Cooled Radiofrequency Ablation Versus Cryo-neurolysis of Genicular Nerves: A Comparative Study on Pain Relief and Functional Outcomes in Symptomatic Knee Osteoarthritis

Purpose: This study aimed to compare the effectiveness of cooled radiofrequency ablation (cRFA) and cryo-neurolysis (CN) of genicular nerves in alleviating pain and improving function in patients with advanced knee osteoarthritis (KOA). Methods: In this single-centre, prospective, randomised study, thirty patients with moderate to severe KOA (Kellgren–Lawrence grade 3–4) who responded to a fluoroscopy-guided genicular nerve block were assigned (1:1) to cRFA (n = 15) or CN (n = 15). Pain and function were assessed at baseline and 1-, 3-, 6-, and 12-month post-procedure using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Linear mixed-effects models (LMM) analysed longitudinal outcomes, incorporating fixed effects for group, time, and interaction with random patient intercepts. Results: Thirty patients were included in this study. Both groups significantly reduced VAS and WOMAC scores over time (p < 0.001). LMM-predicted VAS scores decreased from 7.1 ± 0.4 (CN) and 7.2 ± 0.4 (cRFA) at baseline to 2.0 ± 0.3 and 2.5 ± 0.3 at 12 months, respectively (p = 0.20), with a transient CN advantage at 6 months (1.5 ± 0.3 vs. 2.4 ± 0.3, p = 0.03). WOMAC scores fell from 70.0 ± 3.2 (CN) and 73.0 ± 3.2 (cRFA) to 28.0 ± 2.9 and 31.0 ± 2.9 (p = 0.41), showing no significant group differences (interaction p = 0.36). Adverse events were minimal, consisting of transient numbness in 2 CN patients. Conclusion: Based on the current study’s results, cRFA and CN offer comparable, sustained pain relief and functional improvement in advanced KOA, with CN providing a mid-term VAS benefit. Both are viable options for managing refractory KOA pain. Graphic Abstract: (Figure presented.)