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J Knee Surg 2019; 32(01): 072-079
DOI: 10.1055/s-0038-1676071
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Minimally Invasive Interventional Management of Osteoarthritic Chronic Knee Pain

Ivan Urits
1   Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Mark Jones
1   Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Riki Patel
2   Department of Anesthesiology, Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
,
Leena Adamian
2   Department of Anesthesiology, Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
,
Danica Seifert
2   Department of Anesthesiology, Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
,
William Thompson IV
3   Division of Pain, Valley Anesthesiology and Pain Consultants, Phoenix, Arizona
,
Omar Viswanath
4   Department of Anesthesiology and Pain Medicine, Valley Anesthesiology and Pain Consultants, Phoenix, Arizona
5   Department of Anesthesiology, University of Arizona College of Medicine Phoenix, Phoenix, Arizona
6   Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska
› Author Affiliations
Further Information

Publication History

04 September 2018

15 October 2018

Publication Date:
30 November 2018 (online)

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Abstract

Chronic knee pain is a widely prevalent issue that can have a significant impact on a patient's quality of life. One of the leading causes of chronic knee pain is osteoarthritis. Total knee replacement is often the last and definitive resort for patients with severe symptomatic osteoarthritis after trial of less invasive interventions with failure to achieve symptomatic relief. Intra-articular injections are a mainstay of adjunctive conservative management and have demonstrated efficacy in reducing pain. Radiofrequency treatment is a viable option for poor surgical candidates, or for patients having persistent, chronic pain following knee surgery. Extracorporeal shockwave therapy is another modality growing in use that may offer short-term symptomatic relief. In this review, we will discuss widely used minimally invasive interventional options for the symptomatic management of osteoarthritic chronic knee pain.

Keywords

knee osteoarthritis - chronic knee pain - minimally invasive - radiofrequency treatment - intra-articular injection
 

