Patient-Reported Outcomes Following Two-Tined Three-Site Conventional Radiofrequency Ablation of Genicular Nerves for Chronic Knee Pain.

BACKGROUND

Genicular nerve radiofrequency ablation (GNRFA) has emerged as an effective therapy for chronic knee pain. Although some studies have evaluated its effectiveness, there is limited real-world data on the long-term patient-reported outcome (PRO) data for GNRFAs.

OBJECTIVE

This study aimed to evaluate PROs following conventional GNRFAs performed using two-tined electrodes and the classical three-site technique targeting the superior medial, superior lateral, and inferior medial genicular nerves.

METHODS

We performed a retrospective chart review to gather data from consecutive GNRFAs at an academic medical center from 2016 to 2023. Inclusion criteria were all adult patients who received a conventional GNRFA performed using the classical three-site technique using two-tined electrodes. All included subjects were confirmed to have a positive diagnostic response (≥50% Numeric Rating Scale (NRS) reduction) to a previous genicular nerve block. Primary outcomes were NRS pain scores, Patient Reported Outcomes Measurement Information System (PROMIS) Global Health, and Patient Health Questionnaire-9 (PHQ-9).

RESULTS

A total of 31 patients underwent 38 GNRFAs. Relative to the pre-procedure baseline, the average NRS reduction post-procedurally was -3.17 during 0-3 months (p<0.0001), -1.31 during 3-6 months (p<0.05), and -1.92 during 6-12 months (p<0.05). Half of all patients maintained pain relief (NRS reduction greater than or equal to a minimal clinically important difference (MCID) of -2.0) for 11.17 months (95% CI: 7.29, 13.40). Although there was a positive trend for improvement in the quality-of-life measures, no statistically significant post-procedure improvement or worsening was observed during all time periods for PROMIS Physical Health, PROMIS Mental Health, and PHQ-9. Lastly, a history of depression was associated with treatment failure.

CONCLUSION

In this real-world cohort, conventional GNRFA using the classical three-site technique demonstrated robust short-term pain reduction, and at least half of the cohort maintained clinically meaningful pain improvements for 11 months. For chronic knee pain, GNRFA is a reasonable therapeutic option in appropriately selected patients.