DOI QR코드

DOI QR Code

Comparing the effectiveness of ultrasound guided versus blind genicular nerve block on pain, muscle strength with isokinetic device, physical function and quality of life in chronic knee osteoarthritis: a prospective randomized controlled study

  • Cankurtaran, Damla (Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Education and Research Hospital) ;
  • Karaahmet, Ozgur Zeliha (Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Education and Research Hospital) ;
  • Yildiz, Sadik Yigit (Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Education and Research Hospital) ;
  • Eksioglu, Emel (Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Education and Research Hospital) ;
  • Dulgeroglu, Deniz (Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Education and Research Hospital) ;
  • Unlu, Ece (Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Education and Research Hospital)
  • Received : 2020.02.03
  • Accepted : 2020.05.13
  • Published : 2020.07.01

Abstract

Background: The genicular nerve block (GNB) is demonstrated from several reports to alleviate pain and improve knee functionality in patients with chronic knee osteoarthritis (OA). Ultrasound (US)-guided GNB has been the most used imaging method. This study aimed to compare the effectiveness of US-guided versus blind GNB in the treatment of knee OA. Methods: This prospective, randomized clinical trial included patients with knee OA based on American College of Rheumatology diagnostic criteria. The patients were evaluated for clinical and dynamometer parameters at the baseline, 4 weeks after treatment, and 12 weeks after treatment. The patients underwent blind injection or US-guided injection. Results: When compared with the baseline, both groups showed significant improvement in pain, physical function, and quality of life parameters. Significant differences were observed between the groups for clinical parameters (30-second chair stand test, 6-minute walk test) in favor of the US-guided group. On the other hand, blind injection was more significantly effective on some parameters of the Nottingham Health Profile. There wasn't any significant improvement in isokinetic muscle strength for either group. Conclusions: This study demonstrated that both US-guided and blind GNB, in the treatment of knee OA, were effective in reducing symptoms and improving physical function. GNB wasn't an effective treatment for isokinetic muscle function. US-guided injections may yield more effective clinical results than blind injections.

