Rates of knee arthroplasty after genicular nerve ablation: A retrospective study utilizing a large national database

Genicular nerve ablation (GNA), which includes radiofrequency ablation (GNRFA), cryoneurolysis, and chemical neurolysis, is a minimally invasive procedure with growing evidence for improved pain and functional outcomes in the treatment of knee osteoarthritis (KOA). With conservative management for KOA having variable efficacy and knee arthroplasty (KA) carrying substantial risks, there is utility in identifying if GNA may delay or defer surgery.

The purpose of this study was to assess the rate of patients receiving KA, including total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) after receiving GNA.

TriNetX, a national database, was queried for patients 18 years or older who underwent GNA between 2004 and 2025. Patients with severe medical comorbidities and patients with prior TKA or UKA were excluded. Descriptive analyses were performed using the TriNetX Analytics platform and the incidence of post-GNA TKA or UKA was calculated. Secondary analysis calculating the cumulative incidence of arthroplasty among patients without prior KA within 3 months, 6 months, 1 year, 2 years, and 5 years after GNA was also assessed.

There were 6035 patients who underwent GNA during this study period and who were included in the final analysis after excluding patients with select comorbidities or who had a prior TKA or UKA. Among this cohort, 795 (13.2 %; 95 % CI 12.3-14.0) patients underwent TKA (N = 753; 12.5 %; 95 % CI 11.7-13.3) or UKA (N = 42; 0.7 %; 95 % CI 0.5-0.9) after receiving GNA. For patients without prior KA, 152 patients underwent KA at 3 months post-GNA (1.3 %; 95 % CI 1.1-1.5), 415 patients underwent KA at 6 months post-GNA (3.5 %; 95 % CI 3.2-3.9), 847 patients underwent KA at 1 year post-GNA (7.2 %; 95 % CI 6.7-7.6), 1219 patients underwent KA at 2 years post-GNA (10.3 %; 95 % CI 9.8-10.9), and 1469 patients underwent KA at 5 years post-GNA (12.4 %; 95 % CI 11.8-13.0).

This is the largest cohort study to identify rates of KA following GNA. We found that roughly one in eight patients in this cohort received TKA or UKA after GNA, suggesting that GNA may offer clinically meaningful symptom relief for patients with KOA, such that KA may be delayed or deferred. Causality for whether GNA delays or prevents KA cannot be established from this study. The cost effectiveness and surgical sparing efficacy of GNA for symptomatic KOA should be further explored.