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Skeletal Radiology
Erschienen in:

02.11.2021 | Scientific Article

Management of uncomplicated total knee arthroplasty chronic pain and stiffness utilizing cooled radiofrequency ablation: a single institution pilot study

verfasst von: Fiza M. Khan, Andrew Tran, Philip Kin-Wai Wong, Samuel Aiyedipe, Mohammed F. Loya, Mircea M. Cristescu, Felix M. Gonzalez

Erschienen in: Skeletal Radiology | Ausgabe 6/2022

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Abstract

Objective

The objective of this study is to introduce cooled radiofrequency ablation technical feasibility as an alternative percutaneous image-guided treatment of chronic pain and stiffness in the setting of uncomplicated total knee arthroplasty.

Material and method

This retrospective pilot study includes a total of 19 consecutive patients experiencing persistent chronic pain after total knee arthroplasty, without underlying hardware complications who had failed conservative care. Patients initially underwent anesthetic blocks of the genicular nerve branches to determine C-RFA candidacy. After adequate response to the anesthetic blocks (> 50% immediate pain relief), patients were subjected to cooled radiofrequency ablations 2–3 weeks later. Treatment response was evaluated utilizing clinically validated questionnaires (KOOS, the Knee Injury and Osteoarthritis Outcome Score) and visual analog scale (VAS) to assess pain severity, stiffness, functional activities of daily living, and use of pain medication. Follow-up outcome scores were collected up to 1 year after C-RFA procedure.

Result

A total of 21 knees were treated consecutively between 4/2019 and 1/2020 (mean age 70.5 years; 5 M:14F). The mean total KOOS score improved significantly from baseline at 35.0 ± 14.0 to 64.2 ± 14.7 at a mean of 10.2 months after treatment (p < 0.0001), with significant improvement in mean stiffness score from 44.8 ± 16.7 to 68.8 ± 20 (p < 0.0001). The mean VAS score improved significantly from baseline at 8.30 ± 1.1 to 2.45 ± 1.8 (p < 0.0001). No major complications were encountered. No patients went on to receive re-treatment, surgical revision, or other intervention.

