Three Needles Approach-A New Technique of Genicular Nerves Radiofrequency Ablation for Pain Relief in Advanced Chronic Knee Osteoarthritis: A Randomized Trial.
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.
['Mohamed|Omyma Shehata|OS|', 'Omar|Sara Mohamed|SM|', 'Gaber|Alaa Fouli|AF|', 'Hassanien|Manal Mohamed|MM|', 'Mohamed|Abd-Elraheem Mahmoud|AM|']
three needles radiofrequency Chronic knee osteoarthritis