In recent years, radiofrequency ablation of the genicular nerves has emerged as a promising and minimally invasive technique to manage pain associated with severe knee osteoarthritis.
The genicular nerves are sensory nerves that innervate the knee joint, transmitting pain signals to the brain. In knee osteoarthritis, these nerves become hyperactive, contributing to the persistent pain experienced by patients. Radiofrequency ablation targets these nerves, interrupting the transmission of pain signals and offering a potential solution for long-term pain relief.
Radiofrequency ablation is a minimally invasive procedure performed by pain management specialists. The patient is typically awake during the procedure, and local anesthetic is administered to ensure comfort. Using fluoroscopic guidance, the physician inserts a thin needle into the targeted area, often guided by the use of nerve stimulation or sensory testing.
Once the needle is in position, radiofrequency energy is applied to the genicular nerves. This energy heats and damages the nerves, thereby disrupting their ability to transmit pain signals. Importantly, this procedure is precise, with minimal damage to surrounding tissues.
As an orthopedic surgeon that treats osteoarthritis many of my patients have inquired about this method of treatment as an alternative to total knee arthroplasty. Prior to writing this article I actually had very little knowledge about this procedure so I was always unsure of what to tell them. After doing a little research it would appear that RFA for the knee is similar in terms of efficacy and risks to its correlate procedure in the spine. This procedure has been used for years to help people with pain originating from multiple facet joints. In the literature for both of these procedures it would appear that the degree of pain relief and the longevity of pain relief have a high standard deviation (i.e. - some people have a very good result and some people have a very poor result). This is likely because the location of the genicular nerves is variable, as is the amount of energy to ablate them from the tip of the needle.
On a whole, the risk of the procedure is low, so especially in younger patients, that would benefit from maintaining their native knee, it is a very reasonable treatment option. That being said, there are obvious limitations relative to surgical intervention. The first limitation is that the pain relief is typically not complete - even in people who respond well the to the treatment. The second is that it will not solve any of the other issues associated with osteoarthritis - stiffness, malalignment, buckling or locking. The third is that the procedure is temporary. Genicular nerves will regenerate over time and typically, even in cases where treatment is effective, the procedure would need to be repeated every 2-3 years.
Overall, I am encouraged by the preliminary data in support of this procedure. I believe that in the correct patient - namely a younger patient (under 65) with minimal mechanical symptoms - this is an excellent treatment option.
Dr. Barrett
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