Fluoroscopic Versus Ultrasound Guidance for Cooled Radiofrequency Ablation of Geniculate Nerves in Knee Osteoarthritis: A Randomized Control Trial

Inclusion Criteria: * 1\) patients of either gender with primary knee OA of one or both knees fulfilling the diagnostic criteria for knee OA by the American College of Rheumatology, * 2\) Kellgren-Lawrence score of two to four, * 3\) reported NPRS pain intensity of at least four on most or all days of the past week * 4\) pain resistant to conventional treatments which may include but is not limited to medications (e.g. acetaminophen, oral or topical non-steroidal anti-inflammatory drugs, opioids), physical therapy, and intra-articular injections (e.g. corticosteroids, hyaluronic acid, platelet-rich-plasma) for at least 3 months. In the case of bilateral knee OA, the most symptomatic knee will be treated and studied. Exclusion Criteria: * 1\) age \<35 years, * 2\) non-English speaking patients, * 3\) body mass index greater than 40, * 4\) previous radiofrequency ablation procedure for the knee, * 5\) active systemic or local infections at the site of needle/cRFA probe placement, * 6\) previous knee joint replacement surgery, * 7\) autoimmune or inflammatory cause of knee arthritis such as rheumatoid or psoriatic arthritis, * 8\) non-ambulatory patients, * 9\) patients who are unable to provide their own consent (e.g. dementia), * 10\) unstable medical or psychiatric illness, * 11\) patients with pacemakers, spinal cord stimulators, deep brain stimulators, or similar devices, * 12\) patients seeking care as a part of workman's compensation or have litigation pending * 13\) a negative response to diagnostic geniculate nerve lidocaine injections.