  • References

  • 1 Wallace IJ, Worthington S, Felson DT. , et al. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci U S A 2017; 114 (35) 9332-9336
    CrossrefPubMedGoogle Scholar
  • 2 Litwic A, Edwards MH, Dennison EM, Cooper C. Epidemiology and burden of osteoarthritis. Br Med Bull 2013; 105: 185-199
    CrossrefPubMedGoogle Scholar
  • 3 Mathiessen A, Conaghan PG. Synovitis in osteoarthritis: current understanding with therapeutic implications. Arthritis Res Ther 2017; 19 (01) 18
    CrossrefPubMedGoogle Scholar
  • 4 Silawal S, Triebel J, Bertsch T, Schulze-Tanzil G. Osteoarthritis and the complement cascade. Clin Med Insights Arthritis Musculoskelet Disord 2018; 11: 1179544117751430
    CrossrefPubMedGoogle Scholar
  • 5 McAlindon TE, Bannuru RR, Sullivan MC. , et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 2014; 22 (03) 363-388
    CrossrefPubMedGoogle Scholar
  • 6 Chatham WW, Kimberly RP. Treatment of lupus with corticosteroids. Lupus 2001; 10 (03) 140-147
    CrossrefPubMedGoogle Scholar
  • 7 McCrum C. Therapeutic review of methylprednisolone acetate intra-articular injection in the management of osteoarthritis of the knee - part 2: clinical and procedural considerations. Musculoskelet Care 2016; 14 (04) 252-266
    CrossrefPubMedGoogle Scholar
  • 8 Kumar A, Dhir V, Sharma S, Sharma A, Singh S. Efficacy of methylprednisolone acetate versus triamcinolone acetonide intra-articular knee injection in patients with chronic inflammatory arthritis: a 24-week randomized controlled trial. Clin Ther 2017; 39 (01) 150-158
    CrossrefPubMedGoogle Scholar
  • 9 MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology 2009; 252 (03) 647-661
    CrossrefPubMedGoogle Scholar
  • 10 Hollander JL, Jessar RA, Brown Jr EM. Intra-synovial corticosteroid therapy: a decade of use. Bull Rheum Dis 1961; 11: 239-240
    PubMedGoogle Scholar
  • 11 Faúndez J, Cotoras P, Irarrázaval S. Are intraarticular steroids effective for knee osteoarthritis?. Medwave 2016; 16 (Suppl5): e6599
    CrossrefPubMedGoogle Scholar
  • 12 McAlindon TE, LaValley MP, Harvey WF. , et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA 2017; 317 (19) 1967-1975
    CrossrefPubMedGoogle Scholar
  • 13 Maricar N, Parkes MJ, Callaghan MJ. , et al. Structural predictors of response to intra-articular steroid injection in symptomatic knee osteoarthritis. Arthritis Res Ther 2017; 19 (01) 88
    CrossrefPubMedGoogle Scholar
  • 14 Maheu E, Bannuru RR, Herrero-Beaumont G, Allali F, Bard H, Migliore A. Why we should definitely include intra-articular hyaluronic acid as a therapeutic option in the management of knee osteoarthritis: results of an extensive critical literature review. Semin Arthritis Rheum 2018; S0049-0172(18)30235-X
    PubMedGoogle Scholar
  • 15 Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord 2015; 16: 321
    CrossrefPubMedGoogle Scholar
  • 16 Bhandari M, Bannuru RR, Babins EM. , et al. Intra-articular hyaluronic acid in the treatment of knee osteoarthritis: a Canadian evidence-based perspective. Ther Adv Musculoskelet Dis 2017; 9 (09) 231-246
    CrossrefPubMedGoogle Scholar
  • 17 Leighton R, Fitzpatrick J, Smith H, Crandall D, Flannery CR, Conrozier T. Systematic clinical evidence review of NASHA (Durolane hyaluronic acid) for the treatment of knee osteoarthritis. Open Access Rheumatol 2018; 10: 43-54
    CrossrefPubMedGoogle Scholar
  • 18 Bannuru RR, Osani M, Vaysbrot EE, McAlindon TE. Comparative safety profile of hyaluronic acid products for knee osteoarthritis: a systematic review and network meta-analysis. Osteoarthritis Cartilage 2016; 24 (12) 2022-2041
    CrossrefPubMedGoogle Scholar
  • 19 Bannuru RR, Vaysbrot EE, Sullivan MC, McAlindon TE. Relative efficacy of hyaluronic acid in comparison with NSAIDs for knee osteoarthritis: a systematic review and meta-analysis. Semin Arthritis Rheum 2014; 43 (05) 593-599
