Preprocedural superomedial pain localization as a predictor for short-term clinical improvement after cooled radiofrequency ablation in advanced knee osteoarthritis

Cooled radiofrequency ablation (CRFA) has shown clinical benefits in patients with advanced knee osteoarthritis (OA); however, predictors of treatment response remain limited. Preprocedural pain localization may offer a simple and clinically relevant predictor for enhanced patient selection for CRFA. To evaluate whether preprocedural superomedial pain localization and overall pain site count are associated with clinical outcomes after CRFA in patients with advanced knee OA. This prospective cohort study included 47 patients (54 knees) with Kellgren–Lawrence grade 3 or 4 OA who underwent ultrasound-guided genicular nerve block and standardized CRFA. Pain localization was assessed using an 8-zone knee pain map. The primary outcome was the 3-month change in International Knee Documentation Committee (IKDC) score. Secondary outcomes included Lysholm score, visual analog scale (VAS), and Knee Injury and Osteoarthritis Outcome Score (KOOS) domains. Univariate and multivariate regression analyses were performed. Superomedial pain, the most common localization (66.7%), was significantly associated with worse baseline IKDC (β = − 8.2, p = 0.02) and KOOS–Pain (β = − 13.9, p = 0.01). However, it was independently associated with greater IKDC improvement after CRFA (β = 9.1, p = 0.02) after adjusting for age, sex, and BMI. Total number of pain sites correlated with worse baseline function but not with treatment response. Superomedial knee pain was independently associated with superior short-term functional improvement following CRFA. These findings support the utility of pain localization as a prognostic tool for patient selection in advanced knee OA.