Objectives: While a total knee arthroplasty (TKA) is currently used for the alleviation of chronic knee pain (CKP) from severe osteoarthritis, a significant number of these patients (7-30%) go on to suffer from CKP, which, reportedly, can be more severe than the preoperative osteoarthritic pain. Recently, promising interventions have emerged with the potential to alleviate this chronic post-TKA pain: therapeutic or diagnostic nerve blocks with often subsequent radiofrequency ablation (RFA) of the genicular nerves. This narrative literature review will summarize all of the pertinent published studies regarding genicular nerve blocks (GNB) as a possible treatment for CKP after receiving a TKA.
Designs: A review was performed using the PubMed database in September 2019. The authors constructed a search term using the following phrases: (genicular nerve block OR genicular nerve blocks OR genicular nerves block) AND (total knee arthroplasty OR total knee replacement).
Results: The literature search yielded (5) articles pertaining to GNB and post-TKA CKP: (3) case reports, (1) prospective study, and (1) retrospective study.
Conclusions: There is a paucity of published evidence on the usage of GNB for post-TKA CKP, and the available evidence is primarily case reports, with a few prospective and retrospective studies. Despite this limitation, there is a growing body of literature supporting the usage of GNB and/or genicular nerve RFA to ameliorate post-TKA CKP. All of the included studies demonstrated positive results, in regards to improvement of pain and reducing disability, and there were no reported adverse events. We suggest continued study of this technique and the reported benefits for patients with post-TKA CKP. In addition, we recommend further prospective trials with larger patient cohorts and ideally a double-blinded, randomized, placebo-controlled trial be completed, in order to provide higher quality evidence for both the efficacy and safety of GNB and RFA for recalcitrant post-TKA CKP.
James Meiling– PGY-1 Resident, Medical City Weatherford
Brandon Barndt– PGY1, Mercy Catholic Medical Center; Temple/Moss Rehab
Ha Chris– Resident Physician, Mayo Clinic
James Eubanks– Resident Physician, University of Pittsburgh Medical Center (UPMC)
Justin Schappell– Resident Physician, Mayo Clinic
Samir Khan– Resident Physician, Vanderbilt University Medical Center