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Long-term Effects of Ultrasound-guided Genicular Nerve Pulsed Radiofrequency on Pain and Knee Functions in Patients with Gonarthrosis.

Yıl 2019, Cilt: 9 Sayı: 1, 52 - 58, 20.03.2019
https://doi.org/10.31832/smj.506472

Öz

Objective: Osteoarthritis of the knee is the most common musculoskeletal disease in older adults which causes chronic knee pain. Pulsed radiofrequency (PRF) on genicular nerves (GN) has become increasingly popular in the treatment of chronic knee pain due to its long duration of action and non-destructive therapy. This study aimed to reveal the effects of ultrasound-guided PRF therapy on GN in patients with knee osteoarthritis (KOA).

Materials and Methods: This study included patients, who were diagnosed with gonarthrosis grade 3 to 4 according to the Kellgren-Lawrence classification which patients suffered from intractable knee pain, at least for six months despite conservative treatment. The ultrasound-guided PRF on GN (GPRF) was performed in those patients with a reduction of 50% or more visual analog scale (VAS) score after the diagnostic GN block (GNB). VAS and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated before, and 1, 3, 6 and 12 months after the procedure.

Results: Of the 293 patients included in the criteria, ultrasound-guided GPRF was administered to 232 patients who responded to GNB. While the mean VAS score of the patients before the GPRF was 6.77 ± 1.24, the mean VAS scores at the 1st, 3rd, 6th and 12th months of the GPRF were 2.76 ± 1.14, 2.94 ± 1.08, 3.53 ± 0.64, and 4.58 ± 0.75, respectively. The mean WOMAC score of the patients before GPRF was 65.75 ± 14.15, while the mean WOMAC score of the 1st, 3rd, 6th and 12th months after GPRF was 36.14 ± 13, 36.52 ± 11.06, 37.88 ± 10.86, and 41.67 ± 10.84, respectively.

Conclusion: Ultrasound-guided GPRF therapy in chronic knee pain which does not respond to conservative treatments reduces pain for at least 12 months and is effective improving knee functions.

Kaynakça

  • 1. Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011;377(9783):2115-2126.
  • 2. Bannuru RR, Natov NS, Obadan IE, Price LL, Schmid CH, McAlindon TE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: A systematic review and meta-analysis. Arthritis Rheum. 2009;61(12):1704-1711.
  • 3. Raynauld J-P, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: A randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2003;48(2):370-377.
  • 4. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(3):494-502.
  • 5. Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthr Cartil. 2005;13(1):28-33.
  • 6. Basaran S, Guzel R, Seydaoglu G, Guler-Uysal F. Validity, reliability, and comparison of the WOMAC osteoarthritis index and Lequesne algofunctional index in Turkish patients with hip or knee osteoarthritis. Clin Rheumatol. 2010;29(7):749-756.
  • 7. Patel N, Gross A, Brown L, Gekht G. A Randomized, Placebo-Controlled Study to Assess the Efficacy of Lateral Branch Neurotomy for Chronic Sacroiliac Joint Pain. Pain Med. 2012;13(3):383-398.
  • 8. Chua NHL, Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications a review. Acta Neurochir (Wien). 2011;153(4):763-771.
  • 9. Masala S, Fiori R, Raguso M, Morini M, Calabria E, Simonetti G. Pulse-Dose Radiofrequency for Knee Osteoartrithis. 2013:3-8.
  • 10. Tun K, Cemil B, Gurcay AG, Gurcay AG, Kaptanoglu E, Sargon MF, et al. Ultrastructural evaluation of pulsed radiofrequency and conventional radiofrequency lesions in rat sciatic nerve. Surg Neurol. 2009;72(5):496-500.
  • 11. Mata J, Valentí P, Hernández B, Mir B, Aguilar JL. Study protocol for a randomised controlled trial of ultrasound-guided pulsed radiofrequency of the genicular nerves in the treatment of patients with osteoarthritis knee pain. BMJ Open. 2017;7(11):e016377.
  • 12. Huang Y-H, Hou S-Y, Cheng J-K, Wu C-H, Lin C-R. Pulsed radiofrequency attenuates diabetic neuropathic pain and suppresses formalin-evoked spinal glutamate release in rats. Int J Med Sci. 2016;13(12):984-991.
  • 13. Polat CS. Is There a Possible Neuropathic Pain Component in Knee Osteoarthritis? Arch Rheumatol. 2017;32(4):333-338.
  • 14. Hochman JR, French MR, Bermingham SL, Hawker GA. The nerve of osteoarthritis pain. Arthritis Care Res (Hoboken). 2010;62(7):1019-1023.
  • 15. Ke M, Yinghui F, Yi J, Xeuhua H, Xiaoming L, Zhijun C, et al. Efficacy of pulsed radiofrequency in the treatment of thoracic postherpetic neuralgia from the angulus costae: a randomized, double-blinded, controlled trial. Pain Physician. 2013;16(1):15-25.
  • 16. Makharita MY, Amr YM. Pulsed radiofrequency for chronic inguinal neuralgia. Pain Physician. 2015;18(5):E147-E155.
  • 17. Manzano D, Jimenez F, Blasi M. Ultrasound-guided pain interventions in the knee region. Tech Reg Anesth Pain Manag. 2013;17(3):140-149.
  • 18. Choi WJ, Hwang SJ, Song JG, Leem JG, Kang YU, Park PH, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial. Pain. 2011;152(3):481-487.
  • 19. Protzman NM, Gyi J, Malhotra AD, Kooch JE. Examining the Feasibility of Radiofrequency Treatment for Chronic Knee Pain After Total Knee Arthroplasty. PM&R. 2014;6(4):373-376.
  • 20. Kesikburun S, Yaşar E, Uran A, Adigüzel E, Yilmaz B. Ultrasound-Guided Genicular Nerve Pulsed Radiofrequency Treatment For Painful Knee Osteoarthritis: A Preliminary Report. Pain Physician. 2016;19(5):E751-9.
  • 21. Ahmed A. Prolonged Pulsed Radiofrequency Ablation of Genicular Nerves of Knee for Intractable Pain from Knee Osteoarthritis : A Case Report. J Pain Reli. 2016;5(6):10-12.

