Genicular nerve ablation (radiofrequency or cryoneurolysis) is a minimally invasive procedure to treat chronic knee pain by destroying the small sensory nerves around the knee joint. It is an option for patients with knee arthritis who are not suitable for or wish to delay knee replacement.
First, diagnostic genicular nerve blocks are performed — local anaesthetic is injected around the superior medial, superior lateral, and inferior medial genicular nerves under fluoroscopic or ultrasound guidance. If these provide at least 50% temporary relief, ablation is offered. For radiofrequency ablation: a needle is placed at each nerve location and heated to destroy the nerve. For cryoneurolysis: a probe freezes the nerve. The procedure takes 30–60 minutes.
Genicular nerve ablation is considered for moderate to severe knee osteoarthritis pain in patients who are not candidates for knee replacement (medical comorbidities, patient preference), waiting for knee replacement, or wishing to delay surgery.
Physiotherapy, weight management, analgesics, corticosteroid or hyaluronic acid injection, bracing, and PRP injection.
Diagnostic genicular nerve blocks must have provided at least 50% relief on at least one occasion. Outpatient procedure.
Pain reduction in approximately 60–70% of patients who had a positive diagnostic block. Relief typically lasts six to twelve months for radiofrequency and three to six months for cryoneurolysis. The procedure can be repeated.
Increased pain for a few days after ablation.
Not all patients achieve adequate pain reduction.
Around the ablation sites.
At needle sites. Very rare.
Rare with proper technique.
Very rare — genicular nerves are purely sensory.
Local anaesthetic with mild sedation.
Normal activities immediately. Full benefit develops over two to four weeks as post-procedure inflammation settles.
Assess response at four to six weeks. Repeat when pain returns.
Radiofrequency ablation: six to twelve months typically. Cryoneurolysis: three to six months. The nerves regenerate over time and the procedure can be repeated.
No — it treats the symptom (pain) not the disease (arthritis). It is best used as a bridge to surgery, for patients who cannot have surgery, or as part of a multimodal pain management strategy.