New procedure offers long-term pain relief without drugs after knee replacement

ATLANTA — A new medical procedure could help to improve the quality of life for millions of people who have to undergo knee replacement surgery. The treatment offers arthritis patients long-term pain relief and an alternative to highly addictive painkillers, say, scientists.

Close to 60 million people in the U.S. suffer from arthritis or similar health conditions that can make their joints, including their knees and hips, extremely painful. A growing number of these patients are getting knee replacement surgery hoping to regain some mobility and quality of life. But between 15 and 30% of those who go under the knife continue to experience pain and stiffness.

While some decide to go through surgery again, there is no guarantee this will solve the problem. Now, scientists have tested a new procedure that could offer them long-term relief at last. “A lot of patients don’t achieve any resolution of pain. ​​It’s a big problem, and up till now, there weren’t any other options,” says assistant professor Felix Gonzalez at the Emory University School of Medicine,

Knee replacement
Radiofrequency ablation electrode is placed into the introducer needle after the placement of the introducer needle. Positioning was verified with imaging. (Credit: RSNA and researcher, Felix Gonzalez, M.D.)

The procedure, dubbed cooled radiofrequency ablation (C-RFA), involves using a large needle to target specific nerve locations around the knee while the patient is under general anesthetic. A probe is then guided to the location before emitting a low voltage current or radiofrequency to the deep sensory nerves around the knee.

“With a larger propagating heat wave, you can account for the differences in nerve anatomy from patient to patient because of a larger treatment zone. Treating a larger zone increases the effectiveness of the procedure,” says Dr. Gonzalez.

The researchers surveyed 21 patients who had complete knee replacement surgery and were suffering from persistent chronic pain. They asked the patients to fill out clinically validated questionnaires to assess their level of pain and how it affected everyday physical tasks.

A year after participants received the C-RFA procedure, researchers collected follow-up surveys that showed the patients had experienced a “statistically significant improvement” in their quality of life. Both pain and stiffness scores had improved dramatically and no major complications were reported. Moreover, they did not require further medical treatments, including surgery or any other kind of intervention.

Knee replacement
Radiofrequency ablation electrode is placed into the introducer needle after the placement of the introducer needle. Positioning was verified with imaging. (Credit: RSNA and researcher, Felix Gonzalez, M.D.)

“This procedure can have a huge impact on patients who have gone through major surgery and are still suffering pain that is very debilitating,” says Gonzalez. The procedure’s long-term relief gives it a “major advantage” over current treatments such as cortisone injections, which usually only work for a few months.

“It’s very encouraging that up to a year out these patients have such significant pain relief and a better quality of life,” adds Gonzalez. “The hope is that in that period of time, the patient can become more mobile and increase their activity. Even if the pain comes back, we predict that it won’t come back with the same intensity as before.”

Every year, almost a million hip and knee replacement operations are performed in the U.S. The new procedure, which the researchers describe as “minimally intrusive,” is also easily replicated if necessary and could reduce patients’ dependency on highly addictive opioid painkillers. ​​“We hope that this procedure will become a standard of treatment for pain in this setting,” Dr. Gonzalez said.

The findings will be presented at the annual meeting of the Radiological Society of North America (RSNA).

South West News Service writer Tom Campbell contributed to this report.

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