Now that we’ve discussed radiofrequency ablation in this prior post, let’s discuss a particular application of the technique called genicular radiofrequency ablation.  This procedure is done for knee pain, particularly knee pain from arthritis.

This procedure is exciting because many people do not want to have a knee replacement if they can avoid it.  Understandable! A knee replacement is a major surgery, with associated recovery time and discomfort. Also, there are many people who have bad knee arthritis but aren’t candidates for a knee replacement, like people who are very overweight, or people with serious heart conditions.  A genicular nerve ablation is an excellent alternative to a knee replacement for this patient population.

There are three areas where small nerves that sense pain in the knee exist- two on the top of the knee, and one on the bottom.  Using an X-ray machine, an interventional pain management physician can target these three areas and “turn them off” by using radiofrequency ablation.  Remember, radiofrequency ablation works by sending out heat to a nerve, which semi-permanently interferes with pain signals from that nerve. On average, pain relief from radiofrequency ablation typically lasts somewhere between six months to 1 year, sometimes longer.

To decide if a patient is a candidate for a genicular nerve ablation, first a pain physician will do a diagnostic block.  This means that the procedure is performed with standard needles and numbing medication (local anesthetic) is injected. The patient is asked to keep close records of how they feel for the remainder of that day, and generally, if the pain decreases more than 50-80%, they are a candidate for an ablation.  The diagnostic block can be a little confusing for patients because by the next day, most people will be back to their normal level of pain. But that is to be expected- this is just a test, a chance to see if the radiofrequency ablation has a good chance of working.

Risks of the procedure mainly relate to needle placement, so we counsel patients about potential bleeding, infection and injury to deeper structures.  This is also one of the more uncomfortable procedures I do, so I tell patients ahead of time what to expect. Some pain physicians use light sedation for the ablation procedure, but it is not always needed. Studies found that there was a chance of prolonged numbness in the area, but no increased risk of falls or balance difficulty.

If you are wondering if you might be a candidate for genicular nerve ablation, the best thing to do is see a pain physician who is trained to perform this procedure.  They will likely obtain baseline X-rays to determine how severe the arthritis in the knee is and then decide if you are a candidate for a diagnostic block.

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