PAIN FROM KNEE OSTEOARTHRITIS
Pain as a result of knee arthritis is a common condition that affects many patients referred to us at Northwest Pain Management.
While total knee replacement is the definitive treatment for end-stage knee arthritis, many of the patients referred to us are unable to have a knee replacement. They may be too young, have medical co-morbidities that make surgery too risky, or have other issues which make surgery difficult or impossible to perform. We also see the occasional patient who has persistent knee pain after knee replacement surgery.
TRADITIONAL TREATMENT FOR PAIN FROM KNEE ARTHRITIS
Treatment for pain from knee arthritis has historically consisted of medical management (NSAIDs and opoids) and selective joint injections (corticosteroid or viscosupplementation).
Unfortunately, the medical management of knee arthritis is associated with undesirable side effects. Chronic NSAID use can lead to gastric ulceration/bleeding and kidney failure. Chronic opoids use risks the triggering of addictive disorders and less severe complications such as constipation, nausea, vomiting, and androgenic hormone suppression
NEW TREATMENT FOR PAIN FROM KNEE ARTHRITIS
RADIOFREQUENCY (RF) NEUROTOMY OF GENICULAR NERVES
Northwest Pain Management has recently begun offering a new treatment modality for painful arthritic knees. Genicular nerve radiofrequency neurotomy substantially reduces pain from knee arthritis. It is ideal for patients who are poor candidates for surgery or who have persistent knee pain after surgery.
HOW ARE PATIENTS EVALUATED?
Patients are evaluated using the same treatment paradigm used to successfully treat cervical and lumbar facet joint pain using radiofrequency neurotomies:
Step 1 : Diagnostic nerve block of the three genicular nerves about the knee (see Figure 1). This is done as an outpatient under local anesthesia with fluoroscopic guidance.
Step 2 : Observe pain relief in response to block. A patient who experiences 80% to 100% pain relief is a good candidate for RF neurotomy of the genicular nerves around the knee. The RF procedure destroys the same nerves that are producing the pain as evidenced by the response to the diagnostic block.
RF NEUROTOMY PROCEDURE
The RF neurotomy procedure is performed in an outpatient facility under local anesthesia (some patients may prefer light sedation). After the procedure, there can be some minor discomfort that can last up to several weeks.
After the initial period of post-procedure discomfort, patients will typically realize significant relief of their knee pain for between six months and one year—sometimes longer.
The duration of pain relief is approximately six months to one year because the genicular nerves will regenerate (as will all nerves after radiofrequency treatment).
When the pain returns, the procedure is can be repeated with similar efficacy. There is no limit to the number of times the procedures can be repeated. As a result, this can be a durable long-term solution for patients who are unable to undergo knee replacement surgery.
COMPLICATIONS AFTER RF NEUROTOMY
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).
Theoretically, there could be injury to the vascular supply to the knee. However, we are unaware of any case reports of this occurring after RF neurotomy of the genicular nerves.
OUTCOMES AFTER RF NEUROTOMY
Patients who experience excellent relief after a diagnostic block typically have a 70% response rate after treatment with RF neurectomy.
RF neurectomy is an exciting new procedure that allows us to provide pain relief for patients with knee arthritis who otherwise would not have access to low-risk, efficacious treatments.
Medicare covers the diagnostic blocks and RF neurotomy procedure. Commercial insurers cover the diagnostic blocks but do not cover the RF neurotomy procedure for knee arthritis.
Northwest Pain Management can do the RF neurotomy procedure in the office, which minimizes the out-of-pocket cost for patients with commercial insurance.
Please feel free to contact Northwest Pain Management if you have any patients you think might benefit from RF neurotomy for knee arthritis.
Figure 1
Figure 2