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Years of high school, college and semiprofessional football meant Layne Herber’s knees didn’t stand much of a chance.
What is joint denervation?
Joint denervation involves disabling the small nerves supplying the joint. This can be done with heat (radiofrequency ablation) or freezing (cryoablation). The purpose of the intervention is to reduce pain. The procedure does not affect the condition of the joint, meaning it does not cure wear and tear. However, the range of motion often improves somewhat because with the decrease in pain and the cessation of sudden sharp pain, healthy muscles can function better.
In which diseases/conditions is joint denervation used?
This procedure has been developed for advanced degenerative conditions of the knee (knee arthrosis), shoulder (shoulder arthrosis), and hip (hip arthrosis) for patients who do not want or cannot receive a prosthesis due to other diseases. Patients who already have a prosthesis but still have significant pain may also benefit from this procedure.
When is the procedure not recommended?
- The procedure is contraindicated in cases of local infection.
- Also, if the diagnostic block does not provide at least 50% pain relief for at least a few hours.
How is joint denervation performed?
The procedure is ultrasound-guided and takes place in the office. It takes about 45 minutes, after which the patient can go home with a companion after about 30 minutes of rest.
Usually, the procedure is performed under sedation, so the patient does not perceive the procedure. The doctor numbs the skin, then inserts the needle into the appropriate area and administers the medications.
What happens after the procedure?
After the procedure, the pain may intensify for a few days, and it may take up to 7 days for the full effect to develop.
Taking additional pain relievers after the procedure is typically not necessary.
Normal activities can be resumed the day after the procedure.
What can the patient do for recovery?
Physical therapy is almost mandatory for all musculoskeletal conditions, including knee, hip, and shoulder osteoarthritis.
Adding PRP treatment to promote the long-term biomechanical integrity of the joint and improve cartilage function and condition.
Pre-procedure instructions
Kumurin, marfarin, plavix, heparin, fragmin, and other anticoagulants increase the risk of bleeding.
If you are taking these or similar medications, it is important to inform your treating physician during the planning phase of the procedure. You should not stop taking these medications on your own.
How should the patient prepare for the procedure?
Possible complications of joint denervation
Like any procedure, denervation has its risks, but these interventions typically carry a low risk and do not significantly burden the patient’s body.
Possible complications include:
- Pain at the injection site
- Inflammation
- Infection (abscess)
- Bleeding
- Nerve damage
- Allergic reaction
- Hematoma
If any of the above complications occur, you should contact us within 24 hours. In urgent cases, you should report to the nearest emergency department.
References:
1. Choi WJ, Hwang SJ, Song JG, Leem JG, Kang YU, Park PH, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial. Pain [Internet]. 2011;152(3):481–7. Available from: http://dx.doi.org/10.1016/j.pain.2010.09.029
2. Ajrawat P, Radomski L, Bhatia A, Peng P, Nath N, Gandhi R. Radiofrequency Procedures for the Treatment of Symptomatic Knee Osteoarthritis: A Systematic Review. Pain Med. 2019;1–16.
More alternatives to knee replacement surgery are emerging
Physicians caution that the treatments aren’t permanent fixes, but they may work well for some.
Reconstructive plastic surgeon Joshua Hustedt examines patient John Kamauff in Hustedt’s Scottsdale, Arizona, office. (Alvin Chow)
By Rebecca Theim
“I’d play golf and literally could not walk, but I wasn’t going to give that up,” Herber recalled from his Phoenix-area home.
He was equally adamant that he didn’t want one of the most common elective orthopedic surgeries in the country: total knee replacement.
Although safe for healthy individuals and the gold standard for patients with knees as damaged as Herber’s, the procedure can be an arduous undertaking that requires up to a year for full recovery. Herber also knew that 20 percent of knee replacement patients are unhappy with their outcome. Even more ominous: A close friend died two weeks after the procedure of complications from an infection he developed because of the surgery.
“I kept putting knee replacement off,” Herber said. “I just didn’t want to go through all of that.”
An estimated 30 million Americans — or more than 11 percent of the adult population — suffer from knee osteoarthritis, the degenerative disease that prompts most knee replacements.
In addition to people like Herber who don’t want to undergo the surgery, many Americans aren’t eligible for it because of health issues, including obesity. For those people, several medical specialties — including reconstructive plastic surgery, interventional radiology, and physical medicine and rehabilitation — have developed clinically recognized treatments designed to bring at least temporary relief.
Physicians said patients suffering from debilitating knee pain should consider the following when weighing which treatment is best for them:
- How quickly do I want to recover?
- How much time do I want to invest in my treatment options?
- How healthy am I overall?
- What is the rate of success of the treatment I’m considering? What’s the likelihood it won’t help?
Treating the nerves that signal pain
The medical community remains essentially united that, at least at this juncture, knee replacement is the only permanent cure.
“Knee replacement is the best treatment we have available, but it unfortunately comes at the cost of a long, challenging recovery,” said Osman Ahmed, a vascular and interventional radiologist and professor at UChicago Medicine.
