Isabel Moghtaderi, BA
Medical Student
Albany Medical College
Albany, New York, United States
Michael Downing, DO
Resident Physician
Albany Medical Center
Albany, New York, United States
Joey Levy, DO
Pain Management Fellow
Albany and Saratoga Centers for Pain Management
Albany, New York, United States
Martin Ferrillo, DO
Adjunct Professor at Albany Medical College
Albany and Saratoga Centers for Pain Management
Albany, New York, United States
Chronic Pain Unresolved Post-Total Knee Replacement
Case Description: A 51-year-old female with a history of left knee osteoarthritis underwent a total knee replacement (TKR) three years ago and has since experienced constant, sharp, and shooting pain. Conservative treatments, including cold/heat therapy, physical therapy, chiropractic manipulation, and anti-inflammatory and neuropathic medications, were unsuccessful. The patient reported no prior trauma or recent injury. Physical examination revealed full range of motion in both knees, with lateral left knee pain on resisted exertion, tenderness over the joint line of the left knee, and an antalgic gait.
Discussions:
Persistent pain is the most common reason for dissatisfaction in 10-20% of patients following TKR. While genicular nerve blocks and joint injections with various anesthetic and steroid combinations have been utilized to manage chronic pain post-TKR, their effects are typically transient. Genicular nerve radiofrequency ablation (GNFRA) has been shown to provide effective pain relief for at least 3 months and up to 1 year, with an average pain reduction of 50-55% and minimal procedural complications.
Setting: Outpatient Pain Management Clinic
Assessment/
Results: The patient first underwent a diagnostic anesthetic-steroid injection targeting the superolateral, superomedial, and inferomedial genicular nerves, while sparing the inferolateral genicular nerve due to its proximity to the peroneal nerve. Post-procedure, the patient's pain score decreased from 5/10 to 1/10. Following this, conventional radiofrequency ablation under fluoroscopic guidance was performed. The patient remains pain-free and has experienced no complications.
Conclusions: For patients experiencing persistent post-surgical pain after total knee replacement, fluoroscopic-guided genicular nerve ablation is an effective pain relief modality.
