RFA Superior to Steroids for Treating Knee Osteoarthritis

A new study shows that cooled radiofrequency ablation (CRFA) provides better pain reduction and functional improvement of knee osteoarthritis (OA) than intra-articular steroid (IAS) injections.

Researchers at Orthopedic Pain Specialists (Santa Monica, CA, USA), the Center for Clinical Research (Winston-Salem, NC, USA), and other institutions conducted a prospective, multicenter, randomized trial involving 151 subjects with chronic knee pain unresponsive to conservative modalities in order to compare the long-term clinical safety and effectiveness of CRFA with IAS injection in managing OA-related knee pain. Outcome measures included knee pain, Oxford Knee Score, overall treatment effect, analgesic drug use, and adverse events.

The results showed that at six months, the CRFA group had more favorable outcomes, including a 50% or greater reduction in pain score. From an initial pain score of about 7 on a 10-point scale, pain ratings at one month were about 3 in the CRFA group versus 4 in the steroid group. With further follow-up, pain scores remained lower in the CRFA group, while increasing toward the pre-treatment level in the steroid group. At six months, 74% of patients assigned to CRFA had at least a one-half reduction in pain scores, compared to 16% of those undergoing steroid injection. The study was published on November 1, 2017, in Regional Anesthesia & Pain Medicine.

“This study demonstrates that CRFA is an effective long-term therapeutic option for managing pain, and improving physical function and quality of life, for patients suffering from painful knee osteoarthritis when compared with intra-articular steroid injection,” concluded senior author Leonardo Kapural, MD, PhD, of the CCR. “The pain may return as the treated nerve regenerates; if so, repeating the CRFA procedure is a reasonable and sensible option.”

OA is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. A variety of causes--hereditary, developmental, metabolic, and mechanical deficits--may initiate processes leading to loss of cartilage. As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax. OA of the knee affects about 250 million people worldwide (3.6% of the population).

Related Links:
Orthopedic Pain Specialists
Center for Clinical Research