FUNCTION, SATISFACTION, AND RESPONDER RATES AFTER PULSED RADIO FREQUENCY, CRYOABLATION, AND INTRA-ARTICULAR BOTULINUM TOXIN FOR KNEE OSTEOARTHRITIS: A THREE-ARM TRIAL

A. El-Sayed Allam¹, A.O.M. Abdallah², M. Hassanien³ | ¹Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University, Tanta, Egypt; ²Department of Anesthesia and Intensive Care, Faculty of Medicine, New Valley University, New Valley, Egypt; ³Department of Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt

Abstract

Background and Aims. Beyond mean pain scores, functional recovery and clinically meaningful responders are crucial for guiding interventional choices in knee osteoarthritis (KOA). We compared function, satisfaction, analgesic pattern, and ≥30% pain-responder rates after pulsed RF, cryoablation, and intra-articular Botox.
Methods. In a three-arm comparative study (Assiut University; March 2023–December 2025), 79 KOA patients received pulsed RF (n=27), cryoablation (n=27), or Botox (n=25) with a 12-month follow-up. Function was assessed by WOMAC (baseline, 1, 3, 6, and 12 months) and the Lequesne index (baseline, 3, 6, and 12 months). Satisfaction (4-point Likert) was recorded at 3, 6, and 12 months. Responders were defined as ≥30% VAS improvement from baseline.
Results. Functional outcomes improved most with Botox (WOMAC ≈ 26.7–30.0 at 1–12 months), with lower Lequesne scores at 3–12 months (4.10–5.00). Cryoablation showed intermediate early WOMAC improvement versus pulsed RF, with partial loss by 12 months. Satisfaction favored Botox at 3 and 6 months (Likert category 4: 76.0% and 68.0%). Responder rates were highest with Botox across timepoints (72–88%). Cryoablation exceeded pulsed RF early (55.6–74.1% vs. 25.9%) but declined to 0% at 12 months.
Conclusions. Botox provided the most durable functional improvement, patient satisfaction, and clinically meaningful responder rates. Cryoablation delivered strong short-term benefit but limited durability, while pulsed RF showed lower responder proportions.