Table 3 What is known about the use of genicular nerve ablation as a treatment modality for the painful, uncomplicated TKA?
Source | Location | Study population | Study design | Thermal or cooled ablation | Ablation timing | Target nerves | Outcome | Main findings | Limitations | Quality assessment |
|---|---|---|---|---|---|---|---|---|---|---|
Khan, 2022 | USA, tertiary academic medical center | 19 patients, aged 60–80 years | Longitudinal retrospective pilot study | Thermal | 14.6 months after TKA | Suprapatellar nerve (SP), superior lateral (SL), superior medial (SM), and inferior medial (IM) genicular nerves | KOOS questionnaire, visual analog scale (VAS), and the usage of pain medication | After 1 year, KOOS, mean VAS, and WOMAC scores improved significantly among RFA treatment compared with control Less patients used antiinflammatory and opioid medications in the RFA treatment group | Small population size (19 patients) Significantly more female patients than male patients, allowing for selection bias | 10/12 |
Qudsi-Sinclair, 2016 | Pain Unit of Hospital Morales Meseguer (Spain) | 28 patients, 60–80 years | Double-blind, randomized controlled trial | Thermal | Greater than 6 months after TKA | Superior lateral (SL), superior medial (SM), and inferior medial (IM) genicular nerves | Pain, functionality, quality of life, and patient satisfaction were evaluated using the numerical rating scale (NRS), Oxford Knee score (subjective), Knee Society Score (objective), Short Form Health Survey (SF-36), and Patient Global Impression Scale of Improvement (PGI-I) | There was no significant difference between the treatment groups in the following outcomes: KSS, OKS, PGI-I, SF-36, and NRS No adverse effects associated with GN-RFA were observed—results were similar with analgesic nerve block | Difference in technique could allow for attack at sensory nerves, which may be transmitting pain as well | 10/11 |
Erdem, 2019 | Ankara, Turkey | 6 patients, aged 75–85 years | Retrospective study | Thermal (42 °C) | 2–10 years after TKA | Superior lateral (SL), superior medial (SM), and inferior medial (IM) genicular nerves, | Pain and knee function assessed via VAS and WOMAC at 3 weeks and 3 months Adverse effects were recorded Patient satisfaction was assessed via a 5-point Likert scale | VAS showed a statistically significant reduction from baseline to 3 weeks and 3 months among RFA Significant reduction in baseline WOMAC at 3 weeks, 3 months No adverse effects were recorded Pain did not differ among treatment groups | Small population TKA patients may have had differences in implants, thus ablation of other nerves may have resulted in different outcomes Lack of control group 3 months may be insufficient length of time | 10/12 |