Ultrasound vs. fluoroscopic guidance in genicular nerve radiofrequency thermocoagulation for chronic knee pain: which one is the future?

OBJECTIVE: Fluoroscopic guiding is commonly utilized for interventional pain management procedures. However, ultrasonography has started to be used more widely in interventional pain procedures. It has become even more popular with its advantages. The clinician who performs the pain procedure and the patient are not exposed to radiation. Vascular structures can be directly visualized. Ultrasonography is more accessible and portable than fluoroscopy. For all these reasons, its use will increase. So, in this study, we aimed to compare the efficacy of the genicular nerve radiofrequency thermocoagulation application under ultrasound guidance and fluoroscopy guidance.PATIENTS AND METHODS: Patients with stage 2 and 3 osteoarthritis, according to the Kellgren-Lawrence classification, were included in our study (n=180). Seventy percent of patients were women. Sixty patients received medical treatment only. Genicular nerve radiofrequency thermocoagulation was performed with fluoroscopy in sixty patients and with ultrasonography guidance in sixty other patients. Visual Analogue Scale at 1 month (VAS1) and Western Ontario and McMaster Universities Arthritis (WOMAC1) were recorded before the procedure, while VAS2 and WOMAC2 were recorded at 3 months.RESULTS: In the ultrasound and fluoroscopy group, a statistically significant difference was found between VAS1 and VAS2, WOMAC1 and WOMAC2 (p<0.05). VAS1 of the patients in the fluoroscopy group was 6.65 +/- 0.93, and it was 5.88 +/- 0.92 in the ultrasonography group, which was similar (p<0.0001). VAS2 was 2.26 +/- 1.16 in the ultrasonography group and 3.83 +/- 1.66 in the fluoroscopy group (p<0.0001). The reduction rate in pain severity in patients undergoing the procedure under ultrasonography guidance was more marked than that in the fluoroscopy group (p<0.0001).CONCLUSIONS: For the radiofrequency thermocoagulation of the genicular nerve, both imaging approaches are available. Ultrasonography guidance appears to be better than fluoroscopy guidance in this technique because of the lower radiation dose and the ability to detect the target location and neighboring tissues more precisely under ultrasonography guidance.