Gonartroz Hastalarında Ultrason Eşliğinde Uygulanan Geniküler Sinir Pulsed Radyofrekans Tedavisinin Ağrı ve Diz Fonksiyonlarına Uzun Dönem Etkisi

Yıl 2019, Cilt: 9 Sayı: 1, 52 - 58, 20.03.2019
https://doi.org/10.31832/smj.506472

Öz

Amaç Gonatroz, yetişkinlerde kronik diz eklem ağrısına neden olan en yaygın kas-iskelet sistemi hastalığıdır. Geniküler sinirlere radyofrekans uygulanması, uzun etki süresi ve dokuda destrüsyona yol açmaması nedeniyle kronik diz ağrısının tedavisinde giderek popüler hale gelmiştir. Çalışmamızda, konservatif tedavilere yanıt vermeyen, kronik diz ağrılı gonartroz hastalarında, geniküler sinirlere ultrason eşliğinde uygulanan pulsed radyofrekans tedavisinin (GPRF) uzun dönem ağrı ve diz fonksiyonlarına olan etkisini incelemeyi amaçladık.
Gereç ve Yöntemler
Çalışmaya, Kellgren-Lawrence sınıflamasına göre evre 3-4 gonartroz tanısı almış olan, en az 6 ay boyunca uygulanan konservatif tedavilere rağmen ağrıları geçmeyen hastalar dahil edildi.
Geniküler sinirlere ultrason eşliğinde gerçekleştirilen tanısal blok ile VAS skoru %50 ve daha fazla azalan hastalara GPRF uygulandı. Hastaların VAS ve Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC) skorları işlem öncesi, işlem sonrası 1, 3, 6 ve 12. ayda değerlendirildi.
Bulgular Kriterleri karşılayan 293 hastadan, geniküler sinirlere ultrason eşliğinde uygulanan tanısal bloğa yanıt veren 232 hastaya GPRF uygulandı. Hastaların GPRF öncesi VAS skoru ortalaması
6.77±1.24 iken GPRF sonrası 1, 3, 6 ve 12.ay VAS skoru ortalamaları sırasıyla 2.76±1.14, 2.94±1.08, 3.53±0.64, 4.58±0.75 bulundu. Hastaların GPRF öncesi WOMAC skoru ortalaması
65.75±14.15 iken GPRF sonrası 1, 3, 6 ve 12.ay WOMAC skoru ortalamaları sırasıyla 36.14±13, 36.52±11.06, 37.88±10.86, 41.67±10.84 bulundu.
Sonuç Konservatif tedavilere yanıt vermeyen gonartroza bağlı kronik diz eklem ağrısında, ultrason eşliğinde uygulanan GPRF tedavisi, en az 12 ay boyunca ağrıyı azaltmakta ve diz fonksiyonlarını
iyileştirmekde etkilidir.