Alternatives, however, may enable a patient “to kick the can down the road until they can reach a time when it’s more advantageous,” noted Anthony Giuffrida, director of interventional spine and pain management at the Cantor Spine Center at the Paley Orthopedic & Spine Institute in Fort Lauderdale, Florida.
The alternatives include procedures that target and at least temporarily silence the nerves that transmit pain signals emanating from the knee.
Physicians who perform the nerve operations note that they don’t permanently solve the problems of an arthritis-riddled knee joint. The three procedures described below are regarded as invasive, with requisite risks, although the risks are lower than with knee replacement.
Pain exists for a reason — to alert the person experiencing it that something is wrong — so concerns abound about whether an individual could do more damage to a knee after a nerve-related treatment.
“Patients ask me all the time: ‘If I don’t feel it, am I going to hurt myself more?’” said Michelle Poliak-Tunis, a double-board-certified physician in pain management and physical medicine and rehabilitation, and associate professor at the University of Wisconsin. “If you’re going to go jump out of airplanes, maybe. But if you’re going to live day-to-day life, the answer is ‘no.’”
There are indications that the procedures could help slow the mechanical decline in the knee.
“The knee doesn’t degenerate any faster,” Giuffrida said. “If anything, it degenerates more slowly because you’ve regained some range of motion and you’re more active,” which helps to maintain the health and function of supporting muscles, ligaments and tendons.
Many insurance policies cover the procedures, but the physicians interviewed for this article said that coverage is market- and insurer-specific. None of these treatments preclude a patient from having a knee replacement later.
Surgical knee denervation
“Neuromodulation [interrupting nerve pain signals] is the future of pain management,” said Joshua Hustedt, a Phoenix-area double-board-certified reconstructive plastic surgeon and assistant professor of orthopedics at the University of Arizona College of Medicine-Phoenix. “We’ll go after the pain signal, not replacing the worn-out parts.”
Hustedt has spent the past five years refining a procedure known as surgical knee denervation that was pioneered 30 years ago by A. Lee Dellon, a Johns Hopkins University School of Medicine professor emeritus and globally recognized expert in neuropathy.
During the 45-minute outpatient procedure, performed under either anesthesia or a local nerve block, Hustedt makes two roughly one-inch incisions on either side of the knee and uses a tiny, endoscopic camera to identify and isolate the four nerves that send pain signals fromthe knee. He then severs and reattaches them to surrounding leg muscles.
Research conducted by Hustedt and his colleagues found that the process of attaching the sensory nerves to motor nerves triggers a reaction in the brain that tricks the sensory nerves into thinking they are motor nerves, leading them to no longer transmit pain signals.
Sixteen days after Hustedt performed the procedure on Herber, the retiree traveled and played three consecutive days of golf without pain, something he said he could have only dreamed of before the surgery. “My knee is not a perfect knee,” Herber said. “But for what I want, at this stage of the game, it’s perfect for me.”
Hustedt has performed the procedure on about 200 knees, starting in 2020. It’s currently available only at his practice in Arizona, although he has launched a campaign to train surgeons worldwide on how to perform it. Patients may still pursue the original procedure championed by Dellon at most U.S. medical teaching hospitals, Hustedt said.
Nerve denervation is permanent, so it doesn’t need to be repeated, Hustedt said, although more studies like one he co-wrote last summer must be conducted to establish its long-term outcomes.
Radiofrequency ablation
A procedure known as radiofrequency (RFA) ablation was introduced in the 1970s to treat back pain and expanded to knees in 2008. RFA uses radio waves guided by X-rays to find and ablate — or destroy — the nerves that transmit pain signals from the knee.
Patients undergoing the 30-minute procedure are lightly sedated. Unlike nerve denervation, the results aren’t permanent because the nerves eventually regrow and reconnect. Patients report relief for six months to one year, and the procedure may be repeated.
Genicular artery embolization
Doctors have deployed embolization — the blocking of blood vessels — for decades to interrupt the blood supply to tumors and to stop internal bleeding. It has been used only in recent years for knee pain.
As knee cartilage breaks down, it results in the release of inflammatory markers that promote abnormal blood vessel growth in the lining of the knee joint, Ahmed said. These abnormal arteries carry nerves with them, causing more pain and inflammation. Genicular artery embolization (GAE) targets and blocks blood flow to these abnormal arteries.
During the 35-minute-to-45-minute procedure, patients are lightly sedated and an interventional radiologist uses an X-ray to identify the abnormal arteries and then injects them with an agent that blocks those specific vessels.
Research shows the results last for at least one year and as long as four years. Ahmed said he is embarking on a study funded by the National Institutes of Health to further investigate GAE. Earlier indications that the procedure may increase infection risks for patients who later have knee replacement have largely been debunked, Ahmed said.
correction
A previous version of this article incorrectly said four nerves that are targeted in a procedure send pain signals to the knee. The nerves send pain signals from the knee.
A previous version of this article incorrectly said four nerves that are targeted in a procedure send pain signals to the knee. The nerves send pain signals from the knee.
Source
https://www.washingtonpost.com/health/2025/05/11/knee-arthritis-replacement-nerves-ablation/
