Radiofrequency neurotomy may be successful alternative treatment for knee osteoarthritis

Nov 14 2013

Chronic knee osteoarthritis (OA) is the deterioration of articular cartilage and is one of the most common diseases of aging. Millions of Americans have been diagnosed with knee osteoarthritis. OA often results in pain, restricted movement, sleep disturbance, and functional disability. Medication therapy is often of limited benefit for OA pain. Moreover, the use of anti-inflammatory drugs is associated with serious side-effects, such as bleeding and stomach ulcers. Non-surgical interventions including joint injection with steroids or hyaluronic acids, acupuncture and periosteal stimulation therapy, are often used as complementary therapies, but are not sufficient to control chronic severe knee OA pain. Although surgery is generally effective for patients with advanced disease, individuals with multiple medical conditions may not be appropriate surgical candidates. In patients who have failed traditional therapies, radiofrequency (RF) neurotomy might be a successful alternative minimally invasive treatment with low risk of complications.

This procedure is based on a theory that blocking the nerve supply to a painful area may alleviate pain and restore function. The knee joint is innervated by the articular branches of various nerves, including the femoral, common peroneal, saphenous, tibial, and obturator nerves. These branches around the knee joint are known as genicular nerves. Several genicular nerves can be easily approached with a needle under fluoroscopic guidance. Patients can get a diagnostic genicular ("G Block") nerve block to determine if this will provide adequate relief.

Two procedures are done to provide relief to patients. First, a diagnostic "G Block" procedure is done and if it provides good relief with improved function then a second procedure, RF ("G-RF") genicular neurotomy is done to provide long term relief.

The fluoroscopic images displayed show the anteroposterior and lateral views of the left knee joint. RF electrode tips were placed on periosteal areas connecting the shaft of the femur to bilateral epicondyles and the shaft of the tibia to the medial epicondyle. Superior medial, superior lateral and inferior medial genicular nerves supply pain signals back to the central nervous system.

In summary, G-RF seems to be a safe, effective, and minimally invasive therapeutic procedure for chronic knee OA patients with a positive response from a diagnostic "G-block." G-RF neurotomy can also be repeated if necessary when nerves regenerate. This technique may be a useful treatment for chronic severe OA pain refractory to other conservative treatments. This procedure has also been tremendously helpful for patients who have had prior knee surgeries with ongoing persistent pain.