1. 2021;24;E1067-E1074Three Needles Approach-A New Technique of Genicular Nerves Radiofrequency Ablation for Pain Relief in Advanced Chronic Knee Osteoarthritis: A Randomized Trial
   Randomized Trial
   Abd-Elraheem Mahmoud Mohamed, MD, Manal Mohamed Hassanien, MD, Alaa Fouli Gaber, MBBCH, Sara Mohamed Omar, MD, and Omyma Shehata Mohamed, MD.

BACKGROUND: Ablation of the genicular nerves (GN) has emerged as a useful alternative therapeutic modality in chronic knee osteoarthritis (OA) specially for high-risk patients. However, in some cases due to the presence of other articular branches or anatomical variability, it may have a poor impact in relieving pain. Ablation of other or additional articular branches might have different outcomes.

OBJECTIVES: We aimed to investigate the efficacy and safety of using 3 needles as a new technique in ablation of GN and compare it to the classic single-needle approach.

STUDY DESIGN: A prospective parallel single-blind randomized study.

SETTING: Department of Anesthesia and Intensive Care, Faculty of Medicine, Minia University, Egypt, and Pain Management Unit, Assiut University Hospital, Egypt.  

METHODS: Fifty patients with advanced knee OA were involved in this clinical study to be treated with radiofrequency ablation of GN using either: the single-needle technique (SN group [n = 25]) or the 3-needle technique (TN group [no = 25]) and assessed for: pain with the Visual Analog Scale (VAS); knee function and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); and patient satisfaction using global-perceived effect throughout 2 weeks, and 1, 3, and 6 months after the procedure.

RESULTS: Significantly longer and better improvement in perceived pain (VAS), function and disability (WOMAC) with more patients’ satisfaction were recorded in the TN group than the SN group at all follow-up time points without untoward events.

LIMITATIONS: Short follow-up time; longer period could permit recognition of long-term outcome.

CONCLUSIONS: Compared to the conventional single-needle GN ablation technique, the 3-needle  approach appears to be a promising, safe, and more effective ablation technique for patients with chronic knee OA.

KEY WORDS: Chronic knee osteoarthritis, radiofrequency, three needles