This patient is a busy 50 year old with advanced OA of the knees. He is still working, coaches football and likes to b out and about. Once again he is much took young to consider knee replacement and has had previous arthroscopic treatments. He has good function but is beginning to struggle with the persisting pain, especially after hard session of coaching. I treated with Hyaluroanan injections (synvisc) and combined these with PRF (Pulsed Radio Frequency) modulation of the 3 main sensory nerves to the knee (The Geniculate branches as shown below). He is currently almost pain free and very pleased with the response.
The reported technique related too this is to use RF Heat lessening to remove the nerve supply permanently. Pulse RF energy, on the other hand, modulates nerve pain transmission but does not remove the nerve altogether and one must expect the pain to return. However PRF treatments are usually durable and responses of 12 -24 months are not uncommon. This is a new treatment and for the moment I am more comfortable with modulating rather than removing Geniculate nerves, particularly in younger patients until there is more experience with the technique.