Ultrasound-Guided Neurolysis of Six Genicular Nerves for Intractable Pain from Knee Osteoarthritis: A Case Series

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Abstract

Introduction

Among the elderly population, chronic osteoarthritis of the knee joint is one of the leading causes of disability and causes considerable pain, joint stiffness, and functional limitations. Although knee replacement is a good option for advanced osteoarthritis, many patients could not undergo surgery due to comorbidities or other reasons.

Methods

Four patients with severe pain from grade 3 and 4 osteoarthritis of the knee had undergone ultrasound-guided alcohol neurolysis of the 6 genicular nerves after a positive genicular nerve block with local anesthetics. The demographics, pain intensity (NRS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quality of life (SF-36) were analyzed.

Results

There was significant improvement in pain intensity at rest, on movement, and on weight bearing after the neurolysis and it has continued for 6 months (P < 0.05). The OKS and WOMAC score had improved from 7.75 ± 1.25 and 77.75 ± 4.34 at baseline, to 20.75 ± 1.70 and 56.25 ± 3.09 at 1 month, and to 18.25 ± 0.95 and 52.00 ± 2.16 at 6 months after the procedure, respectively (P < 0.05). There was also significant improvement in the quality of life after the procedure (P < 0.05).

Conclusion

Ultrasound-guided alcohol neurolysis is a good alternative for patients having severe pain from knee osteoarthritis and provides significant pain relief for more than 6 months.

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