Prevention of complications and risk factors in invasive treatment of knee osteoarthritis

Abstract

Introduction. When conservative treatment of knee osteoarthritis is insufficiently effective, invasive therapeutic approaches are increasingly used, including genicular nerve radiofrequency ablation, intra-articular hyaluronic acid injection, and platelet-rich plasma (PRP) therapy. However, the prediction of post-procedural complications, identification of risk factors, and evaluation of preventive measures remain insufficiently investigated.

Objective. To analyze the risk factors for complications associated with invasive treatment of knee osteoarthritis and to evaluate the effectiveness of preventive measures in patients undergoing genicular nerve radiofrequency ablation, intra-articular hyaluronic acid injection, and PRP therapy.

Materials and Methods. A prospective comparative study was conducted involving 125 patients with clinically and radiographically confirmed Kellgren–Lawrence grade II–III knee osteoarthritis. The radiofrequency ablation group with a multidisciplinary approach included 50 patients, the intra-articular hyaluronic acid group included 35 patients, and the PRP therapy group included 40 patients. Clinical and demographic characteristics, the incidence and structure of post-procedural complications, risk factors for their development, and the effectiveness of preventive measures were analyzed. Statistical analysis was performed using Statistica 13.0 software with calculation of odds ratios (OR). Differences were considered statistically significant at p < 0.05.

Results. The lowest incidence of post-procedural complications was observed after radiofrequency ablation combined with a multidisciplinary approach (6.0%), compared with 7.5% after PRP therapy and 11.4% after intra-articular hyaluronic acid injection. In the radiofrequency ablation group, the most significant risk factors were age over 65 years (OR = 3.42; p = 0.028), previous knee surgery (OR = 3.05; p = 0.045), obesity (OR = 2.87; p = 0.041), and arterial hypertension (OR = 2.11; p = 0.049). In the hyaluronic acid group, chronic synovitis was associated with the highest risk of complications (OR = 5.63; p = 0.006), whereas in the PRP group, the strongest predictor was a reduced platelet count (OR = 4.38; p = 0.017). No infectious complications or hospitalizations were recorded in any treatment group, confirming the effectiveness of the implemented preventive measures.

Conclusions. Genicular nerve radiofrequency ablation combined with a multidisciplinary approach demonstrated the most favorable safety profile among the investigated invasive treatment modalities for knee osteoarthritis.