Preoperative use of the modified radiofrequency neuroablation of the genicular and cutaneous nerves of the knee joint for alleviating postoperative pain after arthroplasty
DOI:
https://doi.org/10.14739/2310-1210.2021.2.214908Keywords:
radiofrequency neuroablation, knee joint, pain syndrome, arthroplastyAbstract
The aim of the study. To improve the effectiveness of pain syndrome management in the postoperative period in patients after knee arthroplasty with radiofrequency neuroablation (RFNA).
Materials and methods. A prospective, open, randomized study on the treatment result analysis of 93 patients with knee joint osteoarthritis of the III–IV stage was conducted. Patients were divided into two groups: the study group (n = 44) and the comparison group (n = 49). The study group patients underwent arthroplasty of one knee and RFNA of the genicular and cutaneous nerves in the preoperative period. The comparison group patients underwent only knee arthroplasty. Assessment of pain intensity, functional status and quality of life of patients was performed using the VAS, WOMAC, KOOS questionnaires before treatment, 1.5, 3 and 6 months after surgery, taking into account the overall quality of life according to the SF-36 questionnaire and the possibility of developing neuropathic pain component according to the PainDetect questionnaire.
Results. The result analysis obtained with the VAS showed pain reduction in both groups in 6 months after total knee arthroplasty (TKA), in the study group – 2 (2; 2) points, in the comparison group – 3 (2; 3) points. The results assessed with the WOMAC questionnaire showed greater improvement in treatment outcomes among patients who underwent knee arthroplasty in combination with RFNA – 32 (28; 34) points after 6 months. In the comparison group, there was also an improvement in functional status on examination in 1.5 months after surgery, but with less effective reduction of pain and physical recovery, which was seen on the examination in 6 months – 33.0 (28.5; 37.0) points. The analysis using the KOOS questionnaire showed a positive increase in postoperative indicators in both groups of patients, and it was 41.88 (37.20; 44.79) points in the comparison group and 47.67 (40.63; 50.51) points in the study group during a 6-month follow-up after arthroplasty. The SF-36 result analysis in 6 months after surgical treatment showed nearly identical restore of the psychological component of health in both patient groups – 56.63 (55.83; 59.03) points in the comparison group and 58.96 (54.24, 60.35) points – in the study group. The study group demonstrated better restoration of the physical component of health. The neuropathic component of pain was not detected among the examined groups of patients using the PainDetect questionnaire.
Conclusions. RFNA of the genicular nerves and additional ablation of cutaneous nerves reduces the intensity of pain in the postoperative period after knee replacement and allows patients more quickly and easier restore functional activity and improve quality of life.
References
Zazirnyi, I. M., & Ryzhkov, B. (2019). Rozvytok totalnoho endoprotezuvannia kolinnoho suhloba za ostanni 50 rokiv [The evolution of the total knee arthroplasty for the last 50 years]. Travma, 20(4), 6-13. https://doi.org/10.22141/1608-1706.4.20.2019.178741 [in Ukrainian].
Wylde, V., Beswick, A., Bruce, J., Blom, A., Howells, N., & Gooberman-Hill, R. (2018). Chronic pain after total knee arthroplasty. EFORT Open Reviews, 3(8), 461-470. https://doi.org/10.1302/2058-5241.3.180004
Chan, E. Y., Blyth, F. M., Nairn, L., & Fransen, M. (2013). Acute postoperative pain following hospital discharge after total knee arthroplasty. Osteoarthritis and Cartilage, 21(9), 1257-1263. https://doi.org/10.1016/j.joca.2013.06.011
Strokan, A. M. (2011). Prolonhovana rehionarna blokada yak efektyvnyi zasib rannoi reabilitatsii patsiientiv pislia endoprotezuvannia kolinnoho suhloba [Continuous regional anaesthesia as an effective method of early postoperative rehabilitation in patients with total knee replacement]. Bil, zneboliuvannia i intensyvna terapiia, (4), 57-65. [in Ukrainian].
Chorny, V. N. (2015). Endoprotezirovanie kolennogo sustava total'nym tsementnym endoprotezom "Motor Sich EPK-2" [Total knee arthroplasty with the cement endoprosthesis "Motor Sich EPK-2"]. Ortopediya, travmatologiya i protezirovanie, (2), 67-69. [in Russian].
