Genicular nerve blocks and radiofrequency genicular neurotomy are treatment options for patients with chronic knee osteoarthritis (OA); a condition that causes pain, restricted movement, sleep disturbance, and functional disability if left untreated. Medication therapy and the use of anti-inflammatory drugs are generally not recommended for patients with chronic knee OA because serious side effects, such as bleeding and stomach ulcers, can occur. Non-surgical interventions, including joint injections, acupuncture, and periosteal stimulation therapy, may be used as complementary therapies to help control chronic knee OA pain. Nevertheless, patients who have not found relief from these treatment options may benefit from a genicular nerve block followed by radiofrequency genicular neurotomy. Both of these therapies are highly effective with a low risk of complications.
A genicular nerve block is a diagnostic and therapeutic injection that blocks pain from the genicular nerves around the knee joint. While this treatment may alleviate pain and restore function for several weeks, it will not provide long-term relief. Radiofrequency genicular neurotomy is typically recommended to patients who’ve experienced adequate pain relief from the diagnostic block procedure. During radiofrequency genicular neurotomy, fluoroscopic images of the anteroposterior and lateral views of the knee joint are shown on a television screen to help physicians accurately located and treat the affected nerves. A local anesthetic and mild sedation will be administered to keep the patient comfortable throughout the procedure. After making a small incision into the knee joint, a physician will place radiofrequency electrode tips on periosteal areas that connect the shaft of the femur to bilateral epicondyles and the shaft of the tibia to the medial epicondyle. With the help of a small generator, radiofrequency waves are produced and introduced to the tip of the electrode needle where a heat lesion is then created. This heat lesion will be placed on the superior medial, superior lateral, and inferior medial genicular nerves to cut off the supply of pain signals to the central nervous system. Once all of the affected nerves have been treated, the needle will be removed and the incision closed.
After the procedure, patients are sent to a separate room to recover. It could take a while for the sedative to wear off; therefore, patients should have a friend or loved one drive them home following treatment. While radiofrequency genicular neurotomy is a safe, effective, and minimally invasive therapeutic procedure for chronic knee OA patients, it can produce adverse effects. Patients should call Orthopedic and Wellness immediately if they begin to experience increased pain, redness, swelling, itching, or an infection around the surgical site. Ice and mild anti-inflammatory medications can usually be applied or taken 1-2 days after the procedure to lessen a patient’s discomfort. This treatment can be repeated if the nerves regenerate.