Radiofrequency Genicular Nerve Ablation Cuts Off Knee Pain Signals
If you’ve been following my column over the past 14 months, you’ve read about the knee pain and swelling that I went through last year, along with multiple cortisone injections, fluid drainage, physiotherapy and medical exercise.
The good news is that I am now pain and swelling free and have returned to activities I couldn’t do last year. A big reason for my recovery has been due to the guidance and treatment provided by orthopedic surgeon Dr. Alex Rabinovich.
I’ve been meeting with Dr. Rabinovich every three months since December 2018 for him to check on my knee and treat it when necessary. At my last visit, we were chatting about a client of mine who is considering knee replacement surgery. Dr. Rabinovich described an alternative to surgery he has added to his practice. It sounded like something several of my clients might be interested in, so I decided to devote this week’s column to it.
The procedure that Dr. Rabinovich described is less invasive than total knee replacement and has a high rate of satisfaction from patients. It is a non-surgical approach to treating the pain associated with osteoarthritis of the knee. It can be performed in the office .
High quality studies show the majority of patients undergoing the ablation procedure has more than 50 per cent pain relief for up to two years, while 20 to 30 per cent of patients who had a total knee replacement regretted having the procedure done.
Providing Better After Care For Patients
We’re funding research which aims to provide a standardised approach and assessment for virtual clinic follow-up of total joint replacement patients and subsequent management of patients identified as ‘at risk’ by this approach. This study would enable us to deliver better and more streamlined after care for patients.
The Current Literature Demonstrates The Potential Benefits Of Utilizing Concentrated Bone Marrow Aspirate For The Repair Of Cartilaginous Lesions Bony Defects And Tendon Injuries
Doctors in New Jersey at the Department of Orthopedic Surgery, Jersey City Medical Center published their findings in support of this research, in the World Journal of Orthopedics, here is what the paper said:
- The current literature demonstrates the potential benefits of utilizing concentrated bone marrow aspirate for the repair of cartilaginous lesions, bony defects, and tendon injuries in the clinical setting. The studies have demonstrated using concentrated bone marrow aspirate as an adjunctive procedure can result in cartilage healing similar to that of native hyaline tissue, faster time to bony union, and a lower rate of tendon re-rupture.
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How Cartilage Restoration Relieves Pain And Retains Mobility
Ligaments connect bones together in a joint. A standard knee replacement removes two ligaments: the anterior cruciate ligament and posterior cruciate ligament . Losing these ligaments means your body loses its ability to know exactly where the knee joint is in relation to its other parts a sort of sixth sense known as proprioception. Proprioception is key to movement. It lets you perform motor tasks like walking without having to think about them. Removing the ligaments in your knee throws that sense out of whack.
In cartilage restoration, we replace arthritic knee cartilage with cartilage from a healthy part of the joint or with a synthetic cartilage-like substance. This way we can patch problematic areas without removing the ligaments. Its like fixing a pothole on your knee. This procedure, called an autograft arthroplasty or an osteochondral autograft transplant, allows people with arthritis in a certain part of their knee to remain active without the mobility restrictions of a full knee replacement.
Surgeons can even reconstruct ligaments that have been damaged by trauma alongside cartilage restoration, giving people with torn ligamentsa common sports injurynew hope of being active again.
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How We Treat Arthritis With Knee Replacement Surgery
To understand whether you may be a candidate for a knee replacement alternative such as cartilage restoration, its good to know a bit about arthritis and how we treat it with standard knee replacement surgery.
The knee joint connects your femur to your tibia . Cartilage covers the areas where these bones come together, allowing them to move against each other as you bend and straighten your leg without too much friction.
Unlike bones, cartilage does not receive blood flow, so it doesnt heal as easily. As we grow older, cartilage tends to wear down, causing inflammation and pain as bones rub against each other without the protective padding of cartilage. This wear and tear is called osteoarthritis, and its most common among people older than 50.
Osteoarthritis is often treated with knee replacement surgery also known as knee arthroplasty. In this procedure, a surgeon replaces arthritic parts of the knee with prosthetic parts. With total knee replacement, a surgeon basically installs an entire artificial knee, removing arthritis in the process.
We perform hundreds of knee replacements each year, and the demand for this surgery is growing. A 2007 study found that U.S. surgeons performed about 700,000 knee replacements every year, but thats expected to rise to nearly 3.5 million procedures by 2030!
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Do I Need A Knee Replacement
If your arthritis isnt responding to non-surgical treatments, you may consider undergoing knee replacement surgery. You mayneed a knee replacement if your knee gives you pain, stiffness, instability or loss of function that affects your daily life andactivities. Knee replacements are most common surgery for osteoarthritis.
