Abstract

In 2021, our Musculoskeletal (MSK) Rehabilitation and Intervention Unit at the North Rehabilitation Center (Portugal) published a case series on ultrasound-guided thermal radiofrequency ablation (RFA) for refractory knee and hip osteoarthritis (OA) pain.1 Since then, RFA has evolved from an emerging technique to a more widely adopted therapeutic strategy. Our center now performs over 100 procedures annually, reflecting both increasing demand and clinical confidence. This letter revisits the original publication in light of recent evidence. Systematic reviews and meta-analyses in the past five years have reinforced the short-term efficacy of RFA while highlighting differences between techniques. Bipolar genicular nerve RFA (GNRFA) demonstrated superior pain relief at six months compared to monopolar and pulsed modalities. Still, methodological heterogeneity persists, with variation in study quality, outcomes, and protocols. While some studies report sustained benefits and functional gains, others emphasize limitations and urge caution regarding routine use. RFA’s scope has also expanded in anatomical targets and clinical indications. Comparative studies suggest that RFA may provide longer-lasting pain relief than intra- articular injections in selected patients. In the knee, newer protocols include additional branches such as the infrapatellar and recurrent fibular nerves. In hip OA, recent data support the efficacy of ablating the obturator and femoral articular branches. Our clinical experience is consistent with the encouraging trends reported in recent literature, while underscoring the need for rigorous research. We advocate for patient-tailored technique selection (e.g., ultrasound vs. fluoroscopy) and evidence-based refinement of neural targets. Importantly, RFA should not be viewed as a stand-alone treatment, but rather as a complementary intervention within a comprehensive rehabilitation strategy-incorporating physical therapy, pharmacological management, patient education, nutrition, and therapeutic exercise. A cautious and structured integration of RFA into clinical pathways may enhance outcomes and support continued critical appraisal of its evolving role in OA pain management.

Keywords

knee and hip, pain, thermal radiofrequency ablation