Genicular Nerve RFA: A Targeted Approach for Chronic Knee Pain
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Published in The Ospina Orthopedic Blog ~ 5 min read ~ Last Updated: July 8, 2025
Introduction: When Knee Pain Persists Despite Everything
For many people living with moderate to severe knee osteoarthritis, the treatment path can be frustrating. You may have diligently tried physical therapy, lost weight, and received injections, yet the chronic pain remains, limiting your ability to enjoy life. Often, the next step presented is a total knee replacement—a major surgery with a long and arduous recovery.
But what if there was another option? For patients seeking a meaningful alternative to surgery, Genicular Nerve Radiofrequency Ablation (G-RFA) is an advanced, minimally invasive procedure. It is designed to provide significant, long-lasting improvement by precisely targeting the specific nerves that send pain signals from the knee to the brain, without altering the joint itself.
What is Genicular Nerve RFA and How Does It Work?
In a knee affected by chronic osteoarthritis, the surrounding sensory nerves, known as the genicular nerves, can become over-sensitized. They get stuck in a "high alert" state, constantly sending pain signals to the brain even with normal movement.
Genicular Nerve RFA is a procedure that directly and precisely addresses this issue. Using a specialized needle-like electrode, radiofrequency energy is applied to gently heat and create a lesion on these specific sensory nerves. This process, also called neurotomy, disrupts the nerves' ability to transmit pain signals. It is important to note that this procedure only targets the sensory nerves responsible for pain; it does not affect the motor nerves that control muscle strength and function in your leg. The effect is like turning down the volume on the pain signals originating from your knee.
The Two-Step Process: A "Test Drive" for Your Knee
One of the most valuable aspects of the G-RFA process is that it is methodical and evidence-based, building confidence every step of the way. It involves a two-step approach that allows you and your physician to confirm that you are an excellent candidate before proceeding with the treatment.
Step 1: The Diagnostic Genicular Nerve Block
The process begins with a simple diagnostic injection. Under precise imaging guidance (fluoroscopy or ultrasound), Dr. Kohler will inject a small amount of local anesthetic (numbing medication) around the genicular nerves. This is the "test drive." The goal is to see what happens when those specific nerves are temporarily turned off.
If you experience a significant reduction in your typical knee pain (usually 50% or more) for the several hours that the anesthetic is active, it serves as powerful confirmation. It tells us that the genicular nerves are a primary source of your pain, and that you are very likely to benefit from the longer-lasting RFA procedure. Depending on the provider, a repeat block may be performed to confirm initial results.
Step 2: The Radiofrequency Ablation
Once the diagnostic block has confirmed your candidacy, you can proceed with the RFA procedure. The process is very similar to the block. It is performed in the office as an outpatient procedure and typically takes about 30 minutes. Under imaging guidance, the radiofrequency electrode is carefully placed next to the confirmed target nerves. The radiofrequency waves are then transmitted for about 90 to 180 seconds to create the lesion and interrupt the pain signals. You can return home the same day.
Who is an Ideal Candidate for Genicular Nerve RFA?
This targeted procedure is not for everyone, but it can be a life-changing option for the right patient. Ideal candidates typically include:
- Individuals with moderate to severe chronic knee pain, primarily caused by osteoarthritis.
- Those who have not found adequate improvement from more conservative treatments like physical therapy, anti-inflammatory medications, or other types of injections.
- Patients who wish to avoid or delay a knee replacement surgery.
- Individuals who are not good candidates for major surgery due to other health concerns.
- In some cases, people who continue to have pain even after a knee replacement surgery.
Conclusion: A Precise Path to Better Function
Genicular Nerve RFA is a safe and innovative procedure that offers a non-surgical solution for a common and debilitating problem. By focusing specifically on the source of the pain signals, it can provide significant improvement in pain and function that may last from six to twelve months, and in some cases, even longer.
This methodical, evidence-based approach is a hallmark of the care at Ospina Medical. We are committed to leveraging advanced technology to create individualized treatment plans that are both targeted and minimally invasive.
To find out if you are a candidate for Genicular Nerve RFA, schedule a consultation with Dr. Matthew Kohler. A comprehensive evaluation, including a review of your history and imaging, is the first step toward a targeted solution for your knee pain.
A Riley Publication ~ Branded Thought Leadership by Riley Partners and Publications, Inc.
Medically Reviewed by: Matthew Kohler, MD