Comparing the Effectiveness of Radiofrequency Ablation and Intra-articular Steroid Injections in the Management of Knee Osteoarthritis: A Systematic Review

Knee osteoarthritis is a progressive joint disorder that causes chronic pain, disability, significant impairment in quality of life, and a substantial burden on the health care system. Although conservative approaches, like physical therapy and pharmacological interventions, provide the initial treatment for knee osteoarthritis, patients with inadequate pain relief and other refractory symptoms often require other minimally invasive therapies, such as intra-articular steroid injection (IASI) or genicular nerve radiofrequency ablation (GNRFA). The purpose of this systematic review is to comprehensively compare the effectiveness of GNRFA and IASI in the treatment of knee osteoarthritis. Using the PRISMA 2020 guidelines, this systematic review searched multiple databases, including PubMed, Web of Science, Scilit, and the Cochrane Library, for articles published between March 2015 and 2025. After screening, four randomized controlled trials, involving 379 patients, met the inclusion criteria and were included in our systematic review. Results demonstrated that both interventions showed significant improvements in pain and also improved function compared to baseline. IASI provided superior pain relief and functional improvement compared to GNRFA at one week post-intervention. At three months, IASI also showed a statistically superior improvement in knee stiffness compared with GNRFA. However, GNRFA consistently showed superior, more sustained benefits from one to six months post-intervention, including greater pain reduction, improved function, decreased non-opioid analgesic use, and higher patient satisfaction. Effect sizes for pain favoring GNRFA progressed from small at one month (SMD: -0.398) to large at six months (SMD: -1.504), reflecting increasing GNRFA superiority over time. At the end of six months, 22% of patients in the GNRFA group reported complete pain relief, compared with only 4% in the IASI group. Both modalities demonstrated equivalent safety outcomes, with minimal adverse effects. These findings suggest that, while IASI offers rapid symptomatic relief suitable for patients requiring immediate pain control or those with prominent joint stiffness, GNRFA provides superior, sustained therapeutic benefits for patients seeking durable pain control and functional improvement. Treatment selection for patients should be individualized and achieved through shared decision-making, considering patient preferences, symptom patterns, and desired duration of therapeutic benefit. Future research should explore longer-term comparative effectiveness studies beyond six months, identify patient subgroups most likely to benefit from each intervention, and evaluate combination or sequential treatment strategies to optimize knee osteoarthritis management.