Is radiofrequency ablation effective in treating patients with chronic knee osteoarthritis? A meta-analysis of randomized controlled trials

Background and aims:This meta-analysis aimed to evaluate the short-term and long-term efficacy of radiofrequency ablation (RFA) and explore the role of diagnostic genicular nerve blocks in predicting treatment outcomes.Methods:A comprehensive literature search was conducted, and nine randomized controlled trials involving 714 participants were included in the analysis. Data extraction, risk of bias assessment, and subgroup analyses were performed. The primary outcome measures were pain scores at 6 and 12 months, assessed using visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.Results:The meta-analysis revealed that RFA demonstrated a significant short-term efficacy in reducing pain compared to the control group at 6 months, as indicated by the pain scores [weighted mean difference (WMD): -2.69, 95% CI: -3.99, -1.40]. Similarly, WOMAC scores at 6 months favored the RFA group (WMD: -4.40, 95% CI: -7.12, -1.68). However, the long-term efficacy of RFA at 12 months remained uncertain for both pain scores (WMD: -0.88, 95% CI: -2.36, 0.61) and WOMAC (WMD: 0.03, 95% CI: -0.25, 0.32). Subgroup analysis suggested that a positive result from the diagnostic genicular nerve blocks test was associated with a more favourable short-term outcome.Conclusion:This meta-analysis provides moderate-quality evidence supporting the short-term efficacy of RFA in reducing pain in patients with knee osteoarthritis. The inclusion of a diagnostic genicular nerve blocks test prior to RFA may help identify patients likely to benefit from the procedure. But it still needs more large sample studies to verify the results. However, further research is needed to determine the long-term efficacy of RFA in managing knee osteoarthritis pain.