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November 23, 2021

Knee replacements don't always alleviate pain – in these cases, a minimally invasive procedure may help

Cooled radiofrequency ablation targets the sensory nerves causing pain without damaging adjacent tissue

Adult Health Arthritis
Chronic Knee Pain Meegan M. Reid/Kitsap Sun

One of the complications of total knee replacement is chronic pain and stiffness. Above, Dr. John West checks on Judy Jackson's knee replacement at his Liberty Knee Center in Poulsbo, Washington earlier this year.

Many people with arthritic knee pain turn to total knee replacements in hopes of alleviating the debilitating condition. Yet, about 15-30% of people who opt for the surgery continue to suffer from pain and stiffness afterward. 

The findings of a new study offer some hope to these patients.

Researchers found that cooled radiofrequency ablation, or CRFA, can provide long-term relief. The minimally invasive procedure targets the sensory nerves causing pain without damaging adjacent tissue.

The researchers view it as a better option than putting patients through another knee replacement, which offers no guarantee of relief. 

"A lot of patients don't achieve any resolution of pain" after replacement surgery, said lead author Dr. Felix Gonzalez, of Emory University. "It's a big problem, and up till now, there weren't any other options."

More than 600,000 knee replacement surgeries are performed in the U.S. every year, the American Academy of Orthopaedic Surgeons reports. The procedure removes damaged bone and inserts an artificial joint in its place.

According to the Mayo Clinic, knee replacement provides pain relief, improved mobility and a better quality of life for most patients. The implant typically lasts more than 15 years. Sometimes, complications occur, including persistent pain and stiffness in the knee.

Cooled radiofrequency involves sending low-voltage current to the deep sensory nerves around the knee by using a probe inserted via a needle. Water circulating through the device creates a cooling effect that allows for a larger area to be treated. Patients are given local anesthesia during the procedure.

"This procedure can have a huge impact in patients who have gone through major surgery and are still suffering pain that is very debilitating," Gonzalez said.

Previous studies have shown the procedure effectively provides lasting pain relief for people with knee, shoulder and hip arthritis. The new study involved 21 patients who had persistent chronic pain after total knee replacements. The pain was not the result of hardware complications and all the patients had already failed conservative care.

After the ablation procedure, all the patients reported experiencing significant improvement in quality life. Pain and stiffness scores improved significantly for all patients. There were no major complications from the procedure.

None of patients needed repeat treatment, surgical revision or another intervention during a one-year follow-up period. This is longer pain relief than the three months cortisone injections typically offer.

The hope, Gonzalez said, is that the patients will be become more mobile and return to their daily activity easier. Researchers predict that even if the pain eventually returns, it won't return at the same intensity level.

If needed, the procedure can easily be repeated, Gonzalez said, and it can reduce the patients' reliance on opioid pain relievers.

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