Radiofrequency Ablation For Knee Pain

Post Radiofrequency Ablation Of Spinal And Peripheral Joints

Patients can go home the same day of a radiofrequency ablation procedure, but are asked to refrain from driving and participating in rigorous activities for 24 hours.

Pain relief from radiofrequency ablation typically lasts somewhere between six months to one year, but will vary for each person, depending on the intensity of the pain and the location. Some patients may even experience pain relief for several years.

Is Radiofrequency Ablation Painful

The RFA procedure can be mildly uncomfortable during the 90 seconds that the nerve is being denervated, Dr. Chen says. Some physicians use light sedation, she says, but the patient has to be conscious so they can give feedback to the doctor.

Afterward, there can be some initial discomfort after the procedure, and the physician may give a small dose of steroid medication to decrease local inflammation from the procedure, Dr. Chen says. Dr. Kapasi says knee patients may have some soreness post-injection on the day of the procedure, and although unlikely, some transient knee numbness can occur later.

How Do I Prepare For Radiofrequency Ablation

To prepare for radiofrequency ablation treatment, you should take a few precautions, including:

• Do not eat within six hours of your appointment however, you may have clear liquids until two hours before the procedure.
• If you have diabetes and use insulin, you must adjust the dosage of insulin the day of the procedure. Your primary care doctor will help you with this adjustment. Bring your diabetes medication with you so you can take it after the procedure.
• Continue to take all other medications with a small sip of water. Bring all medication with you so you can take it after the procedure. Please note: Do not discontinue any medication without first consulting with your primary or referring doctor.
• You will need to bring someone with you to drive you home after the procedure. You should not drive or operate machinery for at least 24 hours after the procedure.

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Is Rfa Suitable For Treating Knee Osteoarthritis Condition

Radiofrequency Ablation is based on the theory that blocking sensory nerves can alleviate pain and re-establish functionality. You should know that the knee joint is supplied by articular branches of many nerves, including tibial, saphenous, femoral, common peroneal, and obturator nerves.

If traditional treatments for chondrosis have failed, then RFA is suitable for treating the condition. Experts usually recommend losing weight, physical therapies, knee support, or pain killers to cure the condition. Sometimes, corticosteroid and hyaluronic acid injections are also used to heal the condition.

If the pain and weakened function continue, a knee replacement is recommended. A few people cannot undergo surgery due to risks caused due to underlying medical conditions. Surgery may be preferred for young and fit people.

Radiofrequency Ablation In The Pain Management Of Knee Osteoarthritis

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Genicular Nerve Block & Radiofrequency Ablation Of Knee Joint

Chronic osteoarthritis pain of the knee is often not effectively managed with prescribed medications. Radiofrequency ablation, when applied to articular nerve branches , provides a therapeutic alternative for effective management of chronic pain associated with osteoarthritis of the knee.

Although surgery is generally effective for patients with advanced disease, some older individuals with other chronic conditions may not be appropriate surgical candidates. In addition some patients do not wish to consider surgery and prefer non- surgical options. In these patients, radiofrequency ablation of the genicular nerves might be a successful alternative to surgery. This procedure is based on the theory that cutting the nerve supply to a painful structure may alleviate pain and restore function.

Genicular Nerve Block

Patients with chronic knee pain that has failed to respond to conservative care may be candidates for a genicular nerve block. This procedure is based on a theory that blocking the nerve supply to a painful area may alleviate pain and restore function. The knee joint is innervated by the articular branches of various nerves, including the femoral, common peroneal, saphenous, tibial, and obturator nerves. These branches around the knee joint are known as genicular nerves. Several genicular nerves can be easily approached with a needle under fluoroscopic guidance. Patients can get a diagnostic genicular nerve block to determine if this will provide adequate relief.

Does Pain Mean The Procedure Didnt Work

Having pain following radiofrequency ablation doesnt mean the procedure didnt work. Radiofrequency ablation often reduces pain, but it may not take your pain away entirely.

If you have radiofrequency ablation for neck or back pain, your doctor will likely consider the procedure successful if you have at least a 50 percent reduction in pain. In fact, some doctors even use a pain reduction of 30 percent or two points on the pain scale as a baseline for success.

In addition, improvements to functionality and quality of life are as important as pain reduction. So, even if you still have some pain, your ablation may be considered successful if you are more active or mobile than you were before the procedure.

Radiofrequency ablation is not permanent. For most people with chronic pain, the effects will last about or longer. After that, the nerves will regrow and the pain can come back.

