One Size Does Not Fit All: A Systematic Review of Preoperative Genicular Nerve Radiofrequency Ablation in Total Knee Arthroplasty

Persistent postsurgical pain and poor functional recovery remain significant challenges following total knee arthroplasty, with patients presenting with severe preoperative pain, central sensitization, or psychological comorbidities at elevated risk.Preoperative genicular nerve radiofrequency ablation aims to preemptively block nociceptive signaling via thermal neuro-destruction or sensory neuromodulation, but its clinical utility remains debated.This systematic review evaluates whether ablation improves functional outcomes, pain trajectories, and opioid consumption after primary joint replacement, focusing on vulnerable populations.Following established reporting guidelines, major biomedical databases were comprehensively searched to identify prospective randomized trials and observational studies evaluating functional scores, pain intensity, opioid consumption, length of stay, and complication rates.No clear increase in reported complications was identified in the available studies, although the evidence base is insufficient to exclude uncommon adverse events.Trial evidence showed no statistically or clinically meaningful improvements in medium-to long-term functional scores, acute postoperative pain, or length of stay compared to control procedures.While retrospective database data suggested a potential reduction in long-term opioid refills, none of the available literature stratified outcomes based on baseline patient risk profiles.Preoperative genicular nerve radiofrequency ablation is safe, but current evidence does not support its routine, unselected application in general surgical populations.Its true clinical value remains untested in high-risk individuals predisposed to chronic postsurgical pain, highlighting a clear need for targeted, riskstratified trials.