Genicular nerve radiofrequency ablation: a systematic review of application for perioperative pain control in total knee arthroplasty and as treatment for chronic pain in well-appearing total knee arthroplasty

Chidebelum O Nnake; Mouhanad M El-Othmani; H John Cooper; Roshan P Shah; Jeffrey A Geller; Alexander L Neuwirth

doi:10.1186/s43019-024-00222-9

Genicular nerve radiofrequency ablation: a systematic review of application for perioperative pain control in total knee arthroplasty and as treatment for chronic pain in well-appearing total knee arthroplasty

Knee Surg Relat Res. 2024 May 19;36(1):18. doi: 10.1186/s43019-024-00222-9.

Authors

Chidebelum O Nnake¹, Mouhanad M El-Othmani¹, H John Cooper¹, Roshan P Shah¹, Jeffrey A Geller¹, Alexander L Neuwirth²

Affiliations

¹ Division of Hip and Knee Reconstruction, Columba University Medical Center, New York-Presbyterian Hospital, 622 West 168t Street, PH 11- Center, New York, NY, 10032, USA.
² Division of Hip and Knee Reconstruction, Columba University Medical Center, New York-Presbyterian Hospital, 622 West 168t Street, PH 11- Center, New York, NY, 10032, USA. aln2137@cumc.columbia.edu.

Abstract

Background: Total knee arthroplasty (TKA) is a successful treatment for end-stage osteoarthritis, yet some patients still experience postoperative pain. Genicular nerve radiofrequency ablation (GNRFA) has become a potential modality to address pain in TKA. This systematic review aims to critically analyze the applicability of GNRFA in perioperative pain control prior to TKA, as well as a treatment modality for chronic painful well-appearing TKA.

Methods: PubMed, Medline, EMBASE, Google Scholar, Scopus, and COCHRANE databases, as well as the ClinicalTrials.gov register, were reviewed. The search included randomized controlled trials and cohort studies. The sample population focused on two cohorts; those who underwent TKA and utilized intentional GNRFA as a perioperative pain control modality, and those utilizing the treatment modality for chronic pain in well-appearing TKA. GNRFA was the intervention studied, and postoperative outcomes were compared with the control group, which consisted of those not receiving GNRFA.

Result: Eight total publications were identified as relevant to this search. Among the pre-TKA studies, there was variability in results; these inconsistencies were attributed to a lack of standardization, especially with regard to type, timing, and targeted nerves with ablation. Likewise, while the results were improved among the population with chronic painful TKA receiving GNRFA, these inconsistencies still existed.

Conclusions: Current evidence suggests GNRFA as a possible pre-TKA intervention to potentially minimize opioid consumption, patient-reported pain, length of stay, and increased range of motion and activity. However, the short-lived duration in the setting of chronically painful well-appearing TKA represents a major barrier that warrants further investigation. Limitations include small sample size, heterogeneity, lack of standardization of techniques among studies, and lack of direct comparison and meta-analysis. Further research should focus on the standardization of technique as well as analyzing various patient and health-system-related factors that correlate with sustained positive outcomes.

Keywords: Chronic painful knee arthroplasty; Cryoablation; Genicular nerve; Perioperative pain control; Radiofrequency ablation; Total knee arthroplasty.

Publication types

Review