Imagine this: You hit middle age and suddenly develop knee pain. The discomfort is excruciating, especially when you move. Your doctor suggests knee replacement surgery—but the thought of a major operation, with its risks and long recovery time, makes you hesitate.
What if there was a minimally invasive alternative to relieve your knee pain?
Knee pain can be caused by many factors. It is a very common complaint, particularly among older adults and individuals with osteoarthritis (OA). OA is a progressive, degenerative condition that wears down joint cartilage, causing the bones to rub together. This friction leads to inflammation, bone spurs, and chronic pain.
While total knee replacement (TKR) surgery is often the go-to solution for severe arthritis, an emerging, minimally invasive procedure – genicular nerve ablation (GNA) – offers a promising alternative.
Dr Nivan Loganathan, pain specialist at Total Pain Specialist Singapore, has seen firsthand how this procedure helps patients reclaim their active lifestyles.
“Many (of my patients) have benefitted from genicular nerve blocks/ablation. They are able to go back to do activities which they enjoy doing (e.g pickleball, hiking, walking etc)” he shares.
What Is Knee Genicular Nerve Ablation (GNA)?
GNA is a minimally invasive pain management procedure that targets the genicular nerves, which transmit pain signals from the knee to the brain. By disrupting these signals, GNA reduces chronic knee pain without affecting mobility.
How Is GNA Performed?
GNA is performed in two key steps.
Step 1: Genicular Nerve Block
- Genicular nerve block acts as a diagnostic test to examine the response of the patient.
- A local anaesthetic is injected near the knee to temporarily block pain signals from the genicular nerves.
- If a patient experiences more than a 50% reduction in pain within 24 hours, they may be suitable for nerve ablation.
Step 2: Radiofrequency Ablation (RFA)
- Using X-ray or ultrasound guidance, a small probe is positioned near the targeted genicular nerves.
- The probe emits radiofrequency (RF) waves, generating heat to disrupt the nerve’s ability to transmit pain signals. This alleviates the pain.
Why Choose Knee Genicular Nerve Ablation Over Knee Replacement Surgery?
Minimally Invasive with Quick Recovery
GNA is performed with a needle under local anaesthesia in an outpatient setting. It does not require an incision and hospitalisation, unlike knee replacement surgery.
GNA offers rapid recovery, meaning patients can resume their normal activities within a few days to a week.
Effective Pain Relief
After knee GNA, many patients experience significant pain relief of months to a year, with some benefiting even longer.
GNA can help maintain joint function and relieve pain for those who are not ready for knee replacement surgery.
Safer Option for High-Risk Patients
Some individuals with heart disease, uncontrolled diabetes, or other medical conditions may not be suitable candidates for knee replacement surgery due to surgical risks.
GNA is a safer option for pain relief without the complications of major surgery.
Who Is a Good Candidate for GNA?
Genicular nerve ablation is an option for individuals who struggle with chronic knee pain but are not ready, or unable, to undergo knee replacement surgery. It provides significant pain relief while preserving mobility, making it ideal for the following groups:
- Patients with chronic knee pain who have not responded to conservative treatment. If you have tried everything but still experience discomfort, GNA may offer the relief you are looking for.
- Patients who are not fit for knee replacement surgery due to medical conditions or high surgical risk
- Patients who wish to avoid or delay knee replacement surgery – whether due to personal preference, work commitments, or concerns about recovery.
Dr Nivan summarises: “Genicular nerve ablation is used for those not wanting surgery, those delaying surgery/not fit for surgery and those who have failed conservative measures (medications/physical therapy).”
If you fall into one of these categories, GNA could be the minimally invasive solution that helps you regain mobility and improve your quality of life.
Who May Not Be Eligible?
Despite the many pros of knee genicular nerve ablation, not everyone is suitable for this procedure.
You may not be suitable for GNA if you have:
- Active knee infections
- Knee instability that requires surgery
- Recent or active knee injuries
- Bleeding disorders
- Pregnancy
- Uncontrolled diabetes
- Implants such as a pacemaker and implantable defibrillator
Some cases are too severe for GNA, and surgery is the only viable option. If the knee is structurally unstable from injury, damage, deformities or advanced osteoarthritis, surgery may be necessary to regain function.
Are There Any Side Effects?
While generally safe, genicular nerve ablation has some risks, including:
- Temporary discomfort or bruising at the injection site.
- Mild numbness or tingling in the knee.
- Incomplete pain relief (some patients may need a repeat procedure).
- Rare nerve damage or burns from the radiofrequency heat.
Final Thoughts
For those struggling with chronic knee pain, genicular nerve ablation is an exciting alternative to surgery.
With its minimally invasive nature, quick recovery time, and effective pain relief, GNA offers hope to patients who are not ready, or unable, to undergo knee replacement.
At the same time, GNA is not a cure-all. While it can significantly reduce knee pain for many, some conditions may require surgery for long-term relief. Always consult an specialist doctor to determine the recommended treatment for your condition.
References
- Knee Pain – When to See A Doctor. Medical Channel Asia. Updated: 19 July 2023. https://medicalchannelasia.com/knee-pain-when-to-see-a-doctor/
- Knee Osteoarthritis. Cleveland Clinic. Updated: 30 January 2025. https://my.clevelandclinic.org/health/diseases/21750-osteoarthritis-knee
- Could Bone Spurs Be The Cause of Your Swollen and Painful Feet? Medical Channel Asia. Updated: 19 December 2024. https://medicalchannelasia.com/could-bone-spurs-be-the-cause-of-your-swollen-and-painful-feet/
- Kidd, V. D., Strum, S. R., Strum, D. S., & Shah, J. (2019). Genicular Nerve Radiofrequency Ablation for Painful Knee Arthritis: The Why and the How. JBJS essential surgical techniques, 9(1), e10. https://pmc.ncbi.nlm.nih.gov/articles/PMC6635137/
- Edvin Koshi, James B. Meiling, Aaron M. Conger, Zachary L. McCormick, Taylor R. Burnham. Long-term clinical outcomes of genicular nerve radiofrequency ablation for chronic knee pain using a three-tined electrode for expanded nerve capture. Interventional Pain Medicine. 2022, 1(1). https://www.sciencedirect.com/science/article/pii/S2772594421000030
