Genicular Neurotomy: A Novel Approach To the Management Of Knee Pain

By Haddis Hagos, MD

Washington Metro Pain Institute

. http://www.metropain.org

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Genicular Neurotomy: A Novel Approach To the Management Of Knee Pain

Knee pain is a common complaint among many patients. It is one of the most common reasons that patients seek medical attention from a physician (general practitioners, orthopedists, rheumatologists, and pain management specialists).

The cause of knee pain arises from several factors. These include factors originating from inside the knee joint, those from around the joint, and that referred from nearby structures like the hip, femur bone and tibia and fibula bones.

Some of the common causes of knee pain from inside the joint include arthritis, infection, fracture, tumor, chronic dislocation of the patella, joint instability, foreign body, patellofemoral syndrome, and hemarthrosis, which is blood formation in the joint. Causes of knee pain attributable to structures around the knee joint includes bursitis, tendonitis, joint instability, muscle strain, muscle sprain, infection around the joint which does not involve the joint space, and adhesive capsulitis (frozen joint). Knee pain can also be caused from systemic disease and some of the most common cases of these are rheumatoid arthritis, gout, Reiter’s syndrome, collagen vascular disease, among others.

Though less common, knee pain can also be caused from other areas of the body. These include lumbar radiculopathy (commonly referred to as sciatica), lumbar spondylosis (degeneration in the spinal discs), fibromyalgia, myofascial pain syndrome, inguinal hernia, nerve entrapment, and pelvic tumors.

Knee pain can be acute or chronic. When the pain is acute in the absence of trauma, it warrants seeking medical attention as some conditions associated with acute knee pain can cause serious damage to the joint, such as bleeding into the joint especially in patients on blood thinners. On the other hand, the prevalence of chronic knee pain has increased over the years. Osteoarthritis of the knee is a common disorder among older adults. Chronic osteoarthritis of the knee is often not effectively treated with our current pharmacological and interventional treatments. As an alternative to current treatment options, a new technology has been developed to effectively treat knee pain: genicular nerve radiofrequency ablation.

Genicular nerve radiofrequency ablation is a new cutting edge treatment currently used to treat osteoarthritis of the knee in patients who have not been effectively treated by current management techniques, those who want to delay surgery, and those who have had knee surgery and failed to have relief of their pain.

The procedure is performed in two stages. These include a diagnostic genicular nerve block and the genicular nerve ablation. The genicular nerve block is a test injection that consists of injecting a small amount of local anesthetic to the genicular nerves. If the patient has sufficient response to the test with significant pain relief, then this justifies going forward with the genicular nerve ablation. The nerve radiofrequency ablation is the therapeutic treatment in which a specialized type of radio wave is applied to the nerves to effectively relieve the pain, provide long-term relief and restore function to the patient. The radiofrequency ablation works by shocking the nerves that supplies pain to the knee and stop them from sending signal to the brain.

While this is a neuro-destructive procedure, the nerves do grow back. The same technology has been used for years in treatment of neck and back pain with excellent success. One of the advantages of this procedure is the fact that it is performed outside of the knee joint.

This procedure is indicated for a number of conditions including osteoarthritis, degenerative joint disease, chronic knee pain, patients who have undergone total or partial knee surgery, patients who are not candidates for knee replacement, and those who want to avoid surgery totally. If you or someone you know suffers from any of the above conditions, contact your local pain management doctor to further discuss this treatment option.