Abstract / Summary
Background: Knee osteoarthritis (KOA) causes pain and disability. Intra-articular corticosteroid injection (IAI) provides short-term relief, whereas image-guided genicular nerve radiofrequency ablation (RFA) may offer longer benefit. Comparative real-world data in advanced KOA are limited. Methods: This retrospective cohort included 184 patients with moderate-to-severe KOA (May 2022–May 2025): IAI (n = 98) and fluoroscopy-guided RFA (n = 86). RFA required >50% pain relief after diagnostic genicular block. Primary outcome was Visual Analog Scale (VAS) at 24 weeks. Secondary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), and Global Perceived Effect (GPE). Exploratory outcomes included non-steroidal anti-inflammatory drugs (NSAIDs) use, adverse events, and satisfaction. Results: Baseline characteristics were balanced (all standardized mean differences < 0.10). Group × time interactions were significant for all primary and secondary outcomes (all p < 0.001). At 1 week, IAI had lower VAS (2.41 vs 2.65, p = 0.004) and higher OKS (33.42 vs 31.56, p = 0.001); the VAS difference persisted at 4 weeks (p = 0.002), but the OKS difference did not (p = 0.484). At 24 weeks, RFA was associated with better outcomes: VAS 3.46 vs 5.12, WOMAC 25.83 vs 34.61, OKS 41.15 vs 31.23, and GPE 5.68 vs 4.36 (all p < 0.001). NSAIDs use at 24 weeks was lower with RFA (59.30% vs 80.61%, p = 0.002), and satisfaction was higher (82.56% vs 40.82%, p < 0.001). Adverse events were 16.3% with RFA vs 10.2% with IAI (p = 0.222), but safety analyses were underpowered. Conclusion: In this retrospective cohort of patients with moderate-to-severe KOA, RFA was associated with more sustained 24-week improvements than IAI. Because of nonrandomized allocation and diagnostic-block selection bias, these findings are associations, not causal; randomized trials are needed.