D Onobun, O Mohammad, M-U Undie, T Awe, A Dwyer, Z Hafeez, M Hefny
Genicular nerve interventions provide clinically meaningful pain relief with favourable safety profiles in knee osteoarthritis. Across the available studies, RFA was associated with larger and more durable improvements in pain than GNB, although most evidence derives from indirect comparisons rather than direct head-to-head trials. Further high-quality studies with standardised protocols and longer follow-up are required to clarify long-term outcomes and surgical implications.
INTRODUCTION: Genicular nerve block (GNB) and radiofrequency ablation (RFA) are increasingly utilised for pain management in knee osteoarthritis, yet their comparative effectiveness, durability and clinical role remain uncertain. This systematic review aimed to compare outcomes of GNB and RFA in patients with knee osteoarthritis.
METHODS: A systematic review was conducted in accordance with PRISMA guidance. MEDLINE, Embase, CENTRAL, CINAHL and Web of Science were searched for randomised controlled trials and comparative observational studies evaluating GNB and/or RFA for knee osteoarthritis. Outcomes included pain, function, durability of effect, safety and reported progression to total knee replacement (TKR). Random-effects meta-analysis was performed where data were sufficiently homogeneous; otherwise, structured narrative synthesis was undertaken.
FINDINGS: Nineteen studies were included, comprising sham-controlled trials, active-comparator trials and prospective or retrospective cohorts. Both GNB and RFA were associated with reductions in pain compared with comparators. Across studies, RFA demonstrated larger and more durable pain relief than GNB, with benefits commonly sustained for 6-12 months and, in some cohorts, beyond 1 year. Functional improvements were variable but were most consistently observed following RFA using broader genicular nerve targeting strategies. No serious procedure-related adverse events were reported, and minor complications were infrequent and self-limiting. Reported conversion to TKR during study follow-up was rare, though follow-up duration and study design limited causal inference.
CONCLUSIONS: Genicular nerve interventions provide clinically meaningful pain relief with favourable safety profiles in knee osteoarthritis. Across the available studies, RFA was associated with larger and more durable improvements in pain than GNB, although most evidence derives from indirect comparisons rather than direct head-to-head trials. Further high-quality studies with standardised protocols and longer follow-up are required to clarify long-term outcomes and surgical implications.