    CrossrefPubMedGoogle Scholar
  • 20 Leighton R, Akermark C, Therrien R. , et al; DUROLANE Study Group. NASHA hyaluronic acid vs. methylprednisolone for knee osteoarthritis: a prospective, multi-centre, randomized, non-inferiority trial. Osteoarthritis Cartilage 2014; 22 (01) 17-25
    CrossrefPubMedGoogle Scholar
  • 21 He W-W, Kuang M-J, Zhao J. , et al. Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: a meta-analysis. Int J Surg 2017; 39: 95-103
    CrossrefPubMedGoogle Scholar
  • 22 Di Y, Han C, Zhao L, Ren Y. Is local platelet-rich plasma injection clinically superior to hyaluronic acid for treatment of knee osteoarthritis? A systematic review of randomized controlled trials. Arthritis Res Ther 2018; 20 (01) 128
    CrossrefPubMedGoogle Scholar
  • 23 Sundman EA, Cole BJ, Karas V. , et al. The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 2014; 42 (01) 35-41
    CrossrefPubMedGoogle Scholar
  • 24 Khoshbin A, Leroux T, Wasserstein D. , et al. The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy 2013; 29 (12) 2037-2048
    CrossrefPubMedGoogle Scholar
  • 25 Huang G, Hua S, Yang T, Ma J, Yu W, Chen X. Platelet-rich plasma shows beneficial effects for patients with knee osteoarthritis by suppressing inflammatory factors. Exp Ther Med 2018; 15 (03) 3096-3102
    PubMedGoogle Scholar
  • 26 Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of intra-articular platelet-rich plasma injections in knee osteoarthritis: a systematic review. Arthroscopy 2016; 32 (03) 495-505
    CrossrefPubMedGoogle Scholar
  • 27 Glynn LG, Mustafa A, Casey M. , et al. Platelet-rich plasma (PRP) therapy for knee arthritis: a feasibility study in primary care. Pilot Feasibility Stud 2018; 4 (01) 93
    CrossrefPubMedGoogle Scholar
  • 28 Chen FH, Tuan RS. Mesenchymal stem cells in arthritic diseases. Arthritis Res Ther 2008; 10 (05) 223
    CrossrefPubMedGoogle Scholar
  • 29 Filardo G, Perdisa F, Roffi A, Marcacci M, Kon E. Stem cells in articular cartilage regeneration. J Orthop Surg Res 2016; 11: 42
    CrossrefPubMedGoogle Scholar
  • 30 Gupta PK, Das AK, Chullikana A, Majumdar AS. Mesenchymal stem cells for cartilage repair in osteoarthritis. Stem Cell Res Ther 2012; 3 (04) 25
    CrossrefPubMedGoogle Scholar
  • 31 Jo CH, Lee YG, Shin WH. , et al. Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a proof-of-concept clinical trial. Stem Cells 2014; 32 (05) 1254-1266
    CrossrefPubMedGoogle Scholar
  • 32 Koh Y-G, Choi Y-J, Kwon S-K, Kim Y-S, Yeo J-E. Clinical results and second-look arthroscopic findings after treatment with adipose-derived stem cells for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2015; 23 (05) 1308-1316
    CrossrefPubMedGoogle Scholar
  • 33 Wong KL, Lee KB, Tai BC, Law P, Lee EH, Hui JH. Injectable cultured bone marrow-derived mesenchymal stem cells in varus knees with cartilage defects undergoing high tibial osteotomy: a prospective, randomized controlled clinical trial with 2 years' follow-up. Arthrosc J Arthrosc Relat Surg 2013; 29 (12) 2020-2028
    PubMedGoogle Scholar
  • 34 Barry F, Murphy M. Mesenchymal stem cells in joint disease and repair. Nat Rev Rheumatol 2013; 9 (10) 584-594
    CrossrefPubMedGoogle Scholar
  • 35 Saw K-Y, Anz A, Siew-Yoke Jee C. , et al. Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: a randomized controlled trial. Arthroscopy 2013; 29 (04) 684-694
    CrossrefPubMedGoogle Scholar
  • 36 Hurley ET, Yasui Y, Gianakos AL. , et al. Limited evidence for adipose-derived stem cell therapy on the treatment of osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2018; 26 (11) 3499-3507
    CrossrefPubMedGoogle Scholar
