Genicular Nerve Ablation – Genicular Nerve Pulsed RF Denervation

What is Genicular Nerve Ablation?

Genicular nerve ablation, also known as genicular nerve pulsed radiofrequency denervation, is a minimally invasive procedure aimed at providing relief from chronic knee pain. The genicular nerves are a group of nerves around the knee joint responsible for transmitting pain signals. 

During the procedure, a specialised needle is guided into place using fluoroscopy or ultrasound imaging. Once in position, radiofrequency energy is applied to the nerves to heat and disable them, thereby interrupting the transmission of pain signals. 

This procedure can provide significant and long-lasting pain relief for individuals suffering from knee pain due to conditions such as osteoarthritis or failed knee surgeries. Genicular nerve ablation is considered to be an effective non-surgical treatment option for managing chronic knee pain when more conservative measures have failed.

How Does Genicular Nerve Ablation Alleviate Chronic Knee Pain?

Genicular nerve ablation alleviates pain in the knee area by disrupting the transmission of pain signals from the knee to the brain. Chronic knee pain often arises from conditions such as osteoarthritis, where the knee joint experiences inflammation and degeneration, leading to persistent discomfort. Chronic knee pain can also be the result of overuse injuries, ligament injuries, a failed knee replacement, or similar conditions.  

During genicular nerve pulsed radiofrequency denervation, a specialised needle is precisely guided to the genicular nerves surrounding the knee joint. Once in position, pulsed radiofrequency energy is applied to these nerves, effectively disabling them. By targeting and deactivating these nerves, the communication of pain signals from the knee to the brain is interrupted and the sensation of discomfort is diminished or eliminated.

As a result, patients who undergo genicular nerve ablation experience relief from chronic knee pain. This pain relief can be significant and long-lasting, providing patients with improved mobility, function, and overall quality of life. In general, the pain relief from such a procedure lasts for 12-18 months but can vary depending on the individual patient. 

Genicular nerve ablation is considered a minimally invasive and safe procedure, offering an alternative to more invasive treatments such as knee surgery. It can be particularly beneficial for individuals who have not responded well to more conservative therapies or who wish to avoid surgical intervention.

Why Would You Get Genicular Nerve Ablation for Chronic Pain?

You might consider genicular nerve ablation or pulsed radiofrequency denervation for chronic knee pain if:

• Conservative treatments haven’t provided sufficient relief. If you’ve already tried medications, physical therapy, injections, and other conservative treatments for knee pain without success, genicular nerve ablation could be an option.
• You want to avoid surgery. Genicular nerve ablation is a minimally invasive procedure that can provide pain relief without the need for surgery. If you prefer to avoid surgical interventions or if you’re not a candidate for surgery due to health reasons, genicular nerve ablation may be a suitable alternative.
• You have contraindications to surgery. Some individuals may have medical conditions or other factors that make them unsuitable candidates for surgery. Genicular nerve ablation can offer a non-surgical option for managing chronic knee pain in such cases.
• You’ve had unsuccessful knee surgery or surgeries. If you’ve undergone knee surgery in the past and continue to experience persistent knee pain, genicular nerve ablation may be considered as a means to address the ongoing discomfort.
• You need long-term pain relief. Genicular nerve ablation can provide significant and often long-lasting pain relief for individuals with chronic knee pain. By targeting the nerves responsible for transmitting pain signals from the knee, this procedure can offer relief that extends beyond the duration of temporary treatments like corticosteroid injections.
• You want to improve your mobility and quality of life. Chronic knee pain can significantly impact your everyday life. By effectively managing pain through genicular nerve ablation, you may experience improved function, increased activity levels, and an enhanced overall quality of life.

It is important to discuss your specific situation with a pain specialist to determine if genicular nerve ablation is a suitable treatment option for your chronic knee pain. At the Persistent Pain Solutions clinic, Dr Meena Mittal and her team will assess your medical history, perform a thorough evaluation, and provide personalised recommendations based on your needs and preferences.

