Investigation of the Effect of Ultrasound-Guided Genicular Nerve Block on Knee Joint Proprioception in Patients With Chronic Knee Osteoarthritis
Overview
- Phase
- Not Applicable
- Intervention
- genicular nerve block
- Conditions
- Osteoarthritis
- Sponsor
- Ankara City Hospital Bilkent
- Enrollment
- 44
- Locations
- 1
- Primary Endpoint
- Proprioception
- Status
- Recruiting
- Last Updated
- 2 months ago
Overview
Brief Summary
The study was conducted to investigate the effect of genicular nerve block on pain, quality of life, and proprioception, which are already diminished due to the impact of osteoarthritis in individuals with knee osteoarthritis.
Does genicular nerve block reduce pain and improve the quality of life in patients with knee osteoarthritis? Does genicular nerve block affect proprioception in patients with knee osteoarthritis?
Detailed Description
Osteoarthritis (OA) is described as a degenerative joint disease characterized by cartilage erosion, osteophytes, subchondral sclerosis, and changes in the joint capsule, commonly observed in the elderly. Knee osteoarthritis is identified as the most prevalent form, with an increasing prevalence attributed to aging. It is recognized as a leading cause of disability, resulting in reduced quality of life and increased healthcare costs. Major risk factors include age, genetics, obesity, and muscle weakness. Current treatments focus on symptom management, with options including medication, physical therapy, and surgery. Genicular nerve block is a minimally invasive procedure used to manage knee osteoarthritis pain by administering local anesthetics and corticosteroids near specific genicular nerves under ultrasound guidance. Temporary pain relief for up to three months has been reported, and the procedure is considered well-tolerated. Proprioception is defined as the sense of joint and limb position, mediated by receptors located in muscles, tendons, and joints. Assessment can be performed through simple methods, such as evaluating the ability to recognize specific joint angles or positions during passive or active movement. Proprioceptive deficits are frequently observed in osteoarthritis, and a better understanding of these changes is suggested to guide treatment strategies.
Investigators
Handan Elif Nur BAYRAKTAR
specialist
Ankara City Hospital Bilkent
Eligibility Criteria
Inclusion Criteria
- •Diagnosis of bilateral primary knee osteoarthritis according to ACR (American College of Rheumatology) criteria.
- •Age between 55 and 75 years.
- •Presence of knee osteoarthritis classified as Grade 2 or Grade 3 according to the Kellgren-Lawrence grading system on radiographs taken within the last year.
- •Knee pain lasting longer than 6 months.
- •Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, total score 48-96
Exclusion Criteria
- •Severe knee trauma within the last 6 months.
- •History of surgical operation on the knee region.
- •Intra-articular steroid and/or hyaluronate injection into the knee joint within the last 6 months.
- •Physical therapy targeting the knee within the last 6 months.
- •Regular use of NSAIDs within the last 6 months.
- •Presence of acute synovitis.
- •Neurological deficits in the lower extremity.
- •Presence of an inflammatory disease.
- •Poor general health condition (e.g., heart failure, advanced asthma, history of malignancy).
- •Any endocrine disorder that may cause polyneuropathy.
Arms & Interventions
Genicular Nerve Block Group
A nerve block will be performed on 22 patients using lidocaine injection under ultrasound guidance. After obtaining informed consent, the procedure will be carried out following sterilization, with 2% lidocaine hydrochloride injected at a total volume of 6 mL, distributed as 2 mL for each of the superomedial, superolateral, and inferomedial branches of the genicular nerve. After the injection, bleeding control will be performed, and the procedure will be concluded. All ultrasound-guided injections will be performed by a single physician, and the examination, investigations, treatment, and clinical evaluations of the patients will be conducted by the physicians participating in the study.
Intervention: genicular nerve block
Genicular Nerve Block Group
A nerve block will be performed on 22 patients using lidocaine injection under ultrasound guidance. After obtaining informed consent, the procedure will be carried out following sterilization, with 2% lidocaine hydrochloride injected at a total volume of 6 mL, distributed as 2 mL for each of the superomedial, superolateral, and inferomedial branches of the genicular nerve. After the injection, bleeding control will be performed, and the procedure will be concluded. All ultrasound-guided injections will be performed by a single physician, and the examination, investigations, treatment, and clinical evaluations of the patients will be conducted by the physicians participating in the study.
Intervention: Exercise
Exercise group
Exercise group: A home exercise program will be provided, including isometric strengthening exercises for the quadriceps muscles and stretching exercises for the hamstring muscles.
Intervention: Exercise
Outcomes
Primary Outcomes
Proprioception
Time Frame: Pre-treatment, 2 weeks, 1 month
Proprioception will be assessed using joint position sense. Joint position sense will be measured as the ability to actively replicate a joint position previously taught passively, referred to as Active Joint Position Sense (AJPS) (28). AJPS will be tested using a Continuous Passive Motion (CPM) device. The knee will be passively moved from 90° flexion toward extension at a slow pace. During this movement, the knee will be paused at 60°, 45°, and 30° flexion for 10 seconds each, and these angles will be taught to the participants. The knee will then be returned to 90° flexion, and the participants will be asked to actively replicate the taught angles. Participants will actively move their knees from the starting position to the taught angles of 60°, 45°, and 30° flexion to identify these positions. The actual taught angles and the angles determined by the participants will be recorded, and the differences between them will be calculated. Each angle will be tested in three trials, and
Secondary Outcomes
- The Nottingham Health Profile (NHP)(Pre-treatment, 2 weeks, 1 month)
- Western Ontario and McMaster Universities Arthritis Index (WOMAC)(Pre-treatment, 2 weeks, 1 month)
- Visual Analog Scale (VAS)(Pre-treatment, 2 weeks, 1 month)