 

Kaynakça

  • 1. Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011;377(9783):2115-2126.
  • 2. Bannuru RR, Natov NS, Obadan IE, Price LL, Schmid CH, McAlindon TE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: A systematic review and meta-analysis. Arthritis Rheum. 2009;61(12):1704-1711.
  • 3. Raynauld J-P, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: A randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2003;48(2):370-377.
  • 4. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(3):494-502.
  • 5. Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthr Cartil. 2005;13(1):28-33.
  • 6. Basaran S, Guzel R, Seydaoglu G, Guler-Uysal F. Validity, reliability, and comparison of the WOMAC osteoarthritis index and Lequesne algofunctional index in Turkish patients with hip or knee osteoarthritis. Clin Rheumatol. 2010;29(7):749-756.
  • 7. Patel N, Gross A, Brown L, Gekht G. A Randomized, Placebo-Controlled Study to Assess the Efficacy of Lateral Branch Neurotomy for Chronic Sacroiliac Joint Pain. Pain Med. 2012;13(3):383-398.
  • 8. Chua NHL, Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications a review. Acta Neurochir (Wien). 2011;153(4):763-771.
  • 9. Masala S, Fiori R, Raguso M, Morini M, Calabria E, Simonetti G. Pulse-Dose Radiofrequency for Knee Osteoartrithis. 2013:3-8.
  • 10. Tun K, Cemil B, Gurcay AG, Gurcay AG, Kaptanoglu E, Sargon MF, et al. Ultrastructural evaluation of pulsed radiofrequency and conventional radiofrequency lesions in rat sciatic nerve. Surg Neurol. 2009;72(5):496-500.
  • 11. Mata J, Valentí P, Hernández B, Mir B, Aguilar JL. Study protocol for a randomised controlled trial of ultrasound-guided pulsed radiofrequency of the genicular nerves in the treatment of patients with osteoarthritis knee pain. BMJ Open. 2017;7(11):e016377.
  • 12. Huang Y-H, Hou S-Y, Cheng J-K, Wu C-H, Lin C-R. Pulsed radiofrequency attenuates diabetic neuropathic pain and suppresses formalin-evoked spinal glutamate release in rats. Int J Med Sci. 2016;13(12):984-991.
  • 13. Polat CS. Is There a Possible Neuropathic Pain Component in Knee Osteoarthritis? Arch Rheumatol. 2017;32(4):333-338.
  • 14. Hochman JR, French MR, Bermingham SL, Hawker GA. The nerve of osteoarthritis pain. Arthritis Care Res (Hoboken). 2010;62(7):1019-1023.
  • 15. Ke M, Yinghui F, Yi J, Xeuhua H, Xiaoming L, Zhijun C, et al. Efficacy of pulsed radiofrequency in the treatment of thoracic postherpetic neuralgia from the angulus costae: a randomized, double-blinded, controlled trial. Pain Physician. 2013;16(1):15-25.
  • 16. Makharita MY, Amr YM. Pulsed radiofrequency for chronic inguinal neuralgia. Pain Physician. 2015;18(5):E147-E155.
  • 17. Manzano D, Jimenez F, Blasi M. Ultrasound-guided pain interventions in the knee region. Tech Reg Anesth Pain Manag. 2013;17(3):140-149.
  • 18. Choi WJ, Hwang SJ, Song JG, Leem JG, Kang YU, Park PH, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial. Pain. 2011;152(3):481-487.
  • 19. Protzman NM, Gyi J, Malhotra AD, Kooch JE. Examining the Feasibility of Radiofrequency Treatment for Chronic Knee Pain After Total Knee Arthroplasty. PM&R. 2014;6(4):373-376.
  • 20. Kesikburun S, Yaşar E, Uran A, Adigüzel E, Yilmaz B. Ultrasound-Guided Genicular Nerve Pulsed Radiofrequency Treatment For Painful Knee Osteoarthritis: A Preliminary Report. Pain Physician. 2016;19(5):E751-9.
  • 21. Ahmed A. Prolonged Pulsed Radiofrequency Ablation of Genicular Nerves of Knee for Intractable Pain from Knee Osteoarthritis : A Case Report. J Pain Reli. 2016;5(6):10-12.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Tolga Ergönenç

Serbülent Gökhan Beyaz

Yayımlanma Tarihi 20 Mart 2019
Gönderilme Tarihi 2 Ocak 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 9 Sayı: 1

Kaynak Göster

AMA Ergönenç T, Beyaz SG. Long-term Effects of Ultrasound-guided Genicular Nerve Pulsed Radiofrequency on Pain and Knee Functions in Patients with Gonarthrosis. Sakarya Tıp Dergisi. Mart 2019;9(1):52-58. doi:10.31832/smj.506472

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