The Risks of Genicular Nerve Ablation

While genicular nerve ablation is generally considered safe and effective, like any medical procedure, it carries some potential risks and complications. These may include:

• Injection Site Reactions. Some patients may experience temporary pain, discomfort, or bruising at the injection site.
• Flare up of pain. There may be a temporary flare up of pain which is usually a ‘pressure effect’ from the injection.
• Infection. There is a risk of infection at the injection site, although this is rare. Signs of infection include increased pain, swelling, redness, or drainage from the injection site.
• Bleeding. There’s a risk of bleeding at the injection site, especially for patients taking blood-thinning medications. This can lead to hematoma (collection of blood) at the injection site.
• Allergic Reactions. Allergic reactions to the medications used in the injection, such as local anaesthetics or corticosteroids, are possible but uncommon. 
• Short term numbness and weakness. It is normal to experience this in the leg and it generally lasts for 4-6 hours after the procedure. It resolves as the local anaesthesia wears off. 
• Nerve Damage. Although rare, there’s a risk of nerve damage due to needle placement (direct trauma), the medication injected, infection or bleeding. Symptoms may include numbness, tingling, weakness, or increased pain. Some patients may experience temporary nerve irritation or exacerbation of pain following the injection, which usually resolves on its own.
• Exposure to X-Rays and CT. Minimal doses of radiation are used to reduce the lifetime risk of long term complications (such as cancer) due to exposure to Xray and/ or CT scanning.
• Failure. The procedure may not provide the expected result or benefit.
• Sedation anaesthesia. There are risks of undergoing the sedation anaesthetic which is discussed on the day by the anaesthetist. Anaesthesia is generally very safe but there may be increased risk depending on your specific medical conditions.

It is essential to discuss the potential risks and benefits of genicular nerve ablation with your doctor before undergoing the procedure. Dr Mittal and her team can provide personalised recommendations based on your medical history, specific condition, and individual risk factors. Additionally, following post-procedure instructions and attending follow-up appointments are important for monitoring and managing any potential complications.

The Process of Getting Genicular Nerve Ablation

The process of getting genicular nerve ablation typically involves a series of steps, including an initial evaluation, preparation, the procedure itself, and post-procedure care. 

Here’s an overview:

1. Evaluation. Your doctor will conduct a thorough evaluation to determine if genicular nerve ablation is an appropriate treatment for your chronic knee pain. This may include a review of your medical history, physical examination, imaging studies (such as X-rays or MRI), and possibly diagnostic nerve blocks to confirm the source of your pain.
2. Pre-Procedure Preparation. Once genicular nerve ablation is deemed suitable for you, your doctor will provide instructions on how to prepare for the procedure. This may include fasting for a certain period before the procedure, temporarily discontinuing certain medications (such as blood thinners), and arranging for transportation to and from the medical facility.
3. The Procedure Day. On the day of the procedure, you will typically check in at the medical facility, where you may be asked to change into a hospital gown. You’ll then be taken to a procedure room, where the genicular nerve ablation will take place.
4. Procedure. Genicular nerve ablation is performed using fluoroscopy (a type of X-ray) or ultrasound guidance to ensure precise placement of the needle. You will be administered sedation anaesthesia prior to commencement of the procedure. You may receive a local anaesthetic to numb the skin and underlying tissues at the insertion site. Once numb, a needle will be inserted into the targeted genicular nerves. Pulsed radiofrequency energy is then delivered through the needle to deactivate the nerves, interrupting the transmission of pain signals. The procedure typically takes about 30 to 45 minutes to complete.
5. Post-Procedure Care. After genicular nerve ablation, you will be monitored for a short period in a recovery area to ensure there are no immediate complications. You may experience some discomfort or mild soreness at the procedure site, which can usually be managed with over-the-counter pain medications. Your doctor will provide specific instructions on post-procedure care, including any restrictions on activities and when you can resume normal daily activities.
6. Follow-up. Follow-up appointments may be scheduled to monitor your progress and assess the effectiveness of the procedure. You may require additional treatments or adjustments to your pain management plan based on your response to genicular nerve ablation.

