PNS used to treat Knee OA?

[cameroncarter]

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Found this study on LinkedIn looking at targets for PNS for knee OA. I wanted to find some guidance, but looks like everyone is doing something different. Great.

Thoughts on best approach for PNS for knee pain, if any? I have yet to do this.

Jay Karri on LinkedIn: #painmedicine #peripheralnervestimulation #chronicpain #crpsâ¦

 

[cameroncarter]

I'm still skeptical but I have an insurance who offers this, yet considers genicular RFA experimental.

 

[thecentral09]

What is reimbursement like?

 

[Ducttape]

there is one big nerve, bigger than the rest.

why dont you PNS that one?

 

[drusso]

Did the patient fail PRP? The evidence for PRP is more robust than PNS.

 

[Ducttape]

Did the patient fail PRP? The evidence for PRP is more robust than PNS.

I'm still skeptical but I have an insurance who offers this, yet considers genicular RFA experimental.

 

[cameroncarter]

I did a few cases in fellowship.

Stimulating proximally leads to unwanted paresthesias in non-painful areas and greater likelihood of motor stimulation.

PRP may be an option but my patients can’t spare $800.

 

[Scottie_Dog]

I went to a Nalu course and was trained on genicular PNS. Seems pretty slick, reimbursement is good supposedly. Technically was not difficult at all.

Haven’t had any takers willing to wear an external hockey puck battery pack though. Seems annoying. Targets are superior medial and superior lateral genicular nerves.

 

[drmamba]

Not a novel approach. Plenty of PNS of the superolateral and superomedial branches of the genicular nerves. Works great, usually not durable if using a 60 day system. Will lead to permanent implants if not durable.

For post TKA pain, infrapatellar branch of the saphenous nerve can work well but typically if the symptomatology is more neuropathic in nature. Will usually do a 1ml targeted diagnostic block before stimming.

Now, the healthcare economics associated with a PNS is a completely discussion altogether...

 

[TIVAndy]

i have a case series about 15 pts post tka for infrapaterallar saphenous. most of them do well. for virgin knee, it's hard to justify when TKA is an option

 

[lobelsteve]

Really easy to do, and really no reason it should help other than placebo or KOL paid ads masquerading as RCT.