Clinical Effectiveness and Economic Impact of Genicular Radiofrequency, Hyaluronic Acid, and Platelet-Rich Plasma in Knee Osteoarthritis: A Systematic Review

Introduction: Knee osteoarthritis is a chronic, prevalent, and progressive degenerative disease associated with persistent pain, functional limitation, reduced quality of life, and substantial economic burden for health systems. Among the minimally invasive interventions used for its management, intra-articular hyaluronic acid (HA), platelet-rich plasma (PRP), and genicular nerve radiofrequency (RF) are prominent therapeutic options.

Objective: To compare the clinical effectiveness, economic profile, and therapeutic benefits of HA, PRP, and RF in the treatment of knee osteoarthritis, with additional emphasis on the financial impact on the Brazilian Unified Health System (SUS).

Methods: This review was conducted according to PRISMA recommendations, using international databases and predefined eligibility criteria. Eighteen studies were included and analyzed regarding methodological quality, intervention characteristics, clinical outcomes, cost-effectiveness, and economic implications. Data from public SUS tables, hospital production records, and administrative documents were also incorporated to estimate reference values related to the interventions and knee arthroplasty.

Results: HA showed moderate clinical benefit and greater predictability in patients with mild-to-moderate osteoarthritis; however, its cost may be substantial when the price of the product and repeated treatment cycles are considered. PRP demonstrated potential superiority or non-inferiority compared with HA in pain and function outcomes, but remains limited by technical heterogeneity and the absence of a specific standardized SUS reimbursement value. RF showed a therapeutic profile mainly directed to persistent or refractory pain, with economic plausibility when compared with the reference value of total knee arthroplasty.

Conclusion: HA, PRP, and RF have distinct indications and may contribute to a stepped-care approach for knee osteoarthritis. HA is a consolidated intervention but requires selective use due to the cost per therapeutic cycle; PRP is promising but requires standardization and local micro-costing; and RF represents a relevant option for refractory pain in carefully selected patients. The incorporation of these technologies into SUS should consider clinical effectiveness, safety, total cost of care, budget impact, and objective eligibility criteria.