  • 37 Pers Y-M, Rackwitz L, Ferreira R. , et al; ADIPOA Consortium. Adipose mesenchymal stromal cell-based therapy for severe osteoarthritis of the knee: a phase I dose-escalation trial. Stem Cells Transl Med 2016; 5 (07) 847-856
    CrossrefPubMedGoogle Scholar
  • 38 Xu S, Liu H, Xie Y, Sang L, Liu J, Chen B. Effect of mesenchymal stromal cells for articular cartilage degeneration treatment: a meta-analysis. Cytotherapy 2015; 17 (10) 1342-1352
    CrossrefPubMedGoogle Scholar
  • 39 Kapural L, Mekhail N. Radiofrequency ablation for chronic pain control. Curr Pain Headache Rep 2001; 5 (06) 517-525
    CrossrefPubMedGoogle Scholar
  • 40 Cosman Jr ER, Dolensky JR, Hoffman RA. Factors that affect radiofrequency heat lesion size. Pain Med 2014; 15 (12) 2020-2036
    CrossrefPubMedGoogle Scholar
  • 41 Choi W-J, Hwang S-J, Song J-G. , et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain 2011; 152 (03) 481-487
    CrossrefPubMedGoogle Scholar
  • 42 Qudsi-Sinclair S, Borrás-Rubio E, Abellan-Guillén JF, Padilla Del Rey ML, Ruiz-Merino G. A comparison of genicular nerve treatment using either radiofrequency or analgesic block with corticosteroid for pain after a total knee arthroplasty: a double-blind, randomized clinical study. Pain Pract 2017; 17 (05) 578-588
    CrossrefPubMedGoogle Scholar
  • 43 Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep 2008; 12 (01) 37-41
    CrossrefPubMedGoogle Scholar
  • 44 Todorov L. Pulsed radiofrequency of the sural nerve for the treatment of chronic ankle pain. Pain Physician 2011; 14 (03) 301-304
    PubMedGoogle Scholar
  • 45 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 (05) E751-E759
    PubMedGoogle Scholar
  • 46 McCormick ZL, Korn M, Reddy R. , et al. Cooled radiofrequency ablation of the genicular nerves for chronic pain due to knee osteoarthritis: six-month outcomes. Pain Med 2017; 18 (09) 1631-1641
    CrossrefPubMedGoogle Scholar
  • 47 Bellini M, Barbieri M. Cooled radiofrequency system relieves chronic knee osteoarthritis pain: the first case-series. Anaesthesiol Intensive Ther 2015; 47 (01) 30-33
    CrossrefPubMedGoogle Scholar
  • 48 Ahmed A, Arora D. Ultra-sound guided neurolysis of six genicular nerves of knee for intractable pain from knee osteoarthritis: a case series. Pain Pract 2018
    PubMedGoogle Scholar
  • 49 Le PU, Kim SY, Kosharskyy B, Kaye AD, Shaparin N, Downie SA. Comprehensive review is genicular nerve radiofrequency ablation safe? A literature review and anatomical study. Pain Physician 2016; 19: 697-705
    PubMedGoogle Scholar
  • 50 Kranke P, Diemunsch P. The 2014 consensus guidelines for the management of postoperative nausea and vomiting: a leapfrog towards a postoperative nausea and vomiting-free hospital. Eur J Anaesthesiol 2014; 31 (12) 651-653
    CrossrefPubMedGoogle Scholar
  • 51 Gupta A, Huettner DP, Dukewich M. Comparative effectiveness review of cooled versus pulsed radiofrequency ablation for the treatment of knee osteoarthritis: a systematic review. Pain Physician 2017; 20 (03) 155-171
    PubMedGoogle Scholar
  • 52 Ikeuchi M, Ushida T, Izumi M, Tani T. Percutaneous radiofrequency treatment for refractory anteromedial pain of osteoarthritic knees. Pain Med 2011; 12 (04) 546-551
    CrossrefPubMedGoogle Scholar
  • 53 Davis T, Loudermilk E, DePalma M. , et al. Prospective, multicenter, randomized, crossover clinical trial comparing the safety and effectiveness of cooled radiofrequency ablation with corticosteroid injection in the management of knee pain from osteoarthritis. Reg Anesth Pain Med. 2018; 43 (01) 84-91
    CrossrefPubMedGoogle Scholar
  • 54 Kamel EZ, El-Hakeim EH, Elawamy A. , et al. Randomized trial fluoroscopic guided radiofrequency of genicular nerves for pain alleviation in chronic knee osteoarthritis: a single-blind randomized controlled trial. Pain Physician 2018; 21: 169-177
    PubMedGoogle Scholar
