Osteoarthritis (OA) of the knee is a common joint disease and a leading cause of disability, functional impairment worldwide.
By Dr Amod Manocha
The Hindi idiom “standing on your own feet” (apne pairo pe khare hona) is generally used to refer to the financial independence of a young adult. A little thought, and one realises how it can have a different meaning as one transitions through different phases of life. As a toddler it is about gaining bodily control and as one ages having seen it all, it is about retaining the physical independence, functional capacity and quality of life.
Osteoarthritis (OA) of the knee is a common joint disease and a leading cause of disability, functional impairment worldwide. It is a serious disease with significant financial and socioeconomic implications. The impact is not limited to knee with recent studies pointing towards a link between knee pain and increased mortality due to cardiovascular disease and other causes. The prevalence of OA is increasing across all ages and are likely to continue to rise due to a plethora of reasons including lifestyle changes, obesity and increasingly ageing population. Joint pains are often neglected until it causes distress or impaired quality of life, but still a greater number of young patients are presenting with this problem. Obesity is a key modifiable factor for knee OA and cannot be overlooked as three to six times the body weight is transferred across the knee joint during walking. So, for every 5 kg of extra weight the knees have to carry an extra load of 15 to 30 kg.
Despite the progress in medical technology and decades of trying to understand knee OA, in the absence of a cure the treatments strategies largely focus on symptom management including pain relief, improved joint function, and joint stability. If you think about it we do not cure most conditions and we either remove, replace or manage most conditions.
Joint replacement surgery till date is the preferred option for long term solution in severe cases benefitting a vast majority, yet some of them continue to experience pain. As per research evidence around 9% of the patients undergoing hip replacement surgery and 20% of the patients undergoing knee replacement surgery have an unfavourable pain outcome. Despite the high prevalence, the condition remains under acknowledged like a silent epidemic. Persistent pain not only has an adverse impact on the quality of life but often leaves patients confused or blaming themselves for the pain or the decision to go ahead with surgery. When no obvious cause is found it leads to more dissatisfaction, frustration and breakdown of the doctor–patient relationship, thus promoting doctor shopping. Besides these patients, there is another subgroup of patients who are either not fit for surgery due to other coexisting medical problems or do not want to have surgery, come what may. Mobility may be ever more important for the ones who have other serious comorbidities as its absence often promotes a worsening spiral of health issues. So, what options exist for these subgroups apart from suffering and becoming dependant of others?
The minimally invasive technique of Radio Frequency Ablation (RFA) offers a ray of hope for these patients. The focus in this procedure is to deactivate the nerves responsible for transmitting pain signals from the affected joints to the brain. Less pain signals reaching the brain means less amount of pain experienced and less pain can in turn improve functionality and reduced medication requirements. Knee joint is supplied by many nerves collectively addressed as genicular nerves. The procedure is hence addressed as Genicular Nerve Radiofrequency Ablation. It involves placing special needles close to the nerves around the knee under ultrasound and x-ray guidance, eliminating the need for surgical incisions. The needles are connected to a radiofrequency machine producing special types of radio waves. These are then used to generate heat lesions around the nerves to interrupt the transmission of pain signals.
RFA comes as a boon for those patients who do not wish to undergo joint replacement surgery, those with co-morbidities who cannot undergo invasive treatments, those who have had an unsuccessful outcome after knee replacement or those at younger age who are keen on managing pain using minimally invasive options. This option offers a safe, effective, non-surgical alternative with no requirement for prolonged rehabilitation. It is performed as a day care procedure performed under local anaesthesia and normal activities can generally be resumed soon after the procedure with little or no recovery time. In most cases the nerve cells regenerate within 1-2 years of RFA therapy, and then if necessary, the procedure can be repeated.
Radiofrequency ablation is also used for treating other pains such as those originating from other joints such as those in the neck, lower back, hip and the shoulder. The awareness for this commonly performed procedure in developed countries like UK, US and Europe is now increasing in India.
(The author is Senior Consultant & Head, Pain Management Services, Max Super Speciality Hospital, Saket. Views expressed are personal.)