Cryoneurolysis before Total Knee Arthroplasty in Patients With Severe Osteoarthritis for Reduction of Postoperative Pain and Opioid Use in a Single-Center Randomized Controlled Trial

Abstract

Background: We hypothesized that preoperative cryoneurolysis of the superficial genicular nerves in patients with osteoarthritis would decrease postoperative opioid use relative to standard of care (SOC) treatment in patients undergoing total knee arthroplasty (TKA). Methods: Patients received either cryoneurolysis (intent-to-treat [ITT]: n ¼ 62) or SOC (ITT: n ¼ 62). The cryoneurolysis group received cryoneurolysis of the superficial genicular nerves 3e7 days before surgery plus a similar preoperative, intraoperative, and postoperative pain management protocol as the SOC group. The primary end point was cumulative opioid consumption in total daily morphine equivalents from discharge to the 6-week study follow-up assessment. Secondary end points included changes in pain and functional scores. Primary and secondary end points were assessed using ITT and per-protocol (PP) analyses. Results: The primary end point was not met in the ITT analysis (4.8 [cryoneurolysis] vs 6.1 [SOC] mg; P ¼ .0841) but was met in the PP analysis (4.2 vs 5.9 mg; P ¼ .0186) after excluding patients with medication deviations or missing follow-up data. Compared with the SOC group, the cryoneurolysis group had improved functional scores and numerical improvements in pain scores across all follow-up assessments, with significant improvements observed in current pain from baseline to the 72-hour and 2-week follow-up assessments and pain in the past week from baseline to the 12-week follow-up assessment. Conclusion: Findings from the PP analysis suggest that preoperative cryoneurolysis in patients with knee osteoarthritis can reduce opioid consumption and improve functional outcomes after TKA.

Safety and Efficacy of Genicular Nerve Radiofrequency Ablation for Management of Painful Total Knee Replacement: A Systematic Review

“…After reading the full text of the articles, we excluded five articles that discussed using GNRFA for immediate postoperative pain relief [11][12][13][14][15]. Four articles utilizing GNRFA preoperatively for postoperative pain relief were also excluded [16][17][18][19]. Four review articles were also excluded [20][21][22][23].…”

The Routes of Administration for Acute Postoperative Pain Medication

“…The present review deals with the management of acute postoperative pain medications and their different ways of administration, focusing on the most adopted ones. However, several other approaches can be employed to control acute pain and prevent chronification, such as non-pharmacological treatment (i.e., acupuncture), topical treatments and neuroablative/modulatory techniques, like cryo-analgesia [ 86 ].…”

Better precision of a new robotically assisted system for total knee arthroplasty compared to conventional techniques: A sawbone model study

“…Total knee arthroplasty (TKA) is a currently available surgery that can alleviate pain, restore the mobility and independence of severely affected individuals, and improve the quality of life of patients 1–3 . The demand for TKA continues to grow, with approximately 3.5 million procedures expected to be performed per year by 2030 4 .…”