Osteoarthritis of the Knee
Knee pain is extremely common in the population and can cause significant disability and impairments to quality of life. At Mid-America Orthopedics Kansas City, we offer comprehensive treatment of knee pain. We initially begin with measures to avoid surgery such as physical therapy, anti-inflammatories, bracing, and counseling on lifestyle modifications where appropriate. We also see good results with intra-articular joint injections with corticosteroids or visco-supplementation. Regenerative treatments, such as the injection of stem cells or platelet rich plasma, may hold some promise but at this time are considered experimental due to the need for ongoing research, and are not covered by insurance. Individuals who remain in significant pain despite these measures may go on to have a knee replacement (total knee arthroplasty). However, some individuals may not be good candidates for surgery (too young or too obese, for example), may still want to avoid surgery, or may unfortunately continue to have severe pain despite an arthroplasty. In these situations, genicular nerve blocks may be an effective treatment option.
What are Genicular Nerve Blocks?
A genicular nerve block is a procedure aimed at blocking the nerves in your knee that transmit pain. These nerves, called the genicular nerves, provide sensation and are located all around the knee. Nerve blocks target at least 3 of these nerves – one at the top and inside, one at the top and outside, and one at the bottom and inside of the knee. There is one genicular nerve located at the bottom and outside of the knee, but there are other neural structures in that region which prohibit targeting this nerve.
Local anesthetic is injected over these nerves before they enter the knee joint. If successful, a person can expect to notice a difference within 30 minutes. Individuals should engage in typical activities that cause discomfort to really see if they have obtained some relief.
The duration of relief is typically a short time, several hours, but the effects vary widely between people. Some individuals may obtain relief for weeks, months, or even years. Research has shown that there are additional nerve branches which innervate the knee joint as well, and these can be quite variable from person to person, which may explain why some individuals respond and some do not. At Mid-America Orthopedics Kansas City, we target these additional branches to maximize your potential benefit. As newer research and evidence is released, you can count on us to employ the latest protocols.
In individuals with months or years of relief, genicular nerve blocks may be repeated safely. In individuals where pain relief is significant but short-lasting, we may be a good candidate for radiofrequency ablation.
What is Radiofrequency Ablation of the Genicular Nerves?
Radiofrequency ablation targets the same nerves as a genicular nerve block but generates heat lesions in order to disable the genicular nerves for a sustained period. This treatment is still performed with needles so there is no cutting, no incisions, and no scars. Diagnostic genicular nerve blocks are always done first, and individuals must experience at least 50% pain relief before consideration for radiofrequency ablation.
Indications for Genicular Nerve Blocks
- Chronic knee pain secondary to osteoarthritis
- Failed total knee arthroplasty
- Patients who are poor candidate for total knee arthroplasty
- Patients who want to avoid surgery and have failed other conservative measures
Genicular nerve blocks and radiofrequency ablation of the genicular nerves is generally considered safe. Potential complications, however, can include infection, bleeding, pain at the procedure site, and skin burn. We are committed to your safety, and these injections are performed under fluoroscopic guidance using precise technique. Infection risks are minimized by using aseptic technique and sterile equipment. Post-procedure flareup of pain is not uncommon, but usually resolves after a few days and can be reduced with medication. Radiofrequency ablation can cause patchy numbness around the overlying skin, but this is not common and usually resolves after a few days to a few weeks.
We are honored to serve Kansas City as your local, expert orthopedic and interventional pain resource. If you would like a consultation at Mid-America Orthopedics Kansas City please call (913) 232-9846.