Study: New Data re: Cooled Radiofrequency Ablation for OA

Researchers from 11 facilities have pooled their efforts to examine the efficacy of cooled radiofrequency ablation (CRFA) for the treatment of knee osteoarthritis (OA) pain. They also set out to evaluate hyaluronic acid (HA) patients who went on to undergo CRFA after six months of treatment.

Their work, “Cooled radiofrequency ablation provides extended clinical utility in the management of knee osteoarthritis: 12-month results from a prospective, multi-center, randomized, cross-over trial comparing cooled radiofrequency ablation to a single hyaluronic acid injection,” appears in the June 9, 2020 edition of BMC Musculoskeletal Disorders.

Antonia Chen, M.D. told OTW, “Cooled radiofrequency ablation fills an existing treatment gap for people suffering from knee osteoarthritis. As an orthopaedic surgeon, I believe that total joint replacement is an effective treatment for knee osteoarthritis, but I’m glad other options exist prior to surgery, especially for the large number of patients who aren’t currently candidates for surgery or aren’t interested in surgical intervention.”

Using COOLIEF from Avanos Medical, Inc., the team compared the efficacy of OA knee pain relief brought by the genicular nerve ablation option to a single intra-articular injection of Synvisc-One in a total of 177 patients. Patients not responding to HA treatment were permitted to undergo CRFA after six months.

The authors wrote, “At 12-months, 65.2% of subjects in the cooled radiofrequency ablation cohort reported ≥50% pain relief from baseline. Mean NRS [Numeric Rating Scale] pain score was 2.8 ± 2.4 at 12 months (baseline 6.9 ± 0.8). Subjects in the cooled radiofrequency ablation cohort saw a 46.2% improvement in total WOMAC [The Western Ontario and McMaster Universities Arthritis Index] score at the 12-month timepoint. 64.5% of subjects in the crossover cohort reported ≥50% pain relief from baseline, with a mean NRS pain score of 3.0 ± 2.4 at 12 months (baseline 7.0 ± 1.0). After receiving CRFA, subjects in the crossover cohort had a 27.5% improvement in total WOMAC score. All subjects receiving CRFA reported significant improvement in quality of life.”

Dr. Chen commented to OTW, “This treatment shows far greater clinical durability than existing minimally invasive treatment options. and has now been proven to be superior to intra-articular steroid injections as well as hyaluronic acid injections in two separate level 1 randomized clinical trials.”

“I would consider patient reported outcomes to be the most important results. It is key that all of the results trend in the same direction. For those undergoing cooled radiofrequency ablation, all of the endpoints pointed to the efficacy of the treatment. Pain scores decreased in patients receiving this treatment across two separate measurements (NRS and WOMAC pain subscale). Additionally, knee function and overall quality of life improved, and patients reported that the procedure worked. When all of the data lines up, it is indicative of an effective treatment.”

Human nature resists change. To that point, Dr. Chen noted, “The good news is that cooled radiofrequency ablation is a straightforward procedure and is easy for doctors to learn with fairly minimal training. The current standard of care includes repetitive procedures, such as corticosteroid injections, with short-term clinical durability. There is a missing gap between injections and surgical management, with little research and efficacy on platelet rich plasma and stem cell treatments. Cooled radiofrequency ablation offers better outcomes supported by robust research, and fits in nicely with the existing treatment algorithm. It has been a successful addition to our practice, and I would imagine that it would fit well within the practices of other physicians managing patients with non-operative knee osteoarthritis pain.”