The Effect of Radiofrequency Ablation on the Results of the Genicular Nerve Number in the Treatment of Knee Osteoarthritis
Condition: Osteoarthritis, Knee; Radiofrequency Ablation; Genicular Nerve
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      Knee osteoarthritis is a disease that increases in frequency with age and decreases the
      quality of life and physical activity by leading to a decrease in pain and joint range of
      motion. Basically, the articular cartilage is affected and clinically pain, joint stiffness,
      crepitation and effusion are seen. In imaging techniques applied with weight-bearing, varying
      degrees of joint narrowing are observed, although it is more common in the medial. Treatment
      options include conservative approaches such as weight loss, physical therapy, analgesics, or
      invasive approaches such as intra-articular injections, peripheral nerve blocks,
      joint-sparing surgery or total knee replacement. Surgical operation should be considered in
      the treatment when conservative treatments are insufficient. However, the advanced age of
      this patient group and the large number of comorbidities reduce the possibility of surgical
      operation. Although treatment cannot be cured in knee osteoarthritis, the aim of the
      treatment is to decrease the pain, increase the patient's quality of life and physical
      capacity, and slow down the progression of the disease.

      Although the radiofrequency ablation (RFA) technique has been used since the 1970s, the first
      application area was trigeminal neuralgia. Later, its use in neck and back pain became
      widespread, but the first randomized controlled study on its use in knee osteoarthritis was
      Choi et al. Made by in 2011. The purpose of radiofrequency ablation applied to the genicular
      nerves that receive the sensation of the knee joint capsule is to prevent sensory
      transmission and reduce the sensation of pain by creating axonal damage to these nerves.
      Since the use of RFA in knee osteoarthritis is relatively new, studies on the development of
      the technique continue. Fluoroscopy device or ultrasonography can be used as imaging method
      to show target nerves or to place the RFA electrode in the correct localization.

      The investigators hypothesis; based on the more prominent medial involvement in knee
      osteoarthritis, the conventional RFA procedure applied to the 3 genicular nerves (SMGN, IMGN,
      SLGN) is not superior to the RFA procedure applied to the medial SMGN and IMGN branches.
    


Intervention name(s): Radiofrequency ablation of genicular nerves
Intervention type(s): Procedure
Intervention description(s): The RF cannula will be placed near the nerve with an in-plane technique from proximal to distal. Sensory stimulation will be performed at 50 Hz to ensure localization. The sensory threshold should be less than 0.6 V. To prevent ablation of the motor nerves, when the nerve is stimulated with 2.0 V at 2 Hz, it will be seen that there is no fasciculation in the relevant region of the lower extremity. Before starting the ablation procedure, 2 mL of 1% lidocaine solution will be injected around the nerve, after vascularity control, in order to reduce the pain and the risk of neuritis during the procedure. Then the temperature will be adjusted to 80° degrees and applied for 90 seconds and the process will be terminated.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Osteoarthritis Knee; Genicular Nerve; Radiofrequency Ablation