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Radio Frequency Ablation vs. Hyaluronic Acid


Radio frequency ablation compared with a single injection of hyaluronic acid for chronic knee pain. Reported in the Journal of Bone and Joint Surgery September 2020

There are many potential approaches to alleviating the pain associated with osteoarthritis. The most common approach is suppressing the inflammatory response to cartilage breakdown. This would include icing, oral anti-inflammatory medication, Injectable anti-inflammatory medication like steroids.

Activity modification, weight loss, and physical therapy can also mitigate some of the symptoms of arthritis.

Injection of platelet rich plasma which provides growth factors for cartilage regeneration has been shown to be effective in early arthritis theoretically improving or repairing the cartilage through the delivery of growth factors.

There are also injectable medications that rehydrate the remaining cartilage in an arthritic joint, and lubricate the joint, by incorporating into the articular cartilage. Examples of this would be Synvisc or Euflexxa. (  hyaluronic acid ).

Another approach is simply to try to suppress the pain and stay active despite the arthritis. Examples of this would be Tylenol, Narcotics, or nerve ablation. Nerve ablation is an attempt at decreasing the nerve stimulation Signal coming from the arthritic joint to the brain. Prior studies of radio frequency ablation have demonstrated 6 to 12 months of relieving knee arthritis pain.

The final option is joint replacement which is removing the worn out cartilage and bone spurs, thus eliminating the source of ongoing inflammation and pain in the knee or hip. Joint replacement is a resurfacing of the joint with metal and plastic creating a new weight bearing surface. This new metal cap over the end of the bones ( Joint replacement ) shields the underlying nerves in the bone from stimulation and therefore relieves the pain associated with arthritic wear. This is a permanent solution but a very difficult surgical recovery, Associated with it.

In this randomized perspective trial of 260 subjects. The patients were either given intra-articular injection with hyaluronic acid or underwent nerve ablation. They were comparable and randomly assigned to the treatment option. They were followed at one months three months and six months after the procedure. Consistently the group with radio frequency ablation did better in terms of pain and function. At six months follow up the group with radio frequency ablation still had 48% improvement while the hyaluronic acid group had 22% improvement. The results also demonstrated a much more significant improvement in pain and function in patients with early-stage arthritis versus in stage bone on bone arthritis.

In conclusion radio frequency ablation of the sensory nerves around the knee is a viable alternative with better functional outcome compared to hyaluronic acid injection.