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Are There Harmful Side Effects Of Radiofrequency Ablation

The most important thing to avoid adverse effects post-procedureis to go to a doctor who performs RFA regularly. Care needs to be taken to isolate the nerve being targeted so that the correct nerve is targeted, and the nerve is completely denatured, Dr. Chen says. Inadequate ablation may result in increased pain or altered sensation.

CreakyJoints has heard from patients who had bad reactions to the procedure. I have been bedridden since the ablation, Sally, who had the procedure last month, wrote on our website. The pain is so severe and intense that I cant even describe how awful it is. An increase in pain is not a common side effect, so let your doctor know right away if you experience it.

Is Rfa Right For Your Knee Osteoarthritis

RFA is appropriate only after traditional therapies have been tried, says Dr. Schaefer. Knee osteoarthritis is primarily treated with weight loss, physical therapy, pain medications such as acetaminophen and nonsteroidal anti-inflammatories including ibuprofen and naproxen and possibly a knee brace. Injections of corticosteroids or hyaluronic acid may also be used.

If pain and impaired function persist, the next step often is knee replacement. But some people arent able to undergo surgery because of medical conditions that put them at high risk for complications from the surgery or anesthesia. Still other people are young enough that putting off surgery is preferable.

Were seeing younger and younger people develop knee osteoarthritis. We need an alternative because the knee implants can fail in 10 to 20 years, and then the surgery needs to be redone.

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Common Concerns About Radio Frequency Ablation:

• Patients are frequently concerned that, without the ability to feel sensation through these nerves, they may cause an injury to either the joints or the back. There is no scientific evidence to support this happening. In the many years that RFA have been performed, this has not been found to occur.
• Another concern is that by damaging nerves, pain will be caused rather than relieved. There is a small chance that the pain will worsen after the procedure. This is believed to be from increased irritation of a nerve that was only partially damaged, not completely destroyed. This can be treated with medication and usually goes away in several months. It is less common in the mid and low back than in the neck, and is most common at higher levels of the neck.

Comparison With Previous Studies

In 2018, Hong et al. performed a systematic review and meta-analysis that included 12 RCTs with 841 patients and suggested that the use of RF could decrease the pain scores of patients at 1 week, 1 month, and 3 months after treatment, but revealed no significant improvement in knee function, which is inconsistent with the results of our meta-analysis and those of Zhang et al. . Differently from our study, the negative effect on knee function in the previous systematic review by Hong et al. was evaluated by OKS, while the WOMAC score was not considered. The WOMAC score is widely applied in the evaluation of hip and knee OA for assessment of the activities of gait, daily living, general health, functional mobility, and quality of life, and has been identified as one of the highest performing outcome measures in terms of validity, reliability, interpretability, and responsiveness . Furthermore, although the results for the effectiveness and safety of RF treatment were consistent between the current meta-analysis and previous meta-analyses by Zhang et al. and Li et al. , the heterogeneity requires further analysis. In the present study, subgroup and sensitivity analyses were performed on RCTs to test the robustness of the pooled results and explore the potential sources of heterogeneity in our meta-analysis.

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How Does Rfa For Chronic Knee Pain Work

Radiofrequency ablation uses radio waves to create a heat lesion around the genicular nerves. The genicular nerves are responsible for carrying pain signals from the knee to the brain. Usually performed under local anesthesia, a needle is guided to the genicular nerves using real-time X-ray technology. Once it has been established that the correct nerve is targeted, heat is applied to create a lesion that blocks pain signals.

Contact Atlantas Premier Pain & Wellness Center

Whether youre considering a genicular nerve radiofrequency ablation or a lumbar radiofrequency ablation, learn more about your candidacy and the benefits and risks at Summit Spine & Joint Centers. Our Georgia pain clinic helps patients experiencing a variety of acute and chronic pain conditions to improve their discomfort and live a pain-free life. Call us today at 962-3642 or contact us online!

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Who Is A Candidate

Radiofrequency ablation is a treatment option for patients who have experienced successful pain relief after a diagnostic nerve/pain receptor block injection.

Radiofrequency ablation is done using fluoroscopic guidance and should NOT be performed on people who have an infection, are pregnant, or have bleeding problems.

How Does Radiofrequency Ablation Work

Radiofrequency ablation uses heat produced from radio waves to target diseased tissue. When radiofrequency is applied to nerve tissue, it damages nerves, which prevents or stops the pain signal from reaching the brain and results in pain relief.

During a radiofrequency ablation procedure, a small hollow needle is inserted into the targeted nerve that is causing pain. An electrode is inserted into the top of the needle, which sends the radio waves through the needle to the targeted nerve. The heat causes a lesion that prevents the nerve from sending pain signals to your brain. Nearby healthy nerves are not damaged during the procedure.

