What is genicular nerve radiofrequency ablation for knee pain?

Genicular nerve radiofrequency ablation (RFA) is a treatment designed to help relieve chronic knee pain, especially for those who haven’t had success with more traditional methods like medications, physical therapy, or even knee injections. This procedure targets specific nerves, known as the genicular nerves, which play a significant role in transmitting pain signals from the knee joint to the brain. By "ablating" (or disrupting) these nerves, RFA can reduce the sensation of pain, often providing lasting relief.

We speak to a leading consultant in pain medicine who explains how this treatment works.

How does genicular nerve RFA work?

The genicular nerves are responsible for carrying pain messages from the knee to the brain. During RFA, heat generated by radio waves is applied to these nerves to disrupt their ability to send pain signals. By targeting only these specific nerves, the procedure can relieve pain without affecting the overall function of the knee.

Before the actual RFA treatment, your doctor will usually perform a diagnostic nerve block. This involves injecting a small amount of anaesthetic near the genicular nerves to see if it temporarily relieves your knee pain. If the nerve block is successful, it’s a good indication that RFA may also work well, providing longer-term relief.

What does the procedure involve?

RFA is a minimally invasive, outpatient procedure, meaning you won’t need to stay overnight in a hospital. It’s generally performed under local anaesthesia, which numbs the area around your knee but doesn’t put you to sleep. The doctor may also provide you with a mild sedative to help you relax during the procedure.

The doctor uses a small needle and guides it to the specific genicular nerves using imaging techniques, such as ultrasound or X-ray guidance, to ensure precision. Once in place, a small amount of radiofrequency energy is delivered through the needle to heat the nerve tissue. This controlled heat disrupts the nerve’s ability to send pain signals. The procedure lasts around 30 to 60 minutes.

Who may benefit from genicular nerve RFA?                                     

Genicular nerve RFA can be a suitable option for people with chronic knee pain, especially those dealing with osteoarthritis, which is a common form of arthritis that wears down the joint cartilage over time. It’s also an option for those who aren’t candidates for knee surgery or who wish to delay surgery. Additionally, individuals who have already undergone knee replacement surgery but continue to experience knee pain may find this treatment helpful.

It’s important to consult with a pain management specialist or orthopaedic doctor to assess if you’re a good candidate for RFA. They’ll consider factors like the severity of your pain, any prior treatments, and the results of the diagnostic nerve block test.

What are the potential benefits of RFA?

One of the main benefits of RFA is that it provides targeted pain relief without affecting muscle function or knee stability. Many patients report noticeable pain reduction within a few weeks, with effects lasting from six months to up to a year or more. For some, pain relief can extend even longer, especially with additional maintenance treatments if needed.

Unlike medications, RFA has a low risk of side effects and doesn’t carry risks like dependency or gastrointestinal issues that can be associated with long-term pain medication use. It also requires little downtime—most people can return to their regular activities within a day or two of the procedure.

Are there risks or side effects with RFA?

As with any medical procedure, there are potential risks, although complications from genicular nerve RFA are rare. Possible side effects include temporary swelling, bruising, or minor discomfort at the treatment site. Some patients may experience a slight increase in pain for a few days after the procedure, but this typically resolves on its own. There’s also a very small risk of infection or nerve damage, although these complications are uncommon.

Discussing potential risks with your doctor can help you make an informed decision. If you’re considering RFA, your doctor will assess your health and discuss any personal risk factors.

What can I expect after the procedure?

After RFA, you may experience soreness around the knee for a few days. This is usually mild and can be managed with over-the-counter pain relievers, as directed by your doctor. The full effects of pain relief can take up to three weeks to develop, as the nerve fibres gradually lose their ability to transmit pain signals.

Since RFA doesn’t cure the underlying cause of knee pain, it may not work indefinitely. However, many patients find they can enjoy months of improved mobility and quality of life before needing another treatment. This makes RFA an appealing option for managing knee pain, especially for those looking to avoid or delay more invasive treatments like knee replacement surgery.