Table 2 What is known about the relationship between genicular nerve ablation administered prior to total knee arthroplasty and the impact on post-surgical outcomes?
Source | Location | Study population | Study design | Thermal or cooled ablation | Ablation timing | Target nerves | Outcome | Main findings | Limitations | Quality assessment |
|---|---|---|---|---|---|---|---|---|---|---|
Mishra, 2021 | USA—Vanderbilt Orthopedic Clinic | 60 patients; aged 55–73 years | Single-center, prospective RCT—sham-controlled and double-blind | Thermal | 2–4 weeks prior to TKA | Superior lateral (SL), superior medial (SM), and inferior medial (IM) genicular nerves | Efficacy of conventional GN-RFA for improving postoperative pain at 6 weeks | 6-week follow-up: no significant differences between RFA and sham groups | Pain manifestation is not specific and may appear in other aspects of knee—not covered in this study Procedure for GN-RFA was being updated as the study was underway | 8/11 |
Walega, 2019 | USA | 70 patients; aged 57–75 years | Prospective, randomized, sham-controlled trial | Thermal | 2–6 weeks prior to TKA | Superior lateral (SL), superior medial (SM), and inferior medial (IM) genicular nerves, | Opioid consumption, Medication Quantification Scale III (MSQIII) score, and ambulation scores at 48 h, 1 month, 3 months, and 6 months postoperative | No significant difference in opioid consumption, MSQIII scores, and patient mobility at 48-h, 1-month, 3-month, and 6-month mark | Lack of consensus on timing, articular injections, opioid prescribing, and duration of GN-RFA | 9/11 |
Stake, 2022 | USA | 675 patients | Retrospective cohort | Thermal | 96 days prior to TKA | Superior lateral (SL), superior medial (SM), and inferior medial (IM) genicular nerves | 2-year surgical outcomes, prolonged opioid use 3–6 months postoperative, 90-day readmission, and medical complications | No differences in the 2-year surgical outcomes Significantly lower prolonged opioid use and TKA-associated complications (blood transfusion, anemia, arrhythmias, and UTIs) | Lack of uniformity in GNRFA procedure and management across sites | 12/12 |
Dasa, 2016 | USA—university-based orthopedic practice | 100 patients 56–76 years | Retrospective chart review | Cooled | 5 days prior to TKA | Anterior femoral cutaneous nerve (AFCN) and infrapatellar branches of the saphenous nerve (ISN) | Hospital length of stay, postoperative opioid requirements, and patient-reported outcomes of pain and function (WOMAC, KOOS, SF-12, and PROMIS) | GNRFA treatment group had a significantly shorter length of stay, significantly greater reductions in patient reported outcomes, and significantly less morphine equivalent narcotics than control group postoperatively | Retrospective, non-randomized, and lack of blinding of patients and investigators Some patients missing data on PROMIS among both study groups | 10/12 |
Mihalko, 2019 | USA, single study center | 124 patients, aged 49–79 years | Unblinded randomized controlled trial | Cooled | 3–7 days prior to TKA | Anterior femoral cutaneous nerve (AFCN) and infrapatellar branches of the saphenous nerve (ISN) | Cumulative opioid consumption at 6 weeks postoperative Pain measures: numerical rating scale (NRS), KOOS, Timed Up and Go (TUG)—measured at 72-h, 2-week, 6-week, and 12-week follow-up assessments | GNRFA significantly reduced opioid consumption at multiple assessments compared with control group Similar percentage of patients among both groups experienced an adverse event | Single site nature of study may not allow for generalizability to larger populations Some patients received general anesthesia; associated with higher rates of infection | 9/11 |