If your symptoms are still manageable through conservative therapies and/or your medication is effective, then you may choose to notundergo surgery.
Your orthopaedic surgeon will be able to advise you on the surgical options and on the potential pros and cons of having or delayingsurgery, taking into account your age, health and level of activity.
Most people who have a knee replacement are over 60 years of age. If youre under the age of 50 and decide to go ahead with aknee replacement, then youre more likely to need a repeat operation in later life. However, there is evidence that the surgicaloutcome may be better if you dont wait until the knee becomes very stiff or deformed.
Unfortunately, some people may not be able to have a knee replacement even though their arthritis may be severe:
- If the thigh muscles are very weak they may not be able to support the new knee joint
- If there are deep or long lasting open sores in the skin below the knee the risk of infection may be too great to consider surgery.
- However, there may be other options available to help. This includes:
- Joint injections of Viscosupplementation agents
- Knee braces
What Are The Typical Outcomes Of A Knee Replacement
Recent studies have shown us that there is a significant number of patients who are unhappy with their knee replacement. This is measured by standardised, objective and subjective questions providing knee function scores and quality-of-life scores.
10% of patients will have a fantastic result with zero pain. 70% of patients will feel significantly better but are partly dissatisfied because the knee doesnt feel completely normal .
20% of patients will have a bad result and a small portion having worse pain than before. They may complain of instability and clunking as the knee is straightened.
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Hyaluronic Acid Injections Or Viscosupplementation For Knee Osteoarthritis
Much like cortisone, it is very likely that this knee injection treatment has been explained to you already by your orthopedist. It is a conservative care plan to help you try to manage along until you can get a knee surgery scheduled or you are trying to do everything you can to avoid the knee surgery.
Also like cortisone, you may have already had viscosupplementation and the effects and benefits have now worn off and you need to treat your knee differently. For some people, they may not even be reading this sentence because they have moved down the article to other treatments because this one is no longer an option for them.
Over the years we have seen many patients who have been on the gel shots. These shots are more known by their brand names: Euflexxa ®, Supartz ® Supartz FX ®, Synvisc-One ®, Synvisc ®, Hyalgan ®, Orthovisc ®, et al. All these products offer subtle differences in their treatment goals including the number of injections however, none of them offer a permanent solution. This is what the American Academy of Orthopaedic Surgeons posted on their website:
The theory is that adding hyaluronic acid to the arthritic joint will facilitate movement and reduce pain. The most recent research, however, has not found viscosupplementation to be effective at significantly reducing pain or improving function. Although some patients report pain relief with the procedure, some people are not helped by the injections.
Lets let Dr. Leopold continue:
Two Ways To Help Avoid A Knee Replacement
- Weight Loss And Exercise: By losing weight you are helping put less stress on your knees. Just by losing a few pounds can take a tremendous amount of stress off of your knee. You can achieve weight loss by exercising regularly.
- Physical Therapy: Working with a physical therapist can help you come up with a plan to help take some stress off of your knees. Physical therapists can make sure that you are doing exercises properly and giving your knee the right therapy it needs.
As with any form of medical treatment, you should consult with your physician before embarking on any treatment plan. The information contained in this article is for informational purposes only and should not be deemed accurate for the purposes of diagnosing your particular medical condition.
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Pain After Knee Replacement
Patients get this surgery to reduce pain, so it comes as a surprise to many that a good chunk of knee replacement patients still have knee pain after this invasive surgery. For example, in one recent study, nearly 40% reported that they still had 3-5/10 despite getting a knee replacement . In a different study, some 44% of patients still had moderate pain 3-4 years after surgery . Hence, if you think that this surgery is a sure thing for solving your knee pain, you should be looking for knee replacement alternatives.
Helping Patients To Make Informed Decisions
We’re funding research to improve patient experience before, during and after knee replacement surgery. This includes a project based at the University of Sheffield which aims to help patients make informed decisions about their surgery. The research team will use the UK National Joint Registry dataset to develop and validate a personalised, web-based decision aid to help patients considering knee joint replacement to make informed choices about their treatment.
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Unicondylar Knee Replacement Alternative To Total Knee Replacement
Is walking with osteoarthritis knee a daunting experience for you? is knee pain-killing you while climbing upstairs? Then unicondylar knee replacement can be helpful for you.
Partial knee replacement or unicondylar knee replacement is considered a potential alternative to total knee replacement for those suffering from osteoarthritis or damage confined in one knee compartment.
