A new study suggests that ultrasound-guided thermal radiofrequency ablation of the genicular nerves could offer effective relief after surgery.
While total knee replacement (TKR) remains one of the most effective solutions for managing advanced osteoarthritis, it does not always eliminate pain. In fact, 20 to 25% of patients continue to experience chronic discomfort after surgery and in around 6% of these cases, no clear cause is identified.
A recent study titled “Ultrasound-guided thermal radiofrequency ablation of the genicular nerves after total knee replacement” explores a promising technique to address this very issue. For more information, we encourage you to consult the full publication.
Genicular nerve radiofrequency ablation (GNRFA) is a minimally invasive treatment that targets specific nerve branches responsible for transmitting pain signals from the knee. The technique uses thermal radiofrequency energy to interrupt these signals, without the need for repeat surgery or long-term drug therapy.
In this study, ultrasound guidance was used to precisely locate and treat the superomedial, superolateral and inferomedial genicular nerve branches. These nerves are articular offshoots of the main nerves around the knee and they play a key role in pain transmission. Importantly, the inferolateral genicular nerve (close to the common peroneal nerve) was not included, reducing the risk of nerve injury.
Before proceeding to ablation, patients underwent a diagnostic test block. This involved injecting a combination of lidocaine (a short-acting local anaesthetic), ropivacaine (longer-acting), and Diprostène® to confirm the source of pain and the likelihood of response to GNRFA.
The technique is specifically aimed at patients with persistent pain following TKR, where no identifiable mechanical or infectious cause can be found: a particularly challenging scenario for clinicians. For these patients, revision surgery is often not indicated and analgesic medication may be insufficient.
In the reported case series conducted at the University Hospital of Toulouse between November 2021 and July 2023, 13 patients with refractory post-TKR pain were evaluated. Twelve of them responded positively to the diagnostic test and went on to receive GNRFA.
Preliminary findings from this small cohort are encouraging. Patients reported reduced pain levels and improved comfort following the procedure. While the study is retrospective and involves a limited number of patients, it provides a solid basis for further exploration of GNRFA as an option for chronic pain post-knee replacement.
To dive deeper into the data and understand the full scope of the technique’s outcomes, consult the complete study: “Ultrasound-guided thermal radiofrequency ablation of the genicular nerves after total knee replacement”.
GNRFA opens a new therapeutic pathway in post-arthroplasty care, especially when no anatomical cause for pain is found. Its minimally invasive nature and encouraging safety profile position it as a potential game-changer in managing unresolved postoperative pain.
If you are experiencing chronic pain after TKR or are considering knee surgery, we strongly recommend consulting Professor Étienne Cavaignac, a recognised expert in knee surgery and sports traumatology.
Published on :
Updated on :
