Bipolar Versus Cooled Radiofrequency Ablation for Gonarthrosis

Chronic knee osteoarthritis (gonarthrosis) is a major cause of persistent pain, reduced mobility, and impaired quality of life, particularly in older adults. Although conservative treatment options such as physical therapy, oral analgesics, and intra-articular injections are commonly used, many patients continue to experience significant pain and functional limitation. In recent years, genicular nerve radiofrequency ablation techniques have emerged as effective minimally invasive alternatives for patients who do not achieve adequate benefit from conservative management or are not suitable candidates for surgery. Bipolar radiofrequency ablation (BPRFA) and cooled radiofrequency ablation (CRFA) are two radiofrequency techniques designed to create larger and more effective lesions around the genicular nerves, potentially improving denervation of the complex and variable sensory innervation of the knee joint. While both methods have shown promising results in the treatment of chronic knee osteoarthritis pain, direct comparative data regarding their clinical efficacy, functional outcomes, and safety profiles remain limited. This prospective observational comparative study aims to evaluate and compare the analgesic efficacy and safety of ultrasound-guided BPRFA and CRFA in patients with chronic gonarthrosis refractory to conservative treatment. Patients with moderate-to-severe unilateral knee pain who achieve significant pain relief following diagnostic genicular nerve block subsequently undergo either BPRFA or CRFA targeting the superior medial, superior lateral, and inferior medial genicular nerves under ultrasound guidance as part of routine clinical practice. Clinical outcomes are assessed using multiple validated outcome measures. Pain intensity is evaluated using the Numeric Rating Scale (NRS), functional status is assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), kinesiophobia is evaluated using the Tampa Scale for Kinesiophobia (TSK), and quality of life is assessed using the 12-Item Short Form Health Survey (SF-12). Assessments are performed at baseline and during follow-up visits at 3, 12, and 24 weeks after treatment. The study aims to compare pain reduction, functional recovery, quality-of-life improvement, treatment responder rates, and procedure-related adverse events between BPRFA and CRFA in patients with chronic knee osteoarthritis.