Radiofrequency denervation for osteoarthritic knee pain: NICE Recommendations June 2023

June 29th, 2023
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  1. Radiofrequency denervation for osteoarthritic knee pain may be used if standard arrangements are in place for clinical governance, consent and audit.
  2. The procedure should only be done by clinicians with specific training and experience in this procedure.

Why the committee made these recommendations

There is good evidence to show that this procedure relieves pain in the short term (up to 2 years). There are no major safety concerns, and the complications, including numbness, are well recognised.

OA of the Knee

Osteoarthritis (OA) is characterised by localised loss of cartilage, remodelling of adjacent bone and associated inflammation. Knees are one of the most affected joints, with pain being a significant symptom.

Current treatments

Various treatments are available for pain caused by knee osteoarthritis, including non-pharmacological (such as physiotherapy), pharmacological (such as analgesics and intra-articular corticosteroids) and surgical approaches (such as knee arthroplasty). When non-pharmacological and pharmacological interventions do not work or symptoms are severe, surgery may be needed.

Radiofrequency of the knee

This procedure is often done in 2 stages. Both are done under fluoroscopic or ultrasound guidance. First, to assess suitability for radiofrequency denervation, people are given a diagnostic nerve block by injecting a local anaesthetic to the target nerves. If the diagnostic nerve block relieves the pain, the person is a candidate for radiofrequency denervation.

A probe is introduced to the treatment site. Several targets have been described, including the genicular nerves, the saphenous nerve, and the articular cavity. Radiofrequency energy is used to denervate the target nerves. The radiofrequency energy can be delivered as conventional radiofrequency, cooled radiofrequency or pulsed radiofrequency. The aim is to reduce pain and delay the need for knee arthroplasty.

The evidence

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 9 sources, which was discussed by the committee. The evidence included 1 systematic review and network meta-analysis, 2 systematic reviews and meta-analyses,1 randomised controlled trial, 1 long-term cohort study that was a single- arm extension of a randomised controlled trial, 1 cohort study, 1 narrativeĀ review and 2 case reports. The evidence is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcomes to be: pain relief and improvements in quality of life, mobility and ability to exercise.

The professional experts and the committee considered the key safety outcomes to be: pain, infection, numbness and damage to adjacent structures.

Committee comments

The committee was informed that the typical duration of pain relief is less than 2 years and there is no long-term effect because of nerve regrowth.

There are several modalities of radiofrequency denervation and different modalities might have different efficacy and safety profiles.

At Pain Spa, Dr Krishna is very experienced in performing interventional pain procedures. In December 2013, Dr Krishna became the first clinician in the UK to perform the cooled radiofrequency treatment (Coolief) of the knee joint. Dr Krishna has treated several patients with cooled radiofrequency of the knee. Please contact us for further details if you are interested in having a consultation with Dr Krishna.

Please click on the link below to learn more about Cooled RF of the knee joint:

Coolief: Genicular Nerve Block & RF Neurotomy of Knee Joint