Throughout the entire process, it is important to communicate openly with your doctor, ask any questions you may have, and follow their instructions carefully to ensure the best possible outcome of your genicular nerve ablation.

Preparing for Genicular Nerve Ablation

Preparing for a genicular nerve ablation at the Persistent Pain Solutions clinic will require close communication with Dr Mittal and her team. 

Be sure to disclose all medications you may be taking and note that you may have to discontinue some or all of them immediately prior to the procedure.

Prior to your appointment, please inform us if:

• You are currently taking antibiotics.
• You have a pacemaker or defibrillator.
• You have any allergies.
• You have diabetes.
• You are taking any blood thinning medications.
• You are feeling unwell, as we may need to reschedule your procedure.

You must also avoid eating or drinking anything in the six hours leading up to the procedure. However, you may continue to take medications with a small sip of water on the morning of the procedure. You will be advised to cease some other medications such as those for diabetes and blood thinning medications.

For your safety, we recommend arranging transportation to and from your appointment, as driving yourself is not advised within the 24-hour period following the procedure.

We generally recommend you take leave from work on the day of the procedure AND one day after the procedure, to rest and recover from the procedure. 

If you are receiving genicular nerve ablation, we advise you to refrain from undergoing any additional medical procedures, such as dental treatments or colonoscopies, within 48 hours before or after receiving the therapy.

Dr Meena Mittal and her team will provide specific guidance tailored to your situation. It’s important to adhere to your instructions diligently. If you have any concerns or queries, don’t hesitate to ask—we’re here to support you throughout the process.

After Getting Genicular Nerve Ablation (Follow-Up)

Following your genicular pulsed radiofrequency denervation procedure, you are free to return home. 

There are no specific restrictions on your day-to-day activities. However, it’s advisable to prioritise rest and engage in gentle activities during the initial 24 hours after your procedure.

Occasionally, you may experience some discomfort or bruising at the injection sites. Occasionally there is a temporary flare up of the pain.

You may commence physiotherapy one week after the procedure. You may return to hydrotherapy or a swimming pool/ spa two weeks after the procedure. 

We do not recommend any long distance or overseas travel for at least two weeks after the procedure. This is such that any issues or complications can be monitored and addressed in a timely manner. 

A follow-up appointment will be scheduled at 6 weeks post procedure to assess your response to the genicular nerve pulsed radiofrequency denervation. You will be requested to bring the post procedure Pain Chart such that the results can be analysed by Dr Mittal and next steps in your treatment plan can be discussed with you. 

Finding a Knee Pain Doctor Who Performs Genicular Nerve Ablation Near You

If you are suffering from chronic knee pain and wish to avoid surgical interventions, then a pain specialist who can perform a genicular nerve ablation may be able to provide some short term relief. Chances are, your pain management doctor will start with a genicular nerve block and move on from there to an ablation or denervation if the nerve block proves to alleviate your knee pain.

Request a referral to a knee pain doctor from your general practitioner and consider seeking advice or recommendations from family members, friends, or support groups (both online and in real life) who have dealt with similar knee problems.

Genicular Nerve Ablation at Persistent Pain Solutions

Dr Mittal and her team at the Persistent Pain Solutions clinic provide genicular nerve ablations and genicular nerve blocks, procedures designed to alleviate knee pain stemming from conditions like osteoarthritis, injuries, failed knee surgeries, or similar issues.

These methods target the genicular nerves surrounding the knee. Genicular nerve ablations provide long term relief, they typically follow a successful genicular nerve block, which serves as a diagnostic tool. 

If the nerve block alleviates your knee pain, then we utilise genicular nerve ablation, a technique where a small portion of nerve tissue is incapacitated. This effectively interrupts pain signals, providing long-term relief from chronic knee pain.