (65.5%) and 29/150 (19.3%) RF and control patients achieving >50% pain relief, respectively. Three of the 33 studies reported QOL, with three of three studies (100%) achieving improvements in disease-specific QOL from baseline until three to 12 months. Twenty-eight of the 33 studies reported functional outcomes, with 27/28 (96%) studies obtaining enhanced functionality from baseline up until three to 12 months. Ten of the 33 studies reported patient satisfaction, with eight of 10 studies (80%) indicating that patients were significantly satisfied after RF procedures, and from these eight studies, four were comparative studies that indicated that 86/154 (56%) and 33/104 (32%) RF and control patients were extremely satisfied or satisfied, respectively. Regarding adverse events (AEs), 29 of the 33 studies reported AEs, with 20/29 (69%) studies indicating no AEs related to the RF modalities and the remaining nine studies only indicating minor localized AEs. Twenty-nine of the 33 studies indicated no serious knee-related AEs pertaining to RF modalities.

CONCLUSIONS: Current evidence substantiates that RF modalities for knee OA potentially improve pain, functionality, and disease-specific QOL for up to three to 12 months with minimal localized complications. This suggests that RF modalities are perhaps an effective adjunct therapy for patients with knee OA who are unresponsive to conservative therapies. Further RCTs with larger sample sizes and long-term follow-up that directly compare the three primary RF modalities are warranted to confirm the clinical efficaciousness and superiority of these RF modalities for knee OA.

Ratings
Discipline Area Score
Physician 5 / 7
Rehab Clinician (OT/PT) 5 / 7
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Comments from MORE raters

Physician rater

A concern must be expressed. If one deletes/reduces pain perception, is there potential for producing a "neuropathic joint." Longer term studies with documentation of pain and position sense are required.

Physician rater

I would like to see a large, single or double blinded RCT before being fully convinced of the efficacy of Radio Frequency treatments.

Physician rater

Radio-frequency procedures for knee osteoarthritis is FDA approved. Now as per this systematic review, the procedure seems to be effective also. I feel it will definitely give some relief to the patients.

Physician rater

This systematic review looked at published evidence concerning the efficacy and safety of radio frequency treatment for symptomatic patients with Osteoarthritis of the knee. Thirty three studies were included in the review including 13 randomised trials, two nonrandomised comparative and 18 noncomparative trials with follow up from 3 to 12 months. Radio frequency treatment was significantly superior to control therapies for knee pain, quality of life and functional outcomes with minimal adverse effects. Given the limited conservative treatment options for such patients, this study suggests that radiofrequency treatment has merit in the management of symptomatic knee osteoarthritis.

Rehab Clinician (OT/PT) rater

As an orthopaedic and sports PT, I believe these results provide important data to support strategies in patient education with regard to treatments for this highly prevalent condition, knee OA.

Rehab Clinician (OT/PT) rater

In my typical practice environment, I usually don't see patients with this procedure done as they are usually routed for knee replacement. I do tend to see a few of these cases/year in outpatient PT and concurrently treated by pain management specialists who perform neural ablation procedures. I agree with the findings that most positive impacts last for 3-12 months.
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