S007: EFFECTS OF CLINICAL FACTORS ON COOLED RADIOFREQUENCY ABLATION OUTCOMES: A RETROSPECTIVE SINGLE-CENTER STUDY
Holden Brown, MD, MBA; Pence Jeffrey, MD; Juan Mora, MD; Terrie Vasilopoulos, PhD; Rene Przkora, MD, PhD; University of Florida
Introduction/Background: It is estimated that prevalence of knee OA is nearly 23% for individuals aged 40 and over equating to 654.1 million individuals worldwide and that there are around 86.7 million individuals over the age of 20 years diagnosed with knee OA annually.1 Cooled radiofrequency ablation (CRFA) is a minimally invasive procedure for the treatment of osteoarthritic knee pain. Chen et al. (2020) concluded that CRFA provides significant pain reduction and functional improvement compared to single injections of hyaluronic acid,2 while Davis et al. (2018) demonstrated the benefit of CRFA over intraarticular steroid injection.3 While the benefit of CRFA over other minimally invasive procedures has been established, the impact that prior total knee arthroplasty (TKA) as well as mood disorders and other clinical factors have on outcomes remains unclear. This single-center retrospective study investigates the effects of multiple factors including prior TKA, depression, and other clinical factors on pain relief and improvement after CRFA of the genicular nerves.
Methods: Medical records from 83 patients were reviewed after approval from the University of Florida Institutional Review Board. The variables assessed were smoking history, depression, body mass index, age, medication changes, pain relief and duration, and functional improvement. Pain relief (percent), pain relief duration, functional status improvement, and maximum and average pain at follow-up (indexed by the Numeric Rating Scale [NRS], 0–10) were summarized after initial treatment. Group differences by gender and presence of depression were assessed via Mann-Whitney tests or χ2 tests.
Results: The average age of patients was 65.5 years (SD = 13). Patients had an average pain reduction of 57% (SD = 37.2) from the initial treatment. Fifty-seven percent of patients reported improvement in functional status from initial treatment. No difference in outcomes was identified in patients who had undergone previous total knee arthroplasty. Patients with pre-existing depression had higher levels of maximum pain, 8.8 (SD = 1.5) vs. 7.3 (SD = 2.6) (p = 0.036), and average pain, 6.7 (SD = 1.3) vs. 4.5 (SD = 2.4) (p = 0.006), after treatment than those without depression.
Discussion/Conclusion: Interestingly this study found no difference in patient outcomes between those who had undergone previous TKA and those who had not. This data supports the use of CRFA as a viable treatment option for patients with history of TKA. There was also no difference in outcomes in regards to age, BMI, gender, or smoking status. There was a significant difference in outcomes between those who had preexisting depression and those who did not. This study demonstrates the importance of not only selecting the right procedure for the patient’s pain condition but selecting the right patient based on clinical factors.