Comparative characteristics of RFA and conservative methods of treatment of chronic knee pain syndrome

Abstract

Introduction. Chronic knee pain syndrome associated with osteoarthritis is one of the most common causes of reduced physical activity, disability, and deterioration in the quality of life of elderly patients. Despite the widespread use of conservative treatment methods, including nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular injections of hyaluronic acid, corticosteroids, and platelet-rich plasma (PRP) therapy, their effectiveness in achieving long-term pain control remains limited. In this regard, genicular nerve radiofrequency ablation (RFA) has attracted considerable interest as a modern minimally invasive treatment modality capable of providing sustained analgesic effects and improving patients’ functional status. The aim of the study was to conduct a comparative evaluation of the effectiveness of genicular nerve radiofrequency ablation and the main conservative treatment methods for chronic knee pain syndrome in patients with osteoarthritis based on changes in pain intensity.

Materials and Methods. A retrospective-prospective clinical study was conducted involving 200 patients aged 45–75 years with clinically and instrumentally confirmed knee osteoarthritis. The patients were divided into five treatment groups: NSAIDs combined with therapeutic exercise (n = 45), intra-articular hyaluronic acid injections (n = 35), intra-articular corticosteroid injections (n = 30), PRP therapy (n = 40), and genicular nerve radiofrequency ablation combined with a multidisciplinary approach (n = 50). Treatment efficacy was assessed using the Visual Analog Scale (VAS) before treatment and after 1, 3, and 6 months of follow-up. Statistical analysis was performed using descriptive statistics, the Shapiro–Wilk test, and one-way analysis of variance (ANOVA) with a significance level of p < 0.05.

Results and Conclusions. A statistically significant reduction in pain intensity was observed in all treatment groups throughout the six-month follow-up period (p < 0.001). The lowest effectiveness was demonstrated by NSAID therapy combined with therapeutic exercise, where pain intensity decreased by 25.4% in women and 22.4% in men after six months. Hyaluronic acid and corticosteroid injections resulted in pain reduction ranging from 31.6% to 38.8%, whereas PRP therapy achieved a reduction of 47.0%–52.8%. The best outcomes were obtained in the RFA group combined with a multidisciplinary approach, where pain intensity after six months decreased by 68.0% in women and 61.9% in men. The mean VAS score after RFA was 2.38 ± 0.71 points in women and 2.92 ± 0.83 points in men, corresponding to a transition from severe to mild pain. The advantages of RFA were maintained across all age groups, including patients aged 70–75 years. The obtained results indicate that genicular nerve radiofrequency ablation combined with a multidisciplinary approach is the most effective treatment method for chronic knee pain syndrome among the investigated modalities, providing the greatest and most sustained pain reduction in patients with knee osteoarthritis.