1. 2025;28;S179-S189The Comparison of Intraarticular Bipolar Pulsed Radiofrequency and Genicular Nerve Thermal Radiofrequency Ablation for Pain Caused by Osteoarthritis of the Knee
   Retrospective Study
   Cigdem Yalcin, MD, and Mehmet Alper Salman, MD.

BACKGROUND: Information on the use of intraarticular bipolar pulsed radiofrequency (IA-bPRF) for treating knee osteoarthritis (KOA) is currently limited, and the effectiveness of this technique is not well established. The most effective nonsurgical approach for alleviating pain caused by KOA is still not well-defined.

OBJECTIVES: Our aim was to investigate the effects of genicular radiofrequency (G-RFT) and IA-bPRF on pain relief and functional improvement in patients with advanced KOA. 

STUDY DESIGN: Records of 86 patients with KOA who received either G-RFT or IA-bPRF were evaluated retrospectively.

SETTING: The pain clinic of a state hospital. 

METHODS: KOA patients who received either G-RFT or IA-bPRF were included in the study. The files of patients who were given such interventions between September 2021 and February 2024 were analyzed. Walking pain was evaluated on the numeric rating scale (NRS). Functional assessments were performed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Lequesne Algofunctional Index for Knee (LAI-knee). These evaluations were carried out before the intervention, as well as 2 weeks and 6 months after it.

RESULTS: The IA-bPRF group showed significant improvement in NRS scores when pre-intervention scores were compared to those recorded at the sixth month after the surgery, dropping from 8.62 ± 1.01 to 3.81 ± 1.18, while the scores of the G-RFT group improved from 8.90 ± 1.20 to 5.25 ± 3.40. At the sixth month, WOMAC scores decreased from 75.79 ± 16.00 to 34.21 ± 23.12 in the IA-bPRF group and from 79.02 ± 14.73 to 48.43 ± 30.87 in the G-RFT group. From the pre-intervention period to the sixth month after the procedure, LAI-knee scores went from 18.64 ± 4.16 to 9.90 ± 5.78 in the IA-bPRF group and from 18.89 ± 3.84 to 12.55 ± 7.33 in the G-RFT group. All decreases were significant (P < 0.05). However, WOMAC physical function scores decreased more in the IA-bPRF group than in the G-RFT group (P < 0.05). No serious adverse events occurred.

LIMITATIONS: Our study is subject to several limitations. Primarily, there is a paucity of extensive literature regarding the application of IA-bPRF for KOA. Additionally, our study’s sample size is relatively small. This study was conducted at a single center and was retrospective in nature, rather than prospective and randomized, making it challenging to fully control for nuisance variables. Finally, there is a scarcity of comparable studies. These factors may constrain the external validity of our findings.

CONCLUSIONS: Pain incurred while walking on flat surfaces and up and down stairs was further reduced with IA-bPRF. IA-bPRF is as effective as G-RFT and even more effective than the latter in some subheadings. Furthermore, the former is a safe alternative for relieving pain in and improving daily life for individuals with advanced KOA. With further research, IA-bPRF may be included in future guidelines for managing chronic KOA pain.

KEY WORDS: Radiofrequency, knee joint, osteoarthritis, chronic pain, activities of daily living