International Journal of Hyperthermia

ISSN: 0265-6736 (Print) 1464-5157 (Online) Journal homepage: www.tandfonline.com/journals/ihyt20

Radiofrequency ablation for the treatment of

knee osteoarthritis: present status and future
perspectives

Roberto Luigi Cazzato, Julien Garnon, Jean Caudrelier, Pramod Prabhakar

Rao, Guillaume Koch & Afshin Gangi

To cite this article: Roberto Luigi Cazzato, Julien Garnon, Jean Caudrelier, Pramod Prabhakar
Rao, Guillaume Koch & Afshin Gangi (2018) Radiofrequency ablation for the treatment of knee
osteoarthritis: present status and future perspectives, International Journal of Hyperthermia,
34:8, 1270-1271, DOI: 10.1080/02656736.2017.1413716

To link to this article: https://doi.org/10.1080/02656736.2017.1413716

Published online: 08 Feb 2018.

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INTERNATIONAL JOURNAL OF HYPERTHERMIA
2018, VOL. 34, NO. 8, 1270–1271
https://doi.org/10.1080/02656736.2017.1413716

COMMENTARY

Radiofrequency ablation for the treatment of knee osteoarthritis: present status

and future perspectives

Sir, US/fluoroscopy guidance applied to target the genicular

Knee osteoarthritis (OA) is a leading cause of disability; it has
been estimated that in the United States nearly one-tenth of
the adults are affected by such condition with an expected
radiographic prevalence >37%/year [1]. Clinically, knee OA
presents with pain, limited range of motion, stiffness, osteo-
phytes and effusions. Accordingly, patients’ quality of life is
significantly impaired. Common treatments include conserva-
tive approaches (i.e. weight loss, physical therapy, analgesic
drugs), intra-articular injections and, for advanced cases, total
knee arthroplasty (TKA).
Radiofrequency ablation (RFA) is a relatively novel percu-
taneous technique, which has been widely applied for the
treatment of several different medical conditions including
cancers [2–4] and cardiac arrhythmias [5]. More recently, RFA
has also been applied to treat chronic pain originating form
benign conditions (e.g. radiculopathic pain) [6,7] or from skel-
etal metastases [8].
From a physical point of view, RFA induces ionic agitation
resulting into tissue heating through the application of an
electrical current flowing between two dipoles. Basically,
three different monopolar RFA techniques are available
including conventional RFA, cooled RFA and pulsed RFA.
With conventional RFA, ionic agitation is achieved in order to
obtain tissue charring and carbonisation at temperatures
>60  C [6,9]. On the other hand, when the shaft of the elec-
trode is continuously cooled with cold saline, high tempera-
tures at the interface between the electrode and the target
tissue are prevented, thus avoiding charring and carbonisa-
tion. Accordingly, heating can spread homogeneously into
the tissue and larger areas of ablations are obtained as com-
pared to conventional RFA. In the end, pulsed RFA produces
short (20 milliseconds) pulses of low-amplitude (45 V) every
500 milliseconds. As a consequence, the target tissue is min-
imally warmed (<42  C) without any definitive structural
change. Nevertheless, it has been largely proved that pulsed
RFA results into neuromodulation, which is responsible for
the palliative effect [7,10].
In the particular setting of knee OA, all these three RFA
techniques have been safely and successfully applied to treat
chronic pain; and a large literature core supports RFA with
very encouraging results reported both at short- and mid-
term follow-up (ranging between 1 week and 12 months)
[11]. However, a substantial heterogeneity exists across stud-
ies, especially in terms of ablative protocols, imaging guid-
ance and anatomic targets of the ablation. Despite such
heterogeneity, most of the available papers reported about
nerves [11]. Nevertheless, at the moment, it is not possible to
state whether one approach/technique is superior to another.
Moreover, data about the long-term efficacy of the technique
are substantially lacking; and it is not clear whether and how
RFA should be combined with other non-surgical treatments
such as articular injections.
In conclusion, a large literature core supports RFA as an
effective palliative method for patients suffering from painful
chronic OA of the knee non-responding to conservative
measures. Nevertheless, a standardisation of the technique is
needed to allow definitive acceptance of RFA in the arma-
mentarium of treatments available for knee OA.
Disclosure statement
Authors have no conflict of interests to disclose.
Funding
The present paper received no funding.
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