Abstract

Comparison between Fluoroscopy Guided Radiofrequency Ablation of Genicular Nerves and Intra Articular Injection of Methylprednisolone Acetate in Relieving Pain and Improving Function in Grade 3 and 4 Osteoarthritis of Knee: A Randomised Controlled Trial

Background: Osteoarthritis is the second most common rheumatologic problem in India. The prevalence of osteoarthritis in India is 22% to 39% and knee osteoarthritis alone contributes to 80% of the osteoarthritis burden. Knee osteoarthritis is much more prevalent in India than in the West and accounts for as much more disability as any other chronic condition. Despite the immense impact of this disease, very few effective non-surgical options are available to handle it. In the severe stages of osteoarthritis, knee arthroplasty remains the last option. However, many cannot afford an arthroplasty surgery due to the poor socio-economic condition of the people in this part of the country. Objective: To compare two non-surgical options for relieving pain and function-fluoroscopy-guided radiofrequency ablation of genicular nerves and intra-articular injection of methylprednisolone acetate in patients with osteoarthritis of the knee who are candidates for knee arthroplasty. Methods: A randomized controlled trial was done in the Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences (PMR, RIMS) for 1 year on 76 patients with knee osteoarthritis Kellgren-Lawrence (KL) Grade 3 and 4. The participants were divided into two groups-study and control groups. The study group underwent Radiofrequency Ablation (RFA) of genicular nerves of the knee, while the control group received Intra-Articular (IA) knee injection with 2 ml of Methylprednisolone acetate (40 mg/ml) mixed with 2 ml of Lignocaine 2%. Assessments of Visual Analog Scale (VAS) and Western Ontario Mc- Master University Osteoarthritis Index (WOMAC) were done at 1 week, 4 weeks, and 12 weeks. Results: Study group who received RFA of genicular nerves showed a decrease in VAS score from 6.84 ± 0.64 at baseline to 2.61 ± 0.72 at 1 week and 2.97 ± 0.88 at 12 weeks. The control group receiving 80mg of Methylprednisolone also showed a decrease in VAS score from 5.82 ± 0.56 at baseline to 2.18 ± 0.39 at 1week and 4.03 ± 0.54 at 12 weeks. Consistent improvement was also seen in the WOMAC function score in both groups. It significantly improved from 44.79 ± 7.18 at baseline to 26.79 ± 4.37 at 12 weeks in the RFA group, while in the steroid group it improved from 41.26 ± 5.31 at baseline 24.89 ± 3.43 at 12 weeks (p<0.05). Conclusion: RFA of the genicular nerve provides longer and sustained pain relief in Grade 3, 4 OA knee than the intra-articular steroid. It can thus be used as an effective modality for relieving pain in patients unable to undergo knee joint replacement surgery.

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