By Dr. Puja Shah, DISC Sports & Spine Center in Newport Beach
When 58-year-old Paul M. of Costa Mesa, Calif. learned his daughter had finally rescheduled her COVID-postponed wedding, his initial joy was overshadowed by dread. Paul had needed a total knee replacement for some time – sooner rather than later, his physician had recommended, as he was suffering from debilitating pain.
When I read his chart, I agreed. As a double-board-certified pain management specialist and anesthesiologist, I knew his case was serious. I then paused to hear what was perplexing my patient so much.
“I’ve waited my whole life to walk my daughter down the aisle,” he said. “And now that her wedding has been rescheduled to happen in a couple of months, do you think I can get a knee replacement and be rehabilitated enough by then to still walk her down the aisle?”
Before I could say anything, he answered his own question with a frown: “I think not.”
And while Paul was right to assume that he wouldn’t recover quickly enough from knee replacement surgery to walk his daughter down the aisle without struggle, what he didn’t know was that there was another option that could make this very important walk possible.
I then introduced him to the concept of genicular nerves and an innovative procedure called a genicular nerve radiofrequency, or – more commonly – a genicular nerve block. Paul’s hope began to return as I told him more about the procedure and let him know he’s not alone in his search for a solution that could stave off knee surgery and alleviate pain temporarily.
For so many patients – everyday people, weekend warriors and elite athletes alike – chronic knee pain is a brutal and daily fact of life. The most common musculoskeletal complaint bringing people to the doctor, knee pain is also a very common ailment in the United States, especially among those who are quite active. It can feel like a conundrum when the more active you are in trying to attain great health, the more joint pain some individuals experience. Frustrating, right?
Thankfully, modern pain management techniques can provide minimally invasive treatment options for those that want to continue their mobility without being encumbered by prolonged rehabilitation time.
Once such procedure is the genicular nerve block. Targeting the sensory nerves around the knee joint capsule, the genicular nerve block is an excellent way to provide pain relief for many different types of patient profiles.
For one, this procedure is particularly helpful for patients, like Paul, who need a knee replacement due to severe, end-stage osteoarthritis, but are unable to get the surgery just yet, whether they’re not physically ready, not mentally prepared or don’t have the appropriate amount of time for surgery and rehabilitation.
In these cases, the genicular nerve block procedure can be a great bridge for them that allows some relief while they await knee replacement.
I have also seen many patients that continue to have chronic knee pain even post-knee replacement. Often years out of their knee replacement surgeries, they may have benefited greatly from restored mobility, but they’re both puzzled and frustrated by the dull, aching pain around the knee capsule that lingers.
What they may not realize is that the sensory nerves around the knee joint capsule can still play a role in irritation and pain even after a knee replacement. They may suffer from chronic neuritis, a term for inflammatory nerve pain, if they’re experiencing nerve-related pain for a prolonged period of time after surgery. For these patients, the genicular nerve block can be a great adjunct to their current pain management regimen.
There are also many individuals – especially athletes – that have suffered knee injuries throughout their lives and careers. And because they may not yet be a candidate for a particular surgery, they continue to suffer. The genicular nerve block procedure is an excellent treatment option for those with continuing pain and no other available modalities with which they can alleviate their suffering.
The genicular nerve block is a two-step procedure that begins with three injections targeting the sensory nerves around the kneecap that are most responsible for creating the patient’s pain: the superior medial genicular nerve, inferior medial genicular nerve and superior lateral genicular nerve.
First, I insert three small needles around those nerves, I inject a numbing medication and an anti-inflammatory medication, and the patient can then go home. It’s a quick 15-minute process, and this is Stage One of the treatment.
The following week, we assess whether or not the patient had greater than 50 percent relief. If the patient did find a significant level of relief, we then move on to Stage Two, which is genicular nerve radiofrequency ablation. This is a long, fancy term for burning of the sensory nerves around the knee joint that contribute to chronic neuropathic pain or nerve-related pain.
When we go into Stage Two, instead of using needles to clearly numb those nerves, we now use micro-needles to create micro-burns around those nerves, so they are no longer are firing and causing pain.
I’ve had excellent results with this procedure in my practice for a variety of different patient profiles, and I see results lasting anywhere from three to six months at a time or even longer. As I said previously, this can be a great bridge to patients’ pre-surgery and post-surgery, of course, when cleared by a surgeon. If they continue to have chronic pain, it can be a wonderful adjunct. The genicular nerve block is also a low-risk procedure, given that there is no effect to the knee joint itself and all of these nerves run superficially.
For Paul, the procedure has brought tremendous relief. We scheduled him for the first stage of the treatment shortly after talking in my office that day. After the genicular nerve radiofrequency of the right knee, he’s doing excellent. He has had nearly a month of relief already, and it is my hope that it will continue for at least six months or so.
But – most important – he will soon be walking his daughter down the aisle, as was his dream, and it is a win-win for all of us, as we get to see the smile on his face and know that modern medicine can truly make a difference.
Dr. Puja Shah is a double-board certified pain management specialist and anesthesiologist at DISC Sports & Spine Center in Newport Beach.