Safety and Efficacy of Genicular Nerve Radiofrequency Ablation for Management of Painful Total Knee Replacement: A Systematic Review.

Naga Cheppalli,Solomon F Oloyede,Amit W Bhandarkar,Senthil Sambandham

doi:10.7759/cureus.19489

Abstract

Painful total knee replacement (TKR) without an obvious underlying identifiable pathology is not uncommon. Dissatisfaction after TKR can be up to 20%. Different treatment modalities, including non-operative and operative procedures, have been described in the literature. Radiofrequency ablation of genicular nerves (GNRFA) is emerging as a newer treatment modality for painful TKR without an obvious underlying identifiable pathology. Despite a modest number of publications demonstrating the usefulness of GNRFA in managing pain in knee osteoarthritis, the efficacy of GNRFA has not been completely established in the management of residual pain after TKR. This systematic review aimed to analyze all published studies (nine studies) on GNRFA as an option to manage residual pain after TKR. Based on this current systematic review, we noted that GNRFA is a modality to treat post residual pain and patients can anticipate improvement in pain up to three months with minimal complications. This article provides an overview of the currently available knowledge and techniques employed for this procedure, as well as the expected outcome and safety profile of GNRFA in painful TKR.

Highlights

IntroductionDissatisfaction after total knee replacement (TKR) can be up to 20% [1]
BackgroundDissatisfaction after total knee replacement (TKR) can be up to 20% [1]
Despite a modest number of publications demonstrating the usefulness of GNRFA in managing pain in knee osteoarthritis, the efficacy of GNRFA has not been completely established in the management of residual pain after TKR

Summary

Introduction

Dissatisfaction after total knee replacement (TKR) can be up to 20% [1]. The most common cause of dissatisfaction after TKR is residual pain in the joint. The reasons for a painful knee TKR include infection, aseptic loosening, instability, malalignment, neuroma, and other rare causes [2]. Sometimes it is difficult to ascertain any identifiable pathology as a cause of pain despite extensive workup. Periarticular/intra-articular steroid injections are controversial options as there is an increased risk of infection [4,5]. Most surgeons agree that revising TKR is a more invasive option and may result in unpredictable outcomes for the subset of patients whose identifiable cause for post-TKR residual pain is unknown [1]

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Conclusion