William R. Harden, DO
Resident Physician PGY-3
University of Kentucky PM&R
Lexington, Kentucky, United States
Paul J. Louigene, DO, MS
Resident Physician PGY 2
University of Kentucky Department of Physical Medicine and Rehabilitation
West Orange, New Jersey, United States
Michael C. Parrott, DO
Assistant Professor
University of Kentucky
Lexington, Kentucky, United States
Patient 1:83 y/o female with history of right total knee arthroplasty (TKA) in 2006, complicated by hardware failure, followed by a second TKA in 2012 with ongoing chronic right knee pain. After evaluation, recommended cryoneurolysis to the right knee now s/p intervention on 3/6/24 and 7/11/24.
Patient 2:65 y/o female with moderate right knee osteoarthritis (OA) who had failed conservative management, including NSAIDs, topical medications, bracing, corticosteroid and hyaluronic acid injections. Excessive BMI limited surgery. After evaluation, recommended cryoneurolysis to right knee now s/p intervention on 5/16/24 and 8/16/24.
Procedure Description: Cryoneurolysis targeted the Intermediate Branch of the Anterior Femoral Cutaneous Nerve (IMAFCN), Medial Branch of the Anterior Femoral Cutaneous Nerve (MAFCN), and the superior and inferior branches of the Infrapatellar Branch of the Saphenous Nerve (ISN).
Discussions:
Pre-procedure pain levels for patient 1 were reduced from 9/10 to 0/10 and 5/10 to 0/10 on the Visual Analog Scale (VAS) over 2 appointments respectively. Reported therapeutic benefits for approximately 16 weeks.
Pre-procedure pain levels for patient 2 were reduced from 6/10 to 0/10 and 5/10 to 0/10 on the Visual Analog Scale (VAS) over 2 appointments respectively. Reported therapeutic benefits for approximately 12 weeks.
Given that knee joint OA remains a leading cause of disability, effective pain management is essential for improving quality of life and preserving functional independence. Cryoneurolysis offers a promising alternative for patients struggling with chronic pain. Although current procedures lack advanced imaging guidance and may be time-consuming, future innovations could enhance both the efficacy and efficiency of cryoneurolysis.
Conclusions: Broader applications of cryoneurolysis are seen in Temporomandibular disorder, refractory peripheral neuropathy, sural neuroma, and phantom limb pain. As OA continues to bear a greater burden on society, treating with cryoneurolysis could be considered a viable treatment option.
