Long-term outcomes of cooled versus conventional radiofrequency ablation of genicular nerves for chronic knee osteoarthritis pain: A randomised comparative study

Indian J Anaesth. 2026 Jan;70(1):265-271. doi: 10.4103/ija.ija_573_25. Epub 2026 Jan 2.

ABSTRACT

BACKGROUND AND AIMS: Chronic knee pain due to osteoarthritis is a prevalent cause of disability. Radiofrequency ablation (RFA) of genicular nerves is a promising approach for alleviating pain and improving function in knee osteoarthritis. This study compares the long term efficacy of cooled and conventional RFA in managing chronic knee pain and disability by observing and comparing pain relief and improvement in functional disability up to 24 months postprocedure.

METHODS: Forty patients aged >50 years with Kellgren-Lawrence grade 3 and 4 were enroled. Fluoroscopic-guided genicular nerve ablation was performed on 30 patients: 15 with cooled RFA and 15 with conventional RFA, following positive diagnostic blocks. Pain (Numeric Rating Scale (NRS) and functionality (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC score) were assessed at 3, 6, 12, 18, and 24 months. Chi-square test, independent t-test, and paired t-test were used for the statistical analysis. The P ≤0.05 was considered statistically significant.

RESULTS: At 3 months, the Group cooled RFA demonstrated significantly greater reductions in NRS (73.33% vs 53.33%) compared to the Group conventional RFA. Improvement in the WOMAC functional score was found to be better at 3 months in the Group conventional RFA (73.33% vs 66.66%), but at 6-month and subsequent follow-up, the Group cooled RFA had better improvement in functional score. These differences persisted till 24 months, with NRS P < 0.001 and WOMAC P < 0.001 from 6 months onwards. Inter-group comparisons showed significant advantages for cooled RFA in both pain reduction and functional outcomes.

CONCLUSIONS: Cooled radiofrequency ablation offers superior long-term benefits in pain relief and functional improvement compared to conventional.

PMID:41696392 | PMC:PMC12900230 | DOI:10.4103/ija.ija_573_25