RFA or Chemical Neurolysis of the Genicular Nerves Compared to Conservative Treatment for Knee Pain Caused by OA (RADIOPHENOL)
Osteo Arthritis Knee, Knee Pain Chronic
About this trial
This is an interventional treatment trial for Osteo Arthritis Knee focused on measuring Pain, Thermal ablation, Phenol neurolysis, Genicular nerve
Eligibility Criteria
Inclusion Criteria: Adult patients of both sexes, >35 years who are not a candidate for TKA due to young age, old age, comorbidity or technical reasons. OKS < 30 on a scale from 0 (severe function) to 48 points (satisfactory function). Continued pain in the target knee that is moderate to severe (defined as NRS ≥ 6 on an 11-point NRS scale) either constantly or with motion despite at least 3 months of conservative treatments. Conservative treatment can include: active physiotherapy, pharmacological treatment of pain (acetaminophen or NSAIDs) and intra-articular corticosteroid infiltration. Radiologic confirmation of arthritis for the target knee. Defined as the Kellgren Lawrence (KL) score of 2 or more on X-ray or MRI. Exclusion Criteria: Patient with prior ablation of the genicular nerves, prior partial, resurfacing, or TKA of the target knee (residual hardware). Patient with a history of neurovascular injury or recent trauma of the lower extremities. Patient with chronic widespread pain. Polyneuropathy and/or radicular pain in the lower extremities. Patient is currently implanted with a neurostimulator. Local or systemic infection (bacteraemia). Uncontrolled immune suppression. Intra-articular injections (steroids, hyaluronic acid, platelet enriched plasma, stem cell, …) in the target knee within 90 days from randomisation. Arthroscopic debridement/lavage into the target knee within 180 days from randomisation. BMI<18,5 kg/m2 and patients with minimal subcutaneous tissue thickness that would not accommodate ablation with phenol or radio frequency (risk of skin burns). Allergies to products used during the procedure (lidocaine, phenol, contrast dye). Patients who have a planned TKA in the near future, defined as patients who already have agreed on a date for the TKA procedure. Patients with psychosocial problems as determined by the investigator.
Sites / Locations
- Dijklander Ziekenhuis
- Bravis Ziekenhuis
Arms of the Study
Arm 1
Arm 2
Arm 3
Active Comparator
Active Comparator
No Intervention
Chemical ablation of the genicular nerves with Phenol 6%
Radiofrequency ablation (RFA) of the genicular nerves
Conservative treatment
Chemical ablation with phenol is done by injection of 1,5ml of phenol 6 % at the superomedial, the superolateral and the inferomedial genicular nerve.
In our study we will make two RFA lesions at every target with 80°C for 90 seconds with a 5mm active tip. So we will make 6 lesions in total. The targets are the superomedial, the superolateral and the inferomedial genicular nerve.
Examples of allowed conservative treatments during the study are patient education, physical therapy, weight loss and different pharmacological treatments.