Conclusion

Image-guided genicular nerve cooled radiofrequency ablation offers a promising alternative in treating chronic pain/stiffness in the setting of uncomplicated TKA.
Literatur
1.
Cui A, et al. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 2020. p. 29–30.
2.
Vos T, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–96.
3.
Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26–35.
4.
Sharma L. Osteoarthritis of the Knee. N Engl J Med. 2021. 384(1):51–9.
5.
DeRogatis M, et al. Non-operative treatment options for knee osteoarthritis. Ann Transl Med. 2019;7(Suppl 7):S245.
6.
Foy CG, et al. Intensive lifestyle intervention improves physical function among obese adults with knee pain: findings from the Look AHEAD trial. Obesity (Silver Spring). 2011;19(1):83–93.
7.
Wadden TA, et al. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring). 2006;14(5):737–52.
8.
Yu SP, et al. Effectiveness of knee bracing in osteoarthritis: pragmatic trial in a multidisciplinary clinic. Int J Rheum Dis. 2016;19(3):279–86.
9.
Kompel AJ, et al. Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? Radiology. 2019;293(3):656–63.
10.
Wernecke C, Braun HJ, Dragoo JL. The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Orthop J Sports Med. 2015;3(5):2325967115581163.
11.
Wylde V, et al. Chronic pain after total knee arthroplasty. EFORT Open Rev. 2018;3(8):461–70.
12.
Haroutiunian S, et al. The neuropathic component in persistent postsurgical pain: a systematic literature review. Pain. 2013;154(1):95–102.
13.
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet (London, England). 2006;367(9522):1618–25.
14.
Wright A, et al. Abnormal quantitative sensory testing is associated with persistent pain one year after TKA. Clin Orthop Relat Res. 2015;473(1):246–54.
15.
Haines DE, Verow AF. Observations on electrode-tissue interface temperature and effect on electrical impedance during radiofrequency ablation of ventricular myocardium. Circulation. 1990;82(3):1034–8.
16.
Nath S, DiMarco JP, Haines DE. Basic aspects of radiofrequency catheter ablation. J Cardiovasc Electrophysiol. 1994;5(10):863–76.
17.
Bogduk N. Practice guidelines: spinal diagnostic and treatment procedures, ed. Bogduk N. San Francisco: International Spine Intervention Society. 2004.
18.
Kapural L, Deering JP. A technological overview of cooled radiofrequency ablation and its effectiveness in the management of chronic knee pain. Pain Manag. 2020;10(3):133–40.
19.
Franco CD, et al. Innervation of the anterior capsule of the human knee: implications for radiofrequency ablation. Reg Anesth Pain Med. 2015;40(4):363–8.
20.
Tran J, et al. Anatomical study of the innervation of anterior knee joint capsule: implication for image-guided intervention. Reg Anesth Pain Med. 2018;43(4):407–14.
21.
Gonzalez FM. Cooled radiofrequency genicular neurotomy. Tech Vasc Interv Radiol. 2020;23(4):100706.
22.
Rojhani S, Qureshi Z, Chhatre A. Water-cooled radiofrequency provides pain relief, decreases disability, and improves quality of life in chronic knee osteoarthritis. Am J Phys Med Rehabil. 2017;96(1):e5–e8.
23.
Wong PK, et al. Safety and efficacy comparison of three- vs four-needle technique in the management of moderate to severe osteoarthritis of the knee using cooled radiofrequency ablation. Skeletal Radiol. 2021;50(4):739–50.
24.
Walker LC, et al. The WOMAC score can be reliably used to classify patient satisfaction after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2018;26(11):3333–41.
25.
Cepeda MS, et al. What decline in pain intensity is meaningful to patients with acute pain? Pain. 2003;105(1–2):151–7.
26.
27.
Kachar SM, Williams KM, Finn HA. Neuroma of the infrapatellar branch of the saphenous nerve: a cause of reversible knee stiffness after total knee arthroplasty. J Arthroplasty. 2008;23(6):927–30.
28.
Ilfeld BM, Preciado J, Trescot AM. Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves. Expert Rev Med Dev. 2016;13(8):713–25.
29.
Wunsch H, et al. Opioids prescribed after low-risk surgical procedures in the United States, 2004–2012. Jama. 2016;315(15):1654–7.
30.
Shah R, et al. Opioid use and pain control after total hip and knee arthroplasty in the US, 2014 to 2017. JAMA Network Open. 2020;3(7):e2011972–e2011972.
31.
Dwyer MK, et al. Characterization of post-operative opioid use following total joint arthroplasty. J Arthroplasty. 2018;33(3):668–72.
32.
Qudsi-Sinclair S, et al. A comparison of genicular nerve treatment using either radiofrequency or analgesic block with corticosteroid for pain after a total knee arthroplasty: a double-blind, randomized clinical study. Pain Pract. 2017;17(5):578–88.
33.
Walega D, et al. Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up. Reg Anesth Pain Med. 2019.
34.
Li JW, Ma YS, Xiao LK. Postoperative pain management in total knee arthroplasty. Orthop Surg. 2019;11(5):755–61.
35.
Xu Z, et al. Preemptive analgesia by using celecoxib combined with tramadol/APAP alleviates post-operative pain of patients undergoing total knee arthroplasty. Phys Sportsmed. 2017;45(3):316–22.
36.
Deveza LA, Hunter DJ, Van Spil WE. Too much opioid, too much harm. Osteoarthritis Cartilage. 2018;26(3):293–5.CrossRefPubMed
37.
Greimel F, et al. Matched-pair analysis of local infiltration analgesia in total knee arthroplasty: patient satisfaction and perioperative pain management in 846 cases. J Knee Surg, 2019;32(10):953–59.
38.
Talmo CT. et al. Prospective randomized trial comparing femoral nerve block with intraoperative local anesthetic injection of liposomal bupivacaine in total knee arthroplasty. J Arthroplasty. 2018;33(11):3474–78.
39.
Park YB, et al. Comparison of short-term complications of general and spinal anesthesia for primary unilateral total knee arthroplasty. Knee Surg Relat Res. 2017:29(2):96–103.
40.
Klement MR, et al. Intra-articular corticosteroid injection following total knee arthroplasty: is it effective? J Arthroplasty. 2019;34(2):303–8.
41.
Deyle, GD et al. A multicenter randomised, 1-year comparative effectiveness, parallel-group trial protocol of a physical therapy approach compared to corticosteroid injection on pain and function related to knee osteoarthritis (PTA Trial). BMJ Open. 2016;6(3):e010528.
42.
Holland C, et al. Septic and aseptic complications of corticosteroid injections: an assessment of 278 cases reviewed by expert commissions and mediation boards from 2005 to 2009. Dtsch Arztebl Int. 2012;109(24):425–30.
Metadaten
Titel
Management of uncomplicated total knee arthroplasty chronic pain and stiffness utilizing cooled radiofrequency ablation: a single institution pilot study
verfasst von
Fiza M. Khan
Andrew Tran
Philip Kin-Wai Wong
Samuel Aiyedipe
Mohammed F. Loya
Mircea M. Cristescu
Felix M. Gonzalez
Publikationsdatum
02.11.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
Skeletal Radiology / Ausgabe 6/2022
Print ISSN: 0364-2348
Elektronische ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-021-03944-z

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