If you have knee pain from arthritis that has not settled with non-surgical methods such as tablets, physiotherapy, activity modification, injections or weight loss, you may benefit from Cooled Radiofrequency Ablation of the Genicular nerves. It involves inserting small probes into specific locations around the knee joint and using radiofrequency waves to turn off some of the ability to feel pain (“sensation”) from the genicular nerves. These nerves are responsible for transmitting pain signals in patients with knee arthritis.
This procedure can provide up to 12 months of reduced discomfort, but it does wear off. It can be performed again if required. It is performed as day surgery with a very minimal recovery period.
RFA is primarily useful in patients who are not ready for a knee replacement. If you need permanent relief of pain, then a knee replacement may be a better option for you although it carries a longer recovery period. Talk to Dr Connon about the best option for your particular circumstances – your pain, work, lifestyle and general health to name a few.
Anaesthesia for knee arthroscopic surgery is usually a short general anaesthetic. The procedure generally takes about 10-15 minutes for one knee or 15- 20 minutes for both.
Under sedation or general anaesthetic, 4 needle-like probes are placed around your knee using Xray guidance.
Once the correct location has been established, a motor “stimulation” is performed to ensure no nerves that control movement will be damaged and only the feeling around the knee will be affected. The sensory (“feeling”) nerves to the knee “genicular nerves” are then treated for 2.5 minutes each to numb them for a period. They generally recover slowly over the coming months, so the feeling (and discomfort) will return.
RFA is a day procedure. The day surgery team will make sure you are comfortable walking (either with or without the assistance of crutches) and give you some tablets in case you need them to treat your discomfort.
When you go home you should rest for the rest of the day and then start slowly walking normally the following day. Don’t overdo it with exercises initially to allow the swelling to settle.
You can slowly start to progress your physiotherapy exercises after the 1 week wound check.
The day surgery team will make sure you are comfortable walking (either with or without the assistance of crutches) and give you some tablets in case you need them to treat your discomfort.
After 1 week, your wounds will be checked. All you will have is essentially some pinpricks so this check-up is more to see how you are travelling. As long as you are progressing well you can return to normal life and physiotherapy.
Dr Connon recommends physiotherapy to optimise the function of your knee and get you back to what you want to be doing. Eventually your discomfort will return, in which case, please call Dr Connon’s rooms to discuss whether you would like to repeat the procedure or progress to a more permanent solution (knee replacement).
This is the lowest risk procedure Dr Connon performs but risks are present.
Infection is very rare (a fraction of 1%). Skin burns have been described, though cooling is used around the probes to prevent this. Damage to nerves that control movement is technically possible though minimised by performing motor stimulation before numbing the nerves. Further damage to the knee joint is technically possible through loss of feeling. As this procedure is generally only performed on patients with arthritic knees who would otherwise require knee replacement surgery, it is treated by performing the operation the patient would otherwise have anyway.
Some risks present themselves only after surgery, such as infection and DVT. Please don’t hesitate to call Dr Connon’s rooms if you have any postoperative concerns.