Pain management within your spine

Radiofrequency ablation is often used to manage pain originating from joints and oftentimes related to pain from your spine, especially your neck and lower back .

Within your spine, nerves branch off from your spinal cord and travel to the facet joints and sacroiliac joints.

Facet joints are pairs of small joints between the vertebrae in your spine. These joints give your spine flexibility and allow movement of your back, such as twisting and bending. Two small nerves, called medial branch nerves, are connected to the facet joints and send a signal to your brain that there is pain coming from these joints.

Sacroiliac joints are found near the bottom of your spine, right above your tailbone. Lateral branch nerves that are connected to these joints send pain signals from the spine to your brain.

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The Pain Goes On And On

Persons with severe arthritis often run through the gamut of treatments. These include corticosteroids, physical therapy, and medication. When all fails, doctors can decide on total knee arthroscopy. Even then, a small percentage of persons feel pain. If a patient has continuous knee pain for up to a year after surgery, RFA is the next best option.

Why Is Radiofrequency Ablation Used To Treat Arthritis Pain

The procedure isnt actually treating the arthritis joint damage itself, but rather the way the patient experiences the pain of arthritis joint pain.

RFA is effective because it numbs the targeted joint by burning the nerves to the painful joint, Alice Chen, MD, a physiatrist at the Hospital for Special Surgery in New York City. The radiofrequency waves transmitted through the needle tip causes the nerve to be inactivated. The nerves can grow back, though, so the effects of the procedure will last approximately six months long.

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Conventional Approaches To Knee Oa Pain

Non-operative management of knee pain caused by OA has developed over the past several decades. Conservative methods include diet and weight loss. I tell my patients that 1 pound of weight loss is equivalent to 4 pounds of weight off the knee. By reducing the load on their knees, they can reduce their pain.

Exercise, including physical therapy, can improve knee function by reducing swelling and stiffness.¹ Strengthening exercises can make activities of daily living easier, while flexibility exercises can increase range of motion. Many PT exercises can be done by the patient on their own once they receive a proper demonstration.

Increased physical activity, however, can be somewhat of a catch-22 for some patients. As they are moving around more, their knee pain can increase. Over-the-counter medications such as acetaminophen and NSAIDS may help to reduce this pain, but patients often need to progress to other treatments to alleviate such pain and/or to avoid side effects that may arise with chronic use .

More recently, the treatment paradigm for knee OA has moved into the age of injections. These localized procedures often help to fill the gap between conservative modalities and surgery, providing pain relief and improving function.

Radiofrequency Ablation On Pain Relief Of Knee Osteoarthritis

Introduction

Osteoarthritis is a chronic, progressive disease with high disability and teratogenicity in the joints. Deterioration of the articular cartilage is the main problem associated with osteoarthritis, which decreases joint space between the two bones.

Clinically, patients with knee OA typically present with a chief complaint of pain, often associated with limited range of motion, stiffness, osteophytes, crepitus, and effusions. Due to the progressive degenerative nature of OA and the associated pain, patients become more physically impaired through the course of the disease .

One of the main tissues affected by this disease is the articular cartilage, which is a thin tissue covering the bony end in the joint that mainly provides mechanical support and lubrication during joint movement .

Age, previous knee injuries, but also obesity) ,joint malalignment and instability that result in increased mechanical stress are all strong risk factors for the development of knee OA .

Introduction

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Procedure Of Genicular Nerve Radiofrequency Ablation

Genicular nerve radiofrequency ablation involves the following steps:

• You are taken to the procedure room.
• Your doctor will examine the painful knee joint.
• A local anesthetic is injected around the genicular nerve branches using a needle. This serves as a diagnostic nerve block.
• Your doctor may use imaging tools such as ultrasound or fluoroscopy, to guide the needle.
• After this, your doctor will wait and check if you have 50% reduction in pain for a minimum of 24 hours following the injection.
• If yes, then you are a candidate for genicular nerve ablation.
• For genicular nerve ablation, you will lie in the supine position with your knee bent at an angle of 30°.
• The knee joint and the surrounding area is cleaned with an antiseptic solution to prevent infection.
• Under imaging guidance, one or two thin tubes called cannulas are inserted through a small incision the skin into your knee joint.
• Through the cannula, numbing medication is injected into the genicular nerves to minimize the pain.
• Then, a radiofrequency electrode is placed through the cannulas into your knee joint.
• High-frequency electrical currents are transmitted for a specific time via the electrode to heat the targeted genicular nerves. This damages the nerves that transmit pain signals to your brain.
• After ablation, the cannulas are removed and a bandage is applied.