Effect of preoperative radiofrequency ablation on postoperative pain and discharge criteria in total knee replacement (TKR) patients applied with a rapid recovery protocol

Knee osteoarthritis is a condition that affects many individuals in society and significantly impacts the quality of life of those affected. With demographic changes and the increasing percentage of the population aged 65 and older worldwide, the burden of knee osteoarthritis is also rising. Studies have shown that patients undergoing the Fast Recovery Protocol (FRP) report higher satisfaction levels and shorter hospital stays. One of the key components of the FRP is the implementation of effective and well-monitored pain management strategies. Postoperative pain can adversely affect early mobilization of patients. Reducing pain after total knee arthroplasty (TKA) not only enhances short-term functional outcomes but can also improve overall patient satisfaction. In our study, we aimed to compare the effects of radiofrequency (RF) genicular nerve ablation prior to surgery on postoperative pain, function, and criteria for early discharge in patients undergoing TKA with the application of the Fast Recovery Protocol. This study compares the application of radiofrequency (RF) genicular nerve block in the preoperative period (Group I) with a control group (Group II) in patients undergoing knee arthroplasty at the Department of Orthopedics and Traumatology of Pamukkale University. A power analysis conducted prior to the study indicated that to achieve a strong effect size (d=0.7), at least 50 participants should be included in the study (a minimum of 25 patients per group) to obtain a 95% confidence level (alpha=0.05) and 80% power (1-beta=0.80). Considering the patient numbers from the power analysis, it was planned to include 25 patients in each group. In total, 50 patients were planned for inclusion in the study groups, with 25 patients in Group I and 26 patients in Group II. Preoperative demographic data, Visual Analog Scale (VAS) scores, Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores, and Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected. The Short Form-36 (RAND Corporation) was used for the assessment of quality of life. These evaluation scales were assessed preoperatively, in the early postoperative period, and at postoperative 1 and 3 months. The total WOMAC scores of patients showed a significant difference in favor of the block group at postoperative months 1 and 3 (p<0.050). In the assessment of quality of life, the mental health, energy, and general health subscales indicated that patients in the block group had statistically significantly higher quality of life at the 1-month mark (p<0.050). However, there were no statistically significant differences in pain levels evaluated by VAS, WOMAC, KOOS, and KF-36 between the block group and the control group (p>0.050). Nevertheless, in the early postoperative period, the reduction in pain levels among patients in the block group was found to be significantly lower compared to the preoperative period (p<0.050). There were no differences in knee joint flexion and extension ranges between the groups, and both groups exhibited an increase in joint range of motion compared to pre-surgery measurements (p<0.050). Additionally, there were no differences between the groups in the evaluation of quadriceps and abductor muscle strength (p>0.050). The postoperative symptom scores and performance-based activity limitation measurements did not show any significant differences between the groups (p>0.050). As a result, it was found that preoperative RF ablation in patients who will undergo TDP with the HIP protocol had positive results on quality of life, without affecting the postoperative pain results. All patients are 3. At the end of the month, he indicated a score in a healthy and improved quality of life way. However, according to the preoperative results of RF application in pain and exercise scores, especially 1. We have seen that it is effective on the moon. Keywords: Total Knee arthroplasty, Genicular Nerve Block, Radiofrequency Ablation, Rapid recovery protocol, ERAS