Approximately 1 in 5 adults (18.2%) over 45 years of age in England has osteoarthritis of the knee. Similarly, approximately 1 in 9 adults (10.9%) over 45 years of age in England has osteoarthritis of the hip. The prevalence ranges from around 15% to 21% for knee and 10% to 12% for hip across local authorities in England. The rate of knee replacements in local authority areas ranges from 1/1,000 to 6/1,000 people over 45 years. Knee pain affects 250 million people worldwide, and that number is expected to increase as the population ages and knee pain from OA becomes more common. Risk factors for OA-induced pain include high body mass index (BMI), previous joint injury, occupational hazards that place excessive mechanical stress on the joints, and structural misalignment. Chronic joint pain leads to disability, psychological distress, and impaired quality of life.

For severe pain or those who have failed to respond to conservative treatment, joint replacement surgery is an option. However, the procedure has perioperative and postoperative risks, including development of chronic pain (approximately 20%) and limited implant longevity. Joint replacement surgery has a failure rate of 10-20% and can result in significant morbidity for the patients.In addition, not all patients are eligible for a joint replacement secondary to young age, high BMI, or medical comorbidities.

Because of the lack of optimal treatment options, alternative methods are needed to manage patients with joint pain that results from OA. A relatively novel option is radiofrequency (RF) ablation of the articular nerves supplying sensory innervation to these joints.

Percutaneous radiofrequency (RF) denervation of articular sensory nerves of the knee and hip joint is a minimally invasive neurotomy technique that can provide pain relief in patients with chronic knee and hip pain. There has been an increase in the number of publications on RF denervation of the joints over the last few years although many questions remain regarding anatomical targets, technical aspects, selection criteria, and evidence for effectiveness.

Predictors of success or failure with RFA relate to both patient characteristics and procedural technique. Procedural factors that contribute to success with RFA include the type of RF energy applied, the duration and temperature of treatment, and the gauge of the RF probe itself. An ex vivo trial compared several types of RF and found that Cooled RFA created larger lesions than either continuous or PRF. Unfortunately Cooled RF is not widely available because of cost constrains and in our experience, is a much more painful procedure than traditional RF.

The Trident RF Cannula:

The RF Trident™ Cannula is designed for radio Frequency lesioning of nerves and allows for a faster procedure, less exposure to X-Ray and a shorter patient recovery time with longer-lasting pain relief. This superior technology allows for a large lesion to be created on the target area without the normal collateral damage due to a slim 18g probe creating a much larger based lesion when the 3 tines are deployed. The tine configuration allows for retraction and deployment and is similar to a pyramid, resulting in a pyramid-like shaped lesion with large base encompasses the nerve.

The trident cannula offers the following advances over traditional RF cannula and the Coolief technique:

• Reduction in collateral damage with larger focused lesion
• When the tines are injected they can be deployed or retracted
• Much less X-ray exposure
• Cannula with a small diameter which creates a lesion with a large base
• Quicker patient recovery time
• Longer lasting pain relief

Pain Spa is proud to announce the purchase of a new Diros RF generator that will enable us to use the novel Trident cannulae for joint denervations. This will certainly help in improvement of patient care and outcomes as well as patient experience.

Dr. Krishna is highly experienced in performing joint denervation procedures under ultrasound guidance. Ultrasound enables us to perform these treatments in a clinic setting, there by reducing costs incurred by our patients. Please contact us for further details if you are interested in these treatment options.