Cooled Radiofrequency Ablation of Knee

Cooled radiofrequency ablation (cooled RFA) is a new innovative technique used to treat chronic pain. This advanced procedure uses cooled radiofrequency (RF) energy to safely and quickly target certain sensory nerves. Chronic knee pain is a common problem, and many cases are related to nerve problems. Once the nerves are shut off, they cannot transmit pain signals to the brain.

How common is knee pain?

In a large clinical study, the prevalence of knee pain due to osteoarthritis has doubled in women and tripled in men over a 20-year timeframe. In the study, the prevalence rate was 49% for older women, and 49.4% for older men. In addition, the rate increases with age, with it being more common for those age 60 years and older.

What conditions are treated using cooled RFA?

Cooled RFA is used to treat:

  • Thoracic facet joint pain
  • Cervical (neck) pain
  • Discogenic pain
  • Hip osteoarthritis pain
  • Lumbar (low-back) pain
  • Sacroiliac joint syndrome
  • Chronic knee osteoarthritis

How does cooled RFA work?

In cooled RFA, sterile circulating water passes through an electrode inserted near irritated nerves while nerve tissue is heated. As the electrode heats up from radiofrequency energy, it is cooled by the water. This decreases the pain signals in that immediate area. By using cooled RF, the pain management specialist can increase the amount of power delivered to the nervous tissue, increasing the size of the ablation.

Is cooled radiofrequency painful?

The doctor does not make an incision with cooled RFA. The procedure involves some mild discomfort due to the insertion of the procedure needle, but the doctor first numbs the region with a local anesthetic. After the procedure, there may be tenderness at the injection site, but the soreness resolves in a few hours.

How is the RFA done?

The patient is positioned on the exam table lying down. After the knee region is cleaned with an antiseptic, the skin and deeper tissues are numbed using bupivacaine or another numbing agent. The procedure needle is inserted through the skin and positioned near the nerves that supply the knee. The needle is removed, and a catheter remains. The RF probe is then inserted. The nerves are heated with radiofrequency energy and cooled in the same process. After the needle is removed, the catheter comes out, and a bandage is applied to the site.

How long is the pain relief after the procedure?

Cooled RFA is an outpatient procedure that takes around one hour to perform. However, the results can last for up to 2 years. The length of pain relief does vary from patient to patient, and depends on where the cool RF is used and what caused the pain initially. Some patients will have a faster rate of nerve regeneration, but the cooled RF procedure can be performed a second time.

What are the benefits of cooled radiofrequency?

The benefits of having a cooled radiofrequency ablation procedure include:

  • Increase in physical function
  • Decrease in or elimination of pain
  • Reduction in medication use
  • Minimally-invasive
  • No general anesthesia
  • Go home the same day

Does cooled radiofrequency ablation work?

Knee osteoarthritis is a common cause of chronic knee pain. In a study of patients who underwent cooled RFA of the genicular nerves, researchers analyzed the quality of life and pain using credible scoring methods. In the study, visual analogue scale pain scores improved at 1-, 3-, 6-, and 12-months post-procedure. In addition, quality of life scores improved. The researchers determined that chronic knee pain and function improved following cooled RF of genicular nerve. In another study, RF neurotomy was used to manage chronic osteoarthritis pain of the knee. In 38 elderly patients, RF was performed. The researchers found a 65% efficacy rate at 4-weeks post-therapy.

Researchers

Bellini M & Barbieri M (2015). Cooled radiofrequency system relieves chronic knee osteoarthritis pain: the first case-series. Anaesthesiol Intensive Ther, 47(1), 30-33.

Choi WJ, Hwang SJ, Song JG (2011). Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain, 152(3), 481-487.

Nguyen US, Zhang Y, Zhu Y, et al. (2011). Increasing Prevalence of Knee Pain and Symptomatic Knee Osteoarthritis. Ann Intern Med, 155(11), 725-732.