Radiofrequency  Ablation  of Genicular Nerve in OA Knee

Author: L. Jacob

Introduction

Radiofrequency ablation is a procedure in which pain signals from the knee joint to brain are interrupted by heat lesson thus eliminating pain. In OA knee genicular nerves are ablated to reduce pain.

Nerve Supply of Knee joint

The knee joint consists of just three bones: the femur, tibia, and patella.

These bones are held together by a complex cartilage, ligaments, and tendons. Cartilage helps to cushion and lubricate the bones. Ligaments connect the bones to each other. Tendons connect the muscles to the bones.

Nerve supply to knee is by a network of nerves from femoral, common peroneal, saphenous, tibial and obturator nerves. These nerves are broadly known as genicular nerves.

Indication for RF in OA knee

• Chronic Osteoarthritis

• Patients failed with knee replacement surgery

• Patient not fit for knee replacement surgery

• Patient who want to avoid surgery

Contraindication for RF in OA knee

Absolute contradictions

• Patient refusal

• Infection at site of injection or systemic infection

• Unstable medical conditions

Relative contraindications

• Any process that absolutely destroys bone like osteopenia

• Insufficiency of abductor musculature

• Progressives neurological disorders

Procedure

Diagnostic nerve block of the three genicular nerves (superior lateral genicular nerve, superior medial genicular nerve, inferior medial genicular nerve) around the knee. This is done in as an outpatient under local anaesthesia with fluoroscopic or ultrasound guidance, if the pain relief is more than 70%, then this patient is a good candidate for RF.

After the initial period of post-procedure discomfort, patients will typically realise significant relief of their knee pain for between six months and one year, sometimes even longer.

The duration of pain relief is approximately six months to one-year because the genicular nerves will regenerate (as will any nerve after radiofrequency ablation).

When the pain returns, the procedure can be repeated with similar efficacy. There is no limit to the number of times the procedure can be repeated. As a result, this can be a durable long-term solution for patients who are unable to undergo knee replacement surgery.

Complication in RF

RF neurotomy is an extremely low-risk procedure with the usual complications associated with interventional procedures involving the peripheral nerves (bleeding, infection and allergic reactions to medications used for the procedure).

Conclusion

In conclusion, RF is a promising technique for the palliative management of chronic pain unresponsive to conservative treatments.

Author's Name: Dr Leno Ninan jacob

Email: lenoninan23@gmail.com
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