Should You Get Knee Arthritis Nerve Treatment?

by Chris Centeno, MD /

knee arthritis nerve treatment 2

The newest craze in knee pain treatment is a knee arthritis nerve treatment. This procedure has gone from 0 to 60 in the last few years, but is it a good idea? Does it work? How long does it last? Are there better options?

How the Knee Arthritis Nerve Treatment Works

This new knee arthritis nerve treatment works through radiofrequency (RF) energy. The doctor places a “cool” radiofrequency probe near the nerves that carry pain signals in an arthritic knee joint and then zaps these nerves with this type of electromagnetic energy. The treatment dulls the ability of the nerves to carry pain signals and provides relief for a time.

Does This Treatment Treat Arthritis?

Nope. In fact, it’s more likely than not that it may make arthritis worse over time as the normal instinct to protect the painful arthritic joint isn’t there anymore while the nerves are dulled. See below for the discussion on “Charcot” joints.

How Well Does the Treatment Work?

In one recent study, the procedure was able to reduce knee pain by 50% for only 35% of the knee arthritis patients who had the treatment. Another small randomized controlled trial showed 3–6 months of relief, but interestingly, the radiofrequency procedure wasn’t any better than a steroid and anesthetic injection. A different research investigation found that the injection of steroid anti-inflammatory and anesthetic into these nerves was no better than just local anesthetic at reducing pain.

The company that makes these expensive RF devices sponsored a recent study. This one showed that the procedure was better than steroid/anesthetic, but again, the results are not measured longer than 6 months. There was no randomization of these patients and no blinding, so they knew they were getting the more invasive therapy, potentially biasing results.

Finally, a study was just published out of Egypt that included 60 patients who were randomized to either the RF procedure or Tylenol and NSAIDs (acetaminophen). The study only showed differences between the two groups in the primary outcome measure (WOMAC functional scale) at 6 months. So in summary, none of these studies show that the procedure works all that well. None of them were high-level, double-blind studies where the patient didn’t know whether they got the real or a sham procedure. This kind of blew me away, because this is a very invasive procedure that destroys tissue!

Does This Therapy Kill or Hurt the Nerves?

“Cool” RF sounds like a more gentle version of radiofrequency. Why? Traditional RF works by heating the tissue and thus destroying it with thermal energy. In the case of a nerve, that means damaging the nerve. However, “cool” means lower temperatures. However, based on recent research, it’s the opposite.

Believe it or not, the standard way to check out the lesion size of an RF technique is to stick the probe in an uncooked chicken breast! A recent study checked the lesion size of cool RF in a chicken breast versus the higher temperature version. The result? Cool RF produced an even bigger lesion!

For example, a recent MRI case report showed that the lesions created by the procedure could be seen on MRI (see image below which also shows bone damage). This is not really a good thing as it would indicate that tissue damage beyond the nerve occurred.

knee arthritis nerve treatment

The white arrow above is pointing to a cool RF lesion that not only ablated the nerve but also damaged the bone.

What Happens When a Joint Can’t Feel?

When a joint can’t feel, in medicine, we call it a Charcot joint. These are commonly seen in diabetics whose nerves die off. What happens? The joints become horribly damaged and disfigured. Why? The patient loses the normal protective instinct because they feel no arthritic pain, so they just keep going and damaging the joint.

Is There a Better Way?

Obviously, if you had a choice between killing otherwise important nerves to help pain versus injecting something to spark repair, the latter would be the way to go. Platelet rich plasma (PRP) has growth factors that can help tissue repair and is a good cool RF alternative with solid research support to show that it helps mild to moderate arthritis. See my video below on the different types and quality of PRP:

If the arthritis is more severe, our research is showing that a precise same-day bone marrow stem cell procedure may help the pain for years at a time. See below for how that procedure is performed using best practices:

The upshot? Diving into the research on knee arthritis nerve treatment is a bit scary. If it were my knee, I would try to avoid getting my nerves nuked with “cool RF” and instead focus on on using my own platelets or stem cells to help knee arthritis pain.

Category: Knee, Latest News

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2 thoughts on “Should You Get Knee Arthritis Nerve Treatment?

  1. Cameron Cartier

    Dr. Centeno,
    Thank you for another insightful post. Before I gained interest in regenerative medicine, I performed a few of these procedures. The procedure itself was very uncomfortable for the patient despite IV sedation. Additionally, the procedure itself only provided a few months of relief. Needless to say, I haven’t performed this procedure in quite a while. The reason I wanted to comment is to help clarify some points made about the technology and intent of cooled RFA. It is a misleading term, for sure, given that the intent is still to create a thermal lesion, even bigger than that provided by standard RFA. The difference between cooled RFA and standard RFA is that cooled RFA needles attain the targeted temperature more slowly because sterile water is cycled through the radio frequency needle/probe as it is heated up. Although the temperature is set to be lower than standard techniques, the temperature at the tissue attains the same temperature as standard RFA lesions. The goal here is to indeed to create a bigger thermal lesion because heating the tissue more slowly avoids a charred effect that limits the lesion size, something that is thought to occur with standard RFA. Also, this increased lesion size includes anterior projection of the lesion that helps ablate nerves that are difficult to target with standard techniques, such as genicular nerves for the knee or lateral branches of the sacral foramina for sacroiliac joint pain. All in all, both standard RFA and cooled RFA are far from ideal treatment options in my opinion, but I just wanted to help clarify the procedure, its intent and technology, to hopefully help with future posts.

  2. Debra Woodard

    Having had both thermal and cooled radio frequency ablatation done twice in the last year, I only got relief for a couple of weeks a40 to 50 % reduction in my pain level. This meant I stopped my 1/2tablet of Percocet bid and took Tramadol instead. I never achieved the reported 6 month pain free mark that the makers of these medical devices claim is the minimuim amount of time that their study reported.
    I would love to find some pain relief for my severely arthritic knee. Unfortunately , I am way past PRP and bone marrow stem cell transplant.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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