Our aim in this study is; to investigate the superiority and long-term effectiveness of
radiofrequency ablation therapy applied with 5 nerves, 3 nerves and 2 nerves on fall
risk, balance, proprioception, chronic pain and symptoms in knee osteoarthritis.
Radiofrequency ablation therapy; it is effective in chronic pain by causing nerve damage.
Application of radiofrequency ablation therapy on chronic knee pain with different
protocols has been reported in the literature with different results.
In the literature, it has been shown that the 5-nerve protocol versus the 3-nerve
protocol with the radiofrequency ablation method reduces pain and provides functional
improvement in patients with chronic knee osteoarthritis. In another study in the
literature, functional and physical performance was examined with a 3-nerve protocol in
the same patient group without a control group and was found effective.
To our knowledge, there is no study in the literature evaluating the effectiveness of
radiofrequency ablation therapy on fall risk, balance and proprioception after applying
different protocols in knee osteoarthritis.
There are few studies in the literature regarding radiofrequency ablation treatment
procedures for knee osteoarthritis. In line with this information, it is obvious that
more studies are needed on the radiofrequency ablation method. Although this method has
been shown to be effective and popular in recent years, since it is an invasive
procedure, another aim of ours is to reveal what is the least intervention that will give
the most effective results for patients.
Diagnostic genicular nerve block: It will be performed by injecting lidocaine (%2, 2 cc)
into the superıor lateral (SL), superıor medial (SM) and inferior medial (IM) branches of
the genicular nerve passing through the periosteal areas connecting the femoral shaft to
the bilateral epicondyles and the tibia shaft to the medial epicondyle.
All patients who meet the study eligibility criteria will undergo a diagnostic genicular
nerve block before the procedure, and patients with a decrease in VAS (visual analog
scale) of more than 50 percent for more than 24 hours will be considered for the RFA
procedure. Injection will be performed under ultrasound guidance using a 12 Mhz linear
array transducer probe (GE Logiq P9, GE Healthcare, Boston, MA).
The patients are randomly divided into 3 groups with the help of a computer-based
randomization program. One group will be treated with the RFA method for 2 nerves (SM,
IM), the other group will be treated with 3 nerves (SM, SL, IM), and the other group will
be treated with a single treatment session for 5 nerves (SM, SL, IM, Rekurrent fibular
nerve-RFN, Infrapatellar branch of saphenous nerve-IPBSN).
Before the RFA procedure, all participants will be anesthetized with 1 cc %1 lidocaine
under sterile conditions, in a supine position, with a pillow placed under the popliteal
fossa, and the skin and subcutaneous tissues on the surface of the targeted nerves.
RFA application sites will be determined by finding the arteries between the shaft and
epicondyles of the femur and tibia with the help of Color Doppler Ultrasound. The
infrapatellar branch of the saphenous nerve (IPBSN) will be confirmed by Doppler
Ultrasound of the artery of the nerve 4 cm medial to the apex of the patella and tibial
tubercle. Recurrent fibular nerve (RFN) will be confirmed by Doppler Ultrasound of the
nerve artery along the caudate line of Gerdy's tubercle, 1 cm below the tuberosity tibia.
For the RFA procedure, a 10 cm long, 22 gauge RF cannula with a 10 mm active tip (Model
SC-K, Top Neuropole, MPS Medical Product Service GmbH, Germany) will be used.
In order to increase the accuracy of the location determined by ultrasound, sensory
stimulation will be applied at a frequency of 50 Hz and with a threshold value lower than
0.6 volts. In order to prevent the motor nerves from being affected, the absence of lower
extremity muscle fasciculations in the relevant area will be confirmed with 2 volt
stimulation at 2 Hz frequency. The RFA process will be applied to the existing nerves via
a generator (TOP Lesion Generator TLG-20, MPS Medical Product Service GmbH, Germany) at
42 C, as pulse RFA for 120 seconds.
To address any discomfort that may occur after the procedure, a total of 2 cc of
betamethasone (5 mg+2 mg/1 cc) and %2 lidocaine (1 cc) will be injected into the points
where RFA is applied, after aspiration.
For participants who will not be injected at more than 2 points, the same procedure will
be applied without activating the generator in order to ensure that the participants
remain blind to group allocation and only 2 cc % 0,9 NaCl will be injected into the
treatment points. After the procedure, patients will be advised to continue their current
medication and exercise therapy. Patients will not receive other pain treatments such as
physical therapy, knee re-RFA treatment, intra-articular hyaluronic acid, steroid or
similar injection treatments for 3 months.
