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Management of uncomplicated total knee arthroplasty chronic pain and stiffness utilizing cooled radiofrequency ablation: a single institution pilot study

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Abstract

Objective

The objective of this study is to introduce cooled radiofrequency ablation technical feasibility as an alternative percutaneous image-guided treatment of chronic pain and stiffness in the setting of uncomplicated total knee arthroplasty.

Material and method

This retrospective pilot study includes a total of 19 consecutive patients experiencing persistent chronic pain after total knee arthroplasty, without underlying hardware complications who had failed conservative care. Patients initially underwent anesthetic blocks of the genicular nerve branches to determine C-RFA candidacy. After adequate response to the anesthetic blocks (> 50% immediate pain relief), patients were subjected to cooled radiofrequency ablations 2–3 weeks later. Treatment response was evaluated utilizing clinically validated questionnaires (KOOS, the Knee Injury and Osteoarthritis Outcome Score) and visual analog scale (VAS) to assess pain severity, stiffness, functional activities of daily living, and use of pain medication. Follow-up outcome scores were collected up to 1 year after C-RFA procedure.

Result

A total of 21 knees were treated consecutively between 4/2019 and 1/2020 (mean age 70.5 years; 5 M:14F). The mean total KOOS score improved significantly from baseline at 35.0 ± 14.0 to 64.2 ± 14.7 at a mean of 10.2 months after treatment (p < 0.0001), with significant improvement in mean stiffness score from 44.8 ± 16.7 to 68.8 ± 20 (p < 0.0001). The mean VAS score improved significantly from baseline at 8.30 ± 1.1 to 2.45 ± 1.8 (p < 0.0001). No major complications were encountered. No patients went on to receive re-treatment, surgical revision, or other intervention.

Conclusion

Image-guided genicular nerve cooled radiofrequency ablation offers a promising alternative in treating chronic pain/stiffness in the setting of uncomplicated TKA.

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Acknowledgement

The authors would like to thank Nariman Nezami, MD, University of Maryland Medical Center, Department of Radiology, 22 S. Greene St., Baltimore, MD 21201.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA

    Fiza M. Khan, Philip Kin-Wai Wong, Mohammed F. Loya, Mircea M. Cristescu & Felix M. Gonzalez

  2. Emory University School of Medicine, Atlanta, GA, USA

    Andrew Tran

  3. Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Samuel Aiyedipe

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  1. Fiza M. Khan
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Correspondence to Felix M. Gonzalez.

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Khan, F.M., Tran, A., Wong, P.KW. et al. Management of uncomplicated total knee arthroplasty chronic pain and stiffness utilizing cooled radiofrequency ablation: a single institution pilot study. Skeletal Radiol 51, 1215–1223 (2022). https://doi.org/10.1007/s00256-021-03944-z

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  • DOI: https://doi.org/10.1007/s00256-021-03944-z

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