Genicular nerve RFA prior to elective TKA

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SpineandWine

SpineandWine

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Do you think it's worth offering genicular nerve RFA 2-6 weeks prior to TKA (has it shown to work- seen conflicting evidence- most recent studies suggest it's not effective per lit review but is anyone doing this/have good data or evidence on it?)? Would insurance cover it?
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anujacket said:
Do you think it's worth offering genicular nerve RFA 2-6 weeks prior to TKA (has it shown to work- seen conflicting evidence- most recent studies suggest it's not effective per lit review but is anyone doing this/have good data or evidence on it?)? Would insurance cover this?

Does anyone get paid for following:
-genicular nerve RFA
-suprascapular nerve RFA
-Hip RFA
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I don’t think it’s routinely indicated, but reasonable in some circumstances. Haven’t seen the data on RF, but there was one on Iovera pre-op that was favorable for better post-op phase. Industry sponsored and not great design as I recall, but some evidence.

I am doing a few of said RFs, many coverage issues, progressively more difficult to get covered.
 
Honestly, in this scenario cryo probably is a good option if you do it immediately prior to the surgery.
 
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Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up​


Conclusions: Cooled RFA of the superior lateral, superior medial and inferomedial genicular nerves, when performed 2-6 weeks prior to elective TKA as part of a multimodal postoperative pain management regime, had no measurable effect on postoperative opioid use, analgesia use or function in the 48 hours following surgery. In addition, we found no longer term effect on outcome measures 1, 3 and 6 months after TKA.
 
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My post TKA genicular RF success rate is way higher than my TKA candidate pre TKA genicular nerve block and RF

I think when they Lopp off the end of the femur they must take away some nerve fibers in the diseased subchondral bone… or something

Anyone else see this?
 
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Post TKA pain is far more reliably treated with GN RFA than a severely arthritic joint. In my hands that's definitely true.
 
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soccrwz said:

Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up​


Conclusions: Cooled RFA of the superior lateral, superior medial and inferomedial genicular nerves, when performed 2-6 weeks prior to elective TKA as part of a multimodal postoperative pain management regime, had no measurable effect on postoperative opioid use, analgesia use or function in the 48 hours following surgery. In addition, we found no longer term effect on outcome measures 1, 3 and 6 months after TKA.
Click to expand...
You have a reference for this article
 
Why would you do RF before scheduled surgery?
Does not give better outcomes, increases risks, and if they get pain relief for 1-2 mo before surgery- so what- I am not paying for it.
 
anujacket said:
I agree. Some docs doing it. Never heard of it. Went on pubmed and saw above mentioned walega study
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I read about this somewhere a few yrs ago, and it was cryo. You couldn't force me to go search for that article.

One of our TKA surgeons asked me to do them 4-5 yrs ago too...I very politely declined his request.

It sounds dumb, but at one point ppl were doing this and the belief was post op pain was reduced significantly, but it had nothing to do with long term pain relief.

It was just for post op pain.

The thought process behind this isn't that crazy. Far more idiotic things are done routinely. This isn't a big money maker either.
 
This was a coolief study. There are similar studies showing benefit of cryoablation using iovera. This is the whole premise that Iovera uses for marketing. I’ve done about 50 with mixed results. The home runs about 50% took no pain meds post TKA. I would have it done It does pay very poorly though, certainly not worth the effort financially
 
Iovera doesn't get cold enough IMO. It hits like -160 or so. Takes too long. Inefficient and pays nothing.
 
I remember at ASRA last fall they had a keynote speaker who spoke on geniculars pre and post TKA.

If I remember correctly, the meta analysis they did found like no evidence to do pre TKA genicular RFA- cooled or otherwise. And there was in indeterminate/poor data on post TKA RFA.

As oreo states, I think they postulated that geniculars were already variable enough and surgery just made them too unpredictable.

Take that with a grain of salt though, idk if there’s a full article somewhere.
 
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plus genicular RFA pays peanuts. Iovera pays peanuts.

No reason to get involved and wasted your or the patients time. If they need TKA, just get the TKA.
 
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anujacket said:
I thought it pays 148 bucks doctor fee for 15 minute procedure?
Medicare rates
Click to expand...
Not at all a 15 min procedure when you consider room turnover and everything involved. It's a boring procedure.
 
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