Keywords

References

  1. Li CF, Chen YJ, Lin TY, Hsiao YH, Fu JC, Chen CH, et al. Immediate responses of multi-focal low level laser therapy on quadriceps in knee osteoarthritis patients. Kaohsiung J Med Sci 2019; 35: 702-7. https://doi.org/10.1002/kjm2.12113
  2. Dass RM, Kim E, Kim HK, Lee JY, Lee HJ, Rhee SJ. Alcohol neurolysis of genicular nerve for chronic knee pain. Korean J Pain 2019; 32: 223-7. https://doi.org/10.3344/kjp.2019.32.3.223
  3. Kim DH, Lee MS, Lee S, Yoon SH, Shin JW, Choi SS. A prospective randomized comparison of the efficacy of ultrasound- vs f luoroscopy-guided genicular nerve block for chronic knee osteoarthritis. Pain Physician 2019; 22: 139-46.
  4. Crawford DC, Miller LE, Block JE. Conservative management of symptomatic knee osteoarthritis: a flawed strategy? Orthop Rev (Pavia) 2013; 5: e2.
  5. Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, et al. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg 2008; 51: 428-36.
  6. Kesikburun S, Yasar E, Uran A, Adiguzel E, Yilmaz B. Ultrasound- guided genicular nerve pulsed radiofrequency treatment for painful knee osteoarthritis: a preliminary report. Pain Physician 2016; 19: E751-9.
  7. Choi WJ, Hwang SJ, Song JG, Leem JG, Kang YU, Park PH, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain 2011; 152: 481-7. https://doi.org/10.1016/j.pain.2010.09.029
  8. McCormick ZL, Korn M, Reddy R, Marcolina A, Dayanim D, Mattie R, et al. Cooled radiofrequency ablation of the genicular nerves for chronic pain due to knee osteoarthritis: sixmonth outcomes. Pain Med 2017; 18: 1631-41. https://doi.org/10.1093/pm/pnx069
  9. Protzman NM, Gyi J, Malhotra AD, Kooch JE. Examining the feasibility of radiofrequency treatment for chronic knee pain after total knee arthroplasty. PM R 2014; 6: 373-6. https://doi.org/10.1016/j.pmrj.2013.10.003
  10. Yasar E, Kesikburun S, Kilic C, Guzelkucuk U, Yazar F, Tan AK. Accuracy of ultrasound-guided genicular nerve block: a cadaveric study. Pain Physician 2015; 18: E899-904.
  11. Sutaria RG, Lee SW, Kim SY, Howe R, Downie SA. Localization of the lateral retinacular nerve for diagnostic and therapeutic nerve block for lateral knee pain: a cadaveric study. PM R 2017; 9: 149-53. https://doi.org/10.1016/j.pmrj.2016.06.017
  12. Baert IAC, Meeus M, Mahmoudian A, Luyten FP, Nijs J, Verschueren SMP. Do psychosocial factors predict muscle strength, pain, or physical performance in patients with knee osteoarthritis? J Clin Rheumatol 2017; 23: 308-16. https://doi.org/10.1097/RHU.0000000000000560
  13. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986; 29: 1039-49. https://doi.org/10.1002/art.1780290816
  14. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis 1957; 16: 494-502. https://doi.org/10.1136/ard.16.4.494
  15. Yilmaz V, Umay E, Gundogdu I, Aras B. The comparison of efficacy of single intraarticular steroid injection versus the combination of genicular nerve block and intraarticular steroid injection in patients with knee osteoarthritis: a randomised study. Musculoskelet Surg 2019. doi: 10.1007/s12306-019-00633-y.
  16. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15: 1833-40.
  17. Busija L, Pausenberger E, Haines TP, Haymes S, Buchbinder R, Osborne RH. Adult measures of general health and healthrelated quality of life: Medical Outcomes Study Short Form 36-Item (SF-36) and Short Form 12-Item (SF-12) Health Surveys, Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), Medical Outcomes Study Short Form 6D (SF-6D), Health Utilities Index Mark 3 (HUI3), Quality of Well-Being Scale (QWB), and Assessment of Quality of Life (AQoL). Arthritis Care Res (Hoboken) 2011; 63 Suppl 11: S383-412. https://doi.org/10.1002/acr.20541
  18. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142-8. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  19. Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, et al. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 1985; 132: 919-23.
  20. Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 1999; 70: 113-9. https://doi.org/10.1080/02701367.1999.10608028
  21. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 2003; 41: 582-92. https://doi.org/10.1097/01.MLR.0000062554.74615.4C
  22. Gkrilias P, Tsepis E, Kokkalis Z, Panagiotopoulos E, Megas P. The relationship between isokinetic strength and functional performance tests in patients with knee osteoarthritis. J Phys Ther Sci 2018; 30: 888-91. https://doi.org/10.1589/jpts.30.888
  23. Kim DH, Choi SS, Yoon SH, Lee SH, Seo DK, Lee IG, et al. Ultrasound-guided genicular nerve block for knee osteoarthritis: a double-blind, randomized controlled trial of local anesthetic alone or in combination with corticosteroid. Pain Physician 2018; 21: 41-52.
  24. Maia PAV, Cossich VRA, Salles-Neto JI, Aguiar DP, de Sousa EB. Viscosupplementation improves pain, function and muscle strength, but not proprioception, in patients with knee osteoarthritis: a prospective randomized trial. Clinics (Sao Paulo) 2019; 74: e1207. https://doi.org/10.6061/clinics/2019/e1207

Cited by

  1. Intra-articular corticosteroid injection and genicular nerve block under ultrasound guidance in pain control of knee osteoarthritis vol.52, pp.1, 2020, https://doi.org/10.1186/s43055-021-00577-z