Earlier, knee replacement was considered an option for the elderly. Today, with improvements in implant and surgery techniques, all patients affected with knee osteoarthritis can benefit from unicondylar knee replacement.
The Different Types Of Knee Injections As An Alternative To Knee Replacement Surgery
We have given a lot of research and tried to present information on the good and bad of knee replacement. Again we want to stress that many people do very well with knee replacement surgery. These are people that we do not see at our center. We see the people for whom knee replacement is not an option because the person is not a good surgical candidate, the person who cannot wait any longer for knee replacement and needs to do something now. We also see the person who is working and cannot take the time off from work or the person who is a caregiver to a partner or spouse and they themselves cannot be laid up, for months.
Here we are briefly going to present the various knee injection options that may help you avoid knee surgery. We have a much more comprehensive article with expanded research here: The different types of knee injections.
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More Than 600000 People Undergo Knee Replacement Each Year In The United States Alone
For this reason, more than 600,000 people undergo knee replacement each year in the United States alone. Demand for the procedure is steadily rising, and half of all patients are under the age of 65.
Many people obviously feel that total knee replacement is their only chance to find relief from their pain and reclaim a life of mobilitybut this doesnt mean that the procedure is done without risks.
In fact, despite its widespread practice, knee replacement carries many potential side effects and complications, including severe pain, scar tissue formation, bleeding, wound hematoma, infection, dislocations and fractures, nerve and other tissue damage, and even life-threatening blood clot conditions like deep vein thrombosis and pulmonary embolism.
Even if no complications occur, recovery from knee replacement is very lengthy with swelling and pain possible for the next six months. This may feel like the only option for some peoplebut its certainly not a great one.
Nerve And Other Tissue Damage
There’s a small risk that the ligaments, arteries or nerves will be damaged during surgery.
- Fewer than 1 in 100 patients have nerve damage and this usually improves gradually in time.
- About 1 in 100 have some ligament damage this is either repaired during the operation or protected by a brace while it heals.
- About 1 in 1,000 suffer damage to arteries that usually needs further surgery to repair.
- In about 1 in 5,000 cases blood flow in the muscles around the new joint is reduced . This usually also needs surgery to correct the problem.
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What Are Knee Replacement Alternatives In Treating Knee Arthritis
When steroid injections no longer work, another option would be viscosupplementation, which is a lubricant-type injection that we actually inject into the knees in a series of five shots. If all of these measures fail, then the other option would be a total knee replacement.
Now We Can Design a Custom Knee if You Need Total Knee Replacement
There have been many advancements in the area of total knee replacements over the last few years. Now we can actually give you a custom knee, whereas previously a surgeon had to rely on standard tools that were made forone-size-fits-all type of procedures. Please see our article about the Vanguard Complete Knee.
We can take an MRI of your knee, look at your body anatomy and your alignment from your hip, knee to your ankle joint, and send that MRI to a knee implant manufacturer. The knee manufacturer builds custom jigs that allow us to map your knee and place the implant according to your anatomy. We hope this will increase the longevity of total knee replacements past the current expected outcome of about 15 years.
A Partial Knee Replacement may be an Option
Left knee-joint from behind, showing interior ligaments.
polyethylene here that allows it to glide and slide. This can significantly help a patients pain and allow her to get back to regular activities. But you can only do this in a patient that has isolated arthritis on the medial side of the knee. Heres more information about the partial knee.
Troubled By Knee Arthritis But Not Ready For Knee Replacement Here Are 5 Alternatives
Millions of Americans suffer from knee arthritis, which can cause pain, stiffness and a decrease in activity level and quality of life. Eventually, this often leads to knee replacement surgery, which remains the most effective treatment for permanent pain relief. However, knee replacement should be reserved as a last resort. There are several minimally invasive options you and your surgeon can try before committing to knee replacement surgery:
MAKING THE DECISION
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What About Exercise Following A Knee Replacement
Exercise and sport are recommended after knee replacement, apart from contact sports, which may weaken the cement and lead to loosening of the joint components. Recreational sports including golf, tennis and skiing will gradually become possible depending on how fit and sporty you were before the operation. Cycling is a very good way of building up strength and mobility after knee surgery.
Exercising the main muscle groups around your knee is very important both before and after having a knee replacement. You can download a selection of exercises that are designed to stretch, strengthen and stabilise the structures that support your knee. Try to perform these exercises regularly, for instance for 10 minutes six to eight times a day. However, its important to find a balance between rest and exercise so you dont overwork your knee. Its a good idea to get advice from your doctor or physiotherapist about specific exercises before you begin.