Cooled Radiofrequency Ablation of Genicular Nerves for Knee Osteoarthritis Pain: A Protocol for Patient Selection and Case Series

Chronic knee pain from osteoarthritis (OA) is common in the aging and the obese population. Radiofrequency ablation of the genicular nerves has been introduced as a potential surgery-sparing treatment for chronic knee pain from OA, yet only two outcome studies have been published and optimal patient selection for this procedure has not been established. We describe a standardized protocol for selecting patients for cooled radiofrequency ablation (C-RFA) of the genicular nerves, as well as the clinical outcomes of four patients ages 63-65 years. The threshold for selection based on diagnostic genicular nerve block was ≥ 80% pain reduction. Following successful block, C-RFA of the genicular nerves was performed. Outcomes included pain, function, analgesic medication use, opioid use, and progression to total knee arthroplasty at a minimum of 6 month follow up. C-RFA of the genicular nerves after using the described selection protocol resulted in > 90% pain reduction, improved function and avoidance of surgery at 6 months in all four cases. All opioid and analgesic medication use decreased or was unchanged in all cases. No serious adverse events occurred. The accompanying case series suggests that this protocol is deserving of randomized, prospective study.