Preoperative cryoneurolysis in knee OA patients may reduce opioid consumption and improve functional outcomes after TKA

Clinical evidence from patients undergoing TKA indicates that approximately one third of patients still consume opioids 3 months after surgery. The risk of developing persistent postoperative opioid use is evident in patients undergoing TKA who are opioid naive at the time of surgery and is exacerbated in those consuming opioids preoperatively. For this reason, it is critical that orthopedic surgeons balance effective pain management with the minimization of the risk of persistent opioid use.

William M. Mihalko et al found in a study that preoperative cryoneurolysis of the superficial genicular nerves in patients with osteoarthritis would decrease postoperative opioid use relative to standard of care (SOC) treatment in patients undergoing total knee arthroplasty (TKA).The article has been published in “The Journal of Arthroplasty.”

Patients received either cryoneurolysis (intent-to-treat [ITT]: n = 62) or SOC (ITT: n = 62). The cryoneurolysis group received cryoneurolysis of the superficial genicular nerves 3-7 days before surgery plus a similar preoperative, intraoperative, and postoperative pain management protocol as the SOC group. The primary end point was cumulative opioid consumption in total daily morphine equivalents from discharge to the 6-week study follow-up assessment. Secondary end points included changes in pain and functional scores. Primary and secondary end points were assessed using ITT and per-protocol (PP) analyses.

Key findings of the study were:

• The primary end point was not met in the ITT analysis (4.8 [cryoneurolysis] vs 6.1 [SOC] mg; P = .0841) but was met in the PP analysis (4.2 vs 5.9 mg; P = .0186) after excluding patients with medication deviations or missing follow-up data.

• Compared with the SOC group, the cryoneurolysis group had improved functional scores and numerical improvements in pain scores across all follow-up assessments, with significant improvements observed in current pain from baseline to the 72-hour and 2-week follow-up assessments and pain in the past week from baseline to the 12-week follow-up assessment.

The authors concluded that – “Preoperative cryoneurolysis may be considered as a part of multimodal pain management to minimize opioid use while reducing pain and improving knee function after surgery. Future studies can assess the analgesic efficacy, safety, and opioid-sparing benefits of cryoneurolysis in patients with prior long-term opioid use undergoing TKA. Collectively, these data indicate that cryoneurolysis can be an important component to multimodal postoperative pain strategies and address the growing concern of long term postoperative opioid use.”

Further reading:

Cryoneurolysis before Total Knee Arthroplasty in Patients With Severe Osteoarthritis for Reduction of Postoperative Pain and Opioid Use in a Single-Center Randomized Controlled TrialWilliam M. Mihalko, Anita L. Kerkhof et alThe Journal of Arthroplasty 36 (2021) 1590-1598 https://doi.org/10.1016/j.arth.2020.11.013