Denervation yields short-term benefit in refractory knee osteoarthritis

  • Pain Physician

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • A small meta-analysis finds that denervation therapy for refractory knee osteoarthritis (KOA) shows short-term (up to 6 months) improvements in pain and functional recovery but the long-term benefits remain controversial.

Why this matters

  • There are few treatment options for refractory KOA.
  • Denervation therapy is promising.

Study design

  • Meta-analysis of 6 randomized controlled trials (n=408) after search of Medline, EMBASE, and the Cochrane Library.
  • Pain intensity was rated by visual analog scale or numeric rating scale; functional improvement was rated by total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
  • Funding: None disclosed.

Key results

  • Efficacy at 4 weeks favored denervation therapy (vs controls):
    • Pain standardized mean difference (SMD), −1.17; P=.04.
    • Functional recovery SMD, −0.75; P=.0002.
  • Efficacy at 12 weeks favored denervation therapy (vs controls):
    • Pain SMD, −1.24; P<.00001.>
    • Functional recovery SMD, −0.42; P=.007.
  • Efficacy at 24 weeks:
    • Pain SMD, −1.25; P=.0002.
    • Functional recovery SMD, −0.39; P=.06.

Limitations

  • Small number of trials; most with small sample sizes.
  • Most studies open-label.