Golovakha, M. L., & Bilykh, Ye. O. (2019). Radiochastotna neiroabliatsiia yak metod likuvannia bolovoho syndromu v konservatyvnomu likuvanni honartrozu [Radiofrequency neuroablation as a treatment method for pain syndrome in conservative treatment of knee osteoarthritis]. Ortopediya, travmatologiya i protezirovanie, (3), 35-42. https://doi.org/10.15674/0030-59872019335-42 [in Ukrainian].
Howes, L. G. (2007). Selective COX-2 inhibitors, NSAIDs and cardiovascular events - is celecoxib the safest choice? Therapeutics and Clinical Risk Management, 3(5), 831-845.
Iannaccone, F., Dixon, S., & Kaufman, A. (2017). A Review of Long-Term Pain Relief after Genicular Nerve Radiofrequency Ablation in Chronic Knee Osteoarthritis. Pain Physician, 20(3), E437-E444.
Protzman, N. M., Gyi, J., Malhotra, A. D., & Kooch, J. E. (2014). Examining the Feasibility of Radiofrequency Treatment for Chronic Knee Pain After Total Knee Arthroplasty. PM&R, 6(4), 373-376. https://doi.org/10.1016/j.pmrj.2013.10.003
Povoroznyuk, V., Pryimych, U., & Chebotarev, D. F. (2016). Identification of neuropathic pain component in patients OF various age with knee osteoarthritis. Osteoarthritis and Cartilage, 24(Suppl. 1), S450-S451. https://doi.org/10.1016/j.joca.2016.01.820
Ahmed, A., & Arora, D. (2018). Ultrasound-guided radiofrequency ablation of genicular nerves of knee for relief of intractable pain from knee osteoarthritis: a case series. British Journal of Pain, 12(3), 145-154. https://doi.org/10.1177/2049463717730433
Clendenen, S., Greengrass, R., Whalen, J., & O'Connor, M. I. (2015). Infrapatellar Saphenous Neuralgia After TKA Can Be Improved With Ultrasound-guided Local Treatments. Clinical Orthopaedics and Related Research, 473(1), 119-125. https://doi.org/10.1007/s11999-014-3812-6
Roberts, S. L., Stout, A., & Dreyfuss, P. (2020). Review of Knee Joint Innervation: Implications for Diagnostic Blocks and Radiofrequency Ablation. Pain Medicine, 21(5), 922-938. https://doi.org/10.1093/pm/pnz189
Kim, S. Y., Le, P. U., Kosharskyy, B., Kaye, A. D., Shaparin, N., & Downie, S. A. (2016). Is Genicular Nerve Radiofrequency Ablation Safe? A Literature Review and Anatomical Study. Pain Physician, 19(5), E697-E705.
Yasar, E., Kesikburun, S., Kılıç, C., Güzelküçük, Ü., Yazar, F., & Tan, A. K. (2015). Accuracy of Ultrasound-Guided Genicular Nerve Block: A Cadaveric Study. Pain Physician, 18(5), E899-E904.
Fonkoue, L., Behets, C. W., Steyaert, A., Kouassi, J. K., Detrembleur, C., De Waroux, B., & Cornu, O. (2019). Accuracy of fluoroscopic-guided genicular nerve blockade: a need for revisiting anatomical landmarks. Regional Anesthesia & Pain Medicine, 44, 950-958. https://doi.org/10.1136/rapm-2019-100451
González Sotelo, V., Maculé, F., Minguell, J., Bergé, R., Franco, C., & Sala-Blanch, X. (2017). Ultrasound-guided genicular nerve block for pain control after total knee replacement: Preliminary case series and technical note. Revista Española de Anestesiología y Reanimación, 64(10), 568-576. https://doi.org/10.1016/j.redar.2017.04.001
Choi, W. J., Hwang, S. J., Song, J. G., Leem, J. G., Kang, Y. U., Park, P. H., & Shin, J. W. (2011). Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial. Pain, 152(3), 481-487. https://doi.org/10.1016/j.pain.2010.09.029
Walega, D., McCormick, Z., Manning, D., & Avram, M. (2019). Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up. Regional Anesthesia & Pain Medicine, 44, 646-651. https://doi.org/10.1136/rapm-2018-100094
Dasa, V., Lensing, G., Parsons, M., Harris, J., Volaufova, J., & Bliss, R. (2016). Percutaneous freezing of sensory nerves prior to total knee arthroplasty. The Knee, 23(3), 523-528. https://doi.org/10.1016/j.knee.2016.01.011
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