  • 55 Santana Pineda MM, Vanlinthout LE, Moreno Martín A, van Zundert J, Rodriguez Huertas F, Novalbos Ruiz JP. Analgesic effect and functional improvement caused by radiofrequency treatment of genicular nerves in patients with advanced osteoarthritis of the knee until 1 year following treatment. Reg Anesth Pain Med 2017; 42 (01) 62-68
    CrossrefPubMedGoogle Scholar
  • 56 Iannaccone F, Dixon S, Kaufman A. A review of long-term pain relief after genicular nerve radiofrequency ablation in chronic knee osteoarthritis. Pain Physician 2017; 20 (03) E437-E444
    PubMedGoogle Scholar
  • 57 Wong J, Bremer N, Weyker PD, Webb CAJ. Ultrasound-guided genicular nerve thermal radiofrequency ablation for chronic knee pain. Case Rep Anesthesiol 2016; 2016: 8292450
    PubMedGoogle Scholar
  • 58 Desai MJ, Davis T, Loudermilk E. , et al. 6- and 12-month results of a prospective, multi-center, randomized, trial comparing safety and effectiveness of cooled radiofrequency ablation to corticosteroid injection for management of osteoarthritic knee pain. Asia-Pacific J Sport Med Arthrosc Rehabil Technol 2018; 13: 12
    PubMedGoogle Scholar
  • 59 Bhatia A, Peng P, Cohen SP. Radiofrequency procedures to relieve chronic knee pain: an evidence-based narrative review. Reg Anesth Pain Med 2016; 41 (04) 501-510
    CrossrefPubMedGoogle Scholar
  • 60 Wang C-J, Sun Y-C, Siu K-K, Wu C-T. Extracorporeal shockwave therapy shows site-specific effects in osteoarthritis of the knee in rats. J Surg Res 2013; 183 (02) 612-619
    CrossrefPubMedGoogle Scholar
  • 61 Wang C-J, Sun Y-C, Wong T, Hsu S-L, Chou W-Y, Chang H-W. Extracorporeal shockwave therapy shows time-dependent chondroprotective effects in osteoarthritis of the knee in rats. J Surg Res 2012; 178 (01) 196-205
    CrossrefPubMedGoogle Scholar
  • 62 Hsu S-L, Cheng J-H, Wang C-J, Ko J-Y, Hsu C-H. Extracorporeal shockwave therapy enhances expression of Pdia-3 which is a key factor of the 1α,25-dihydroxyvitamin d 3 rapid membrane signaling pathway in treatment of early osteoarthritis of the knee. Int J Med Sci 2017; 14 (12) 1220-1230
    CrossrefPubMedGoogle Scholar
  • 63 Yılmaz V, Karadaş Ö, Dandinoğlu T, Umay E, Çakçı A, Tan AK. Efficacy of extracorporeal shockwave therapy and low-intensity pulsed ultrasound in a rat knee osteoarthritis model: a randomized controlled trial. Eur J Rheumatol 2017; 4 (02) 104-108
    CrossrefPubMedGoogle Scholar
  • 64 Zhao Z, Jing R, Shi Z, Zhao B, Ai Q, Xing G. Efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a randomized controlled trial. J Surg Res 2013; 185 (02) 661-666
    CrossrefPubMedGoogle Scholar
  • 65 Kang S, Gao F, Han J. , et al. Extracorporeal shock wave treatment can normalize painful bone marrow edema in knee osteoarthritis: a comparative historical cohort study. Medicine (Baltimore) 2018; 97 (05) e9796
    PubMedGoogle Scholar
  • 66 Cho SJ, Yang JR, Yang HS, Yang H-E. Effects of extracorporeal shockwave therapy in chronic stroke patients with knee osteoarthritis: a pilot study. Ann Rehabil Med 2016; 40 (05) 862-870
    CrossrefPubMedGoogle Scholar
  • 67 Lee J-K, Lee B-Y, Shin W-Y, An M-J, Jung K-I, Yoon S-R. Effect of extracorporeal shockwave therapy versus intra-articular injections of hyaluronic acid for the treatment of knee osteoarthritis. Ann Rehabil Med 2017; 41 (05) 828-835
    CrossrefPubMedGoogle Scholar
  • 68 Zwerver J, Hartgens F, Verhagen E, van der Worp H, van den Akker-Scheek I, Diercks RL. No effect of extracorporeal shockwave therapy on patellar tendinopathy in jumping athletes during the competitive season: a randomized clinical trial. Am J Sports Med 2011; 39 (06) 1191-1199
    CrossrefPubMedGoogle Scholar
  • 69 Bitton R. The economic burden of osteoarthritis. Am J Manag Care 2009; 15 (8, Suppl): S230-S235
    PubMedGoogle Scholar