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Is preoperative genicular radiofrequency ablation effective for reducing pain following total knee arthroplasty? A pilot randomized clinical trial
  1. Puneet Mishra1,
  2. David Edwards1,
  3. Marc Huntoon2,
  4. Christopher Sobey1,
  5. Gregory Polkowski3,
  6. John Corey1,
  7. Kelly Louise Mishra1,
  8. Andrew Shinar3,
  9. Stephen Engstrom3,
  10. Cassandra Palmer4 and
  11. Stephen Bruehl1
  1. 1 Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2 Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
  3. 3 Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  4. 4 University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
  1. Correspondence to Dr Puneet Mishra, Anesthesiology, Vanderbilt University Medical Center, Nashville, USA; puneet.mishra{at}


Background and objective Although total knee arthroplasty (TKA) is an effective treatment for severe knee osteoarthritis (OA), a subset of patients experience significant postoperative pain and dissatisfaction. Several clinical trials support the analgesic benefits of genicular nerve radiofrequency ablation (GN-RFA) for non-operative knee OA, but only one prior trial has examined the effects of this intervention given preoperatively on postoperative outcomes following TKA, showing no analgesic benefit of cooled GN-RFA. The current study evaluated whether conventional thermal GN-RFA performed preoperatively resulted in significant improvements in pain and function following TKA.

Methods This was a single-center, prospective, randomized, sham-controlled, double-blinded pilot trial in which patients received either conventional GN-RFA (n=30) or sham (n=30) between 2 and 4 weeks prior to their TKA. Baseline measures were obtained preprocedurally on the day of intervention, with follow-up outcomes obtained preoperatively on the day of surgery, and at 2 and 6 weeks postoperatively.

Results Patients receiving GN-RFA showed no significant improvements relative to sham controls in the primary outcome, pain intensity at rest at 6-week follow-up. Secondary outcomes, including pain with ambulation and physical function, also showed no significant differences between groups at any follow-up assessment.

Conclusions Conventional GN-RFA of the superior lateral, superior medial, and inferior medial genicular nerves when performed prior to TKA did not provide clinically significant pain relief or improvement in functional status at 2 or 6 weeks postoperatively.

Trial registration number NCT02947321.

  • analgesia
  • pain
  • postoperative
  • pain management
  • chronic pain

Data availability statement

Data are available upon reasonable request. All deidentified participant data are in a REDCap database.

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Data availability statement

Data are available upon reasonable request. All deidentified participant data are in a REDCap database.

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  • Contributors PM, DE, MH, CS, GP, JC, AS, SE, and SB all contributed to study design, data collection, results analysis, and writing and editing of the manuscript. CP contributed to data collection and manuscript review. KLM contributed to study design, and manuscript writing and editing.

  • Funding This investigator-initiated clinical trial was funded by a grant from Abbott/St. Jude Medical. The study was also supported in part by National Institutes of Health grant R01AG048915 (SB).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.