Preoperative genicular nerve radiofrequency ablation and outcomes after total knee arthroplasty: A retrospective observational study

Introduction. Persistent pain following total knee arthroplasty (TKA) remains a relevant clinical challenge despite satisfactory prosthetic implantation. Genicular nerve radiofrequency ablation (GNRFA) has emerged as a minimally invasive technique for modulating nociceptive pathways in patients with knee osteoarthritis. This study evaluated whether preoperative GNRFA was associated with improved postoperative outcomes after TKA.Methods. A single-center retrospective observational cohort study was conducted including patients who underwent elective unilateral TKA. Patients were allocated to two groups according to preoperative management: ultrasound-guided continuous GNRFA performed 3–4 weeks before surgery (RF+) or no radiofrequency treatment (RF−). Pain intensity was assessed using the Numeric Rating Scale (NRS), functional status using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and analgesic burden using the Medication Quantification Scale III (MQSIII). Outcomes were evaluated preoperatively, at 48 hours, and at 1 and 3 months postoperatively.Results. Twelve patients were included (6 RF+, 6 RF−). Baseline demographic and clinical characteristics were comparable between groups. Both groups showed significant postoperative improvements in pain and function. No significant difference in NRS scores was observed at 48 hours after surgery (p=0.145). However, the RF+ group demonstrated significantly lower pain scores at 1 month (median NRS 2.5 vs 4.0; p=0.035) and 3 months (1.5 vs 3.5; p=0.022). Functional outcomes favored the RF+ group at 3 months, with lower WOMAC total scores (32.5 vs 42.0; p=0.043) and WOMAC pain subscores (3.0 vs 6.5; p=0.015). No significant differences were observed in MQSIII scores. No major postoperative complications were recorded in either group.Conclusions. In this exploratory cohort, preoperative GNRFA was associated with improved medium-term postoperative pain control and functional recovery following TKA. No significant benefit was observed in the immediate postoperative period or in postoperative analgesic burden. Given the retrospective design and limited sample size, these findings should be considered hypothesis-generating and warrant confirmation in larger prospective studies.