Genicular Nerve RFA

Genicular Nerve Radiofrequency Ablation for Select Patients with Persistent Pain

An option for difficult-to-treat chronic knee pain

Chronic knee pain is often a challenging condition to treat. Medications commonly fail to provide adequate relief and can be limited by side effects. Corticosteroid injections can provide several months of pain reduction or only temporary relief. Hyaluronate injections (joint lubrication) can be expensive and while they do not have the side effects steroids have they are often times no more effective. Newer “regenerative” injection treatments such as stem cells and platelet-rich plasma (PRP) are still considered experimental and are often not covered by insurance. Surgical interventions for joint preservation are limited, and total joint replacement is often not an option for young or obese patients. Even after knee replacement, unremitting knee pain continues to afflict some patients.

Radiofrequency ablation for genicular nerves (GNRFA) is a relatively new and lesser-known treatment option that is proving effective for certain patients. A randomized controlled trial demonstrated significant improvement with GNRFA throughout the 12-week follow-up period. At Sobel Spine and Sports, we can evaluate patients for GNRFA who have failed or are excluded from other treatment modalities.

GNRFA is indicated for a variety of conditions:

• Osteoarthritis (OA)

• Chronic Knee Pain

• Degenerative Joint Disease

• Total Knee Replacement (before or after)

• Partial Knee Replacement (before or after)

• Patients unfit for knee replacement

• Patients who want to avoid a knee replacement

The process begins with a diagnostic genicular nerve block to determine of an ablative treatment would reduce knee pain. While the knee has several sensory nerve branches that provide feedback to the brain, the genicular nerves are primary in the this role and they are also easily located. Other branches have been reported to innervate the knee, but they are not suspected to carry as much pain signals from the joint, so injecting them may be less effective.

Diagnostic Process

Genicular nerve blocks are performed under fluoroscopic guidance. The nerves are targeted in the three locations noted in the picture above.

Under fluoroscopic guidance, a needle is placed alongside each of the nerves. After a negative aspiration, a contrast agent is injected to avoid vascular uptake. To conclude the procedure, a local anesthetic is placed on each of the three genicular nerves.

When to Proceed to Therapeutic Ablation

If the diagnostic injection is positive then the patient is deemed to be a candidate for GNRFA. Certain exclusions apply and include systemic or local infection and electrical devices implanted in the region of the radiofrequency ablation procedure as well as pacemakers and defibrillators.

The GNRFA procedure is typically performed with local anesthetic, although moderate IV sedation also referred to as conscious sedation can be given.

After the procedure, patients remain ambulatory and often return to work the next day. A few days of localized soreness is expected following the procedure with typical final results realized within one week. Pain relief can last anywhere from 3 months to a year. The procedure can be repeated if the pain returns.

Risk associated with procedure

It is important to know risk associated with any medical or surgical treatment. , There are few risks associated with Genicular Radiofrequency Ablation and they tend to be rare. The potential risks include, but are not limited to:

• Immediate or delayed ALLERGIC reaction to anesthetics /contrast

• Infection

• Bleeding

• Complex regional pain syndrome

• Temporary increase in pain

• Transient facial flushing

Infection is a rare complication in patients receiving therapeutic injection performed under sterile conditions. It is more common in diabetic and immune compromised patients. The bleeding complication is more common in patient with bleeding disorder or patients treated with anticoagulant/antiplatelet or patients taking over the counter medication like Motrin and Aspirin

Click here to see a sample list of medication that needs to be stopped before the procedure.