The Knee, ISSN: 1873-5800, Vol: 23, Issue: 3, Page: 523-8

Percutaneous freezing of sensory nerves prior to total knee arthroplasty

Dasa, Vinod; Lensing, Gabriel; Parsons, Miles; Harris, Justin; Volaufova, Julia; Bliss, Ryan
Knee

Highlights

  • We evaluated the use of a novel handheld cryoneurolysis device for post-op TKA pain.
  • Patients treated with cryoneurolysis requested less narcotic pain medication after TKA.
  • Patients treated with cryoneurolysis had significantly improved KOOS symptoms after TKA.
  • Patients treated with cryoneurolysis had significantly reduced length of stay after TKA.
  • Cryoneurolysis may be an effective new treatment to reduce pain and improve function after TKA.

Abstract

Background

Total knee arthroplasty (TKA) is a common procedure resulting in significant post-operative pain. Percutaneous cryoneurolysis targeting the infrapatellar branch of the saphenous nerve and anterior femoral cutaneous nerve could relieve post-operative knee pain by temporarily blocking sensory nerve conduction.

 

Methods

A retrospective chart review of 100 patients who underwent TKA was conducted to assess the value of adding perioperative cryoneurolysis to a multimodal pain management program. The treatment group consisted of the first 50 patients consecutively treated after the practice introduced perioperative (five days prior to surgery) cryoneurolysis as part of its standard pain management protocol. The control group consisted of the 50 patients treated before cryoneurolysis was introduced. Outcomes included hospital length of stay (LOS), post-operative opioid requirements, and patient-reported outcomes of pain and function.

Results

A significantly lower proportion of patients in the treatment group had a LOS of ≥2 days compared with the control group (6% vs. 67%, p < 0.0001) and required 45% less opioids during the first 12 weeks after surgery. The treatment group reported a statistically significant reduction in symptoms at the six- and 12-week follow-up compared with the control group and within-group significant reductions in pain intensity and pain interference at two- and six-week follow-up, respectively.

 

Conclusions

Perioperative cryoneurolysis in combination with multimodal pain management may significantly improve outcomes in patients undergoing TKA. Promising results from this preliminary retrospective study warrant further investigation of this novel treatment in prospective, randomized trials.

Level of evidence

III


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