Is there a role for nerve ablation in the treatment of knee osteoarthritis?

What is radiofrequency nerve ablation? And does it have a role to play in alleviating the pain of osteoarthritis? YKC’s Dave Duffy looks at this FDA-approved treatment.

Do we treat the condition or do we treat the pain? This may sound a strange question. Surely, you might think, in the case of osteoarthritis and knee replacement, to treat the condition is to treat the pain. That’s true, but what if somebody isn’t suitable for surgery? Perhaps they’re too young. Perhaps other health conditions prevent it. Perhaps they simply don’t want surgery.

An individual’s decision to proceed to surgery can vary for a multitude of factors. If they choose not to proceed with knee resurfacing, the question then becomes how to treat the pain. There are many non-surgical or minimally invasive approaches and one of these is radiofrequency nerve ablation.

What is nerve ablation?

As Medscape notes, radiofrequency nerve ablation is a minimally invasive procedure for treatment of chronic pain. During the treatment, a metal probe applies heat to the three major nerves that go around the outside of the knee. The heat disrupts the nerve so that it stops working and once the nerve is deadened, it won’t be able to transmit pain.

As the Medscape article notes, the treatment is FDA approved (the equivalent of it being MHRA approved in the UK). It can be effective at alleviating pain. It doesn’t weaken the knee (because only the sensory nerves are treated) and it doesn’t burn any bridges in terms of future treatment. So if you eventually want or are able to have a knee replacement, you still can.

Frustratingly, the treatment appears effective in only around half of patients. More research is required into understanding the patients in whom it works best, but we do know that it appears less effective in patients with advanced osteoarthritis.

Also, and returning to my initial point, this treatment doesn’t address the condition, so even with pain relieved, function over time may get worse if the arthritis progresses.

Is there value in nerve ablation?

Despite the current coin-toss success rates, there will be circumstances where radiofrequency nerve ablation may be appropriate, depending on the individual patient.

That’s particularly the case when pain rather than function is the predominant concern, and when health factors, attitude or other issues mean knee replacement surgery isn’t an immediate option. Think of it as one of a number of non-surgical or minimally invasive tools in the toolkit, and it is reassuring to have such options.

Who carries out radiofrequency nerve ablation?

Nerve ablation requires the identification of the appropriate nerve either under x-ray guidance or more commonly under ultrasound. That will be done by a radiologist following referral by your knee consultant.

Worried about your knee pain? Explore your treatment options with us. Please contact us, or phone us on 03453 052 579.

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