Bilykh Y. The use of radiofrequency neuroablation in the treatment of pain syndrome in patients with knee osteoarthritis according to knee arthroplasty

The dissertation is based on the results of own observations of surgical treatment, clinical, instrumental and special methods of diagnostic of patients. In traumatology and orthopedics, the method of radiofrequency neuroablation is used to treat pain of various etiologies and has been actively studied in recent years. There are different options for radiofrequency ablation, methods of the procedure providing and there is no consensus among researchers on the anatomical structures that need to be influenced to achieve better results in the treatment of patients with knee osteoarthritis. The traditional technique of denervation of the knee joint is the thermal effect on the superior medial, superior lateral and inferior medial genicular nerves, which respond to the sensory innervation of the intra-articular structures of the knee. We proposed the use of radiofrequency neuroablation of the knee joint in the preoperative period to reduce the intensity of pain after knee arthroplasty. It was also proposed to modify the procedure by additional ablation of the infrapatellar branch of the saphenous nerve and the anterior cutaneous nerve of the femur, which are responsible for sensory innervation of the skin around surgical approach, to reduce pain in the postoperative wound. For the first time, a standard technique of radiofrequency neuroablation of the superior lateral, superior medial and inferior medial knee nerves was used before knee arthroplasty, which allowed to reduce the intensity of pain in the postoperative period. A new method of radiofrequency neuroablation of the knee joint under ultrasound control with denervation of the infrapatellar branch of the saphenous nerve and the anterior branch of the femoral nerve, innervating the skin in the area of surgery for analgesia in patients with arthroplasty. Through long-term prospective observation and analysis of treatment outcomes of patients who underwent knee arthroplasty and radiofrequency neuroablation, new scientific data were obtained on the dynamics of changes in pain intensity, restoration of functional status in patients and the impact of this method on quality of life and development of neuropathic component of pain after surgery. Improved method of surgical treatment of patients with osteoarthritis of the knee joints in the late stages of the disease, by preoperative application of radiofrequency neuroablation of the knee and cutaneous nerves of the knee, which can significantly reduce the intensity of pain in the postoperative period and accelerate the rehabilitation of patients. Substantiated safety of this technique and statistically proven effectiveness of its use to reduce the intensity of pain in the postoperative period after arthroplasty: the results obtained with WOMAC, KOOS and SF-36 were better at all stages of the study in groups of patients who had additional radiofrequency neuroablation of the knee joint in the preoperative period.