Papers of the Week

The objective was to determine the effectiveness of fluoroscopically-guided genicular nerve radiofrequency ablation (RFA) for painful knee osteoarthritis. Primary outcome measure was improvement in pain after six months. Secondary outcomes included Oxford Knee Score (OKS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Two reviewers independently assessed publications before October 10, 2020. The Cochrane Risk of Bias Tool and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system were used. 199-publications were screened, and nine were included. Six-month success rates for >=50% pain relief after RFA ranged from 49-74%. When compared to intraarticular steroid injection (IAS), the probability of success was 4.5 times higher for RFA (RR = 4.58 [95% CI 2.61, 8.04]). When RFA was compared to hyaluronic acid injection (HA), the probability of treatment success was 1.8 times higher (RR = 1.88 [95% CI 1.38, 2.57]). Group mean OKS and WOMAC scores improved in participants receiving genicular RFA compared to IAS and HA. According to GRADE there is moderate quality evidence that fluoroscopically-guided genicular RFA is effective for reducing pain associated with knee osteoarthritis at minimum of six months. Further research is likely to have an important impact on the current understanding of the long-term effectiveness of this treatment.