by Raj N. Sureja, MD
As an Interventional Pain Management Specialist, I treat individuals whose pain is not relieved by first line treatment or even surgical procedures. Knee pain can be cause by a wide number of medical conditions, some of which include osteoarthritis, degenerative joint disease, and chronic knee pain. Besides these conditions, knee pain can also be a result of a medical procedure done on the knee such as a partial or total knee replacement surgery. Whatever the cause of the knee pain, genicular nerve neurotomy is a nonsurgical treatment option.
The genicular nerves supply the knee joint and muscles surrounding the knee with communication from the brain on how to move, bend or jump. These nerves can become inflamed or injured as a result of a medical condition or after surgery. Conversely, knee pain can be controlled effectively by blocking the communication from the genicular nerve to the brain, especially when the nerve is transmitting constant pain signals.
Genicular nerve neurotomy is a groundbreaking, two-part procedure that effectively relieves pain in the knee by treating the genicular nerves and blocking their pain transmission. The first stage is the Diagnostic Genicular Nerve Block in which the physician injects a small amount of local anesthetic on the genicular nerve. This initial procedure will inform the physician as to the patient’s response as well as whether or not the pain relief is enough (at least 50% pain reduction) to warrant the second stage. The second stage of the procedure involves a Genicular Nerve Ablation. In this procedure, a radiofrequency ablation (RFA) is performed on the genicular nerve branches to disrupt the pain signal for an extended period of time, thus providing long-lasting pain relief.
The benefits of genicular nerve neurotomy include the fact that the entire process is completed outside of the knee capsule, reducing the risk of joint infection, and does not require any steroid/ cortisone, hyaluronic acid, or other medicine to be injected into the knee joint. The relief gained from this procedure typically takes effect within 4-6 weeks after the RFA process and can last up to a year or longer. Other benefits include the ability to implement the procedure either before or after surgery, is performed using small probes without an incision, and is performed using a small amount of local anesthetic. This can typically be performed safely in the doctor’s office, and in most cases the patient is able to return to work later that day.
Genicular nerve neurotomy can even provide advantages to patients who require a knee replacement surgery. Performing RFA before the surgery not only alleviates pain during the months prior, but also allows the patient to begin physical therapy sooner by decreasing postoperative pain.
Cortisone or hyaluronic acid injections are alternative options to genicular nerve neurotomy that also relieve pain in the knee. In cases where these treatments or other surgical treatments prove ineffective, genicular nerve neurotomy may be a possibility. Patients experiencing knee pain can talk to me and together we can determine if diagnostic genicular nerve blocks and RFA are suitable pain relieving treatments for their condition. I may recommend this procedure either in lieu of or in conjunction with knee surgery and will work closely with your OSC Orthopaedic surgeon to determine the best course of treatment for you.