title: Percutaneous freezing of sensory nerves prior to total knee arthroplasty.
abstract: BACKGROUND
  Total knee arthroplasty (TKA) is a common procedure resulting in significant post-operative pain. Percutaneous cryoneurolysis targeting the infrapatellar branch of the saphenous nerve and anterior femoral cutaneous nerve could relieve post-operative knee pain by temporarily blocking sensory nerve conduction.
  
  
  METHODS
  A retrospective chart review of 100 patients who underwent TKA was conducted to assess the value of adding perioperative cryoneurolysis to a multimodal pain management program. The treatment group consisted of the first 50 patients consecutively treated after the practice introduced perioperative (five days prior to surgery) cryoneurolysis as part of its standard pain management protocol. The control group consisted of the 50 patients treated before cryoneurolysis was introduced. Outcomes included hospital length of stay (LOS), post-operative opioid requirements, and patient-reported outcomes of pain and function.
  
  
  RESULTS
  A significantly lower proportion of patients in the treatment group had a LOS of ≥2days compared with the control group (6% vs. 67%, p<0.0001) and required 45% less opioids during the first 12weeks after surgery. The treatment group reported a statistically significant reduction in symptoms at the six- and 12-week follow-up compared with the control group and within-group significant reductions in pain intensity and pain interference at two- and six-week follow-up, respectively.
  
  
  CONCLUSIONS
  Perioperative cryoneurolysis in combination with multimodal pain management may significantly improve outcomes in patients undergoing TKA. Promising results from this preliminary retrospective study warrant further investigation of this novel treatment in prospective, randomized trials.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopaedics, LSUHSC School of Medicine, New Orleans, LA 70112, United States. Electronic address: vdasa@lsuhsc.edu.
authors.forename: Vinod
authors.initials: V
authors.lastname: Dasa
authors.affiliation: LSUHSC School of Medicine, 433 Bolivar Street, New Orleans, LA 70112, United States.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Lensing
authors.affiliation: LSUHSC School of Medicine, 433 Bolivar Street, New Orleans, LA 70112, United States.
authors.forename: Miles
authors.initials: M
authors.lastname: Parsons
authors.affiliation: LSUHSC School of Medicine, 433 Bolivar Street, New Orleans, LA 70112, United States.
authors.forename: Justin
authors.initials: J
authors.lastname: Harris
authors.affiliation: LSUHSC School of Public Health, 2020 Gravier Street, Office #256, New Orleans, LA 70112, United States.
authors.forename: Julia
authors.initials: J
authors.lastname: Volaufova
authors.affiliation: Department of Orthopaedics, LSUHSC School of Medicine, New Orleans, LA 70112, United States.
authors.forename: Ryan
authors.initials: R
authors.lastname: Bliss
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D003452:Cryosurgery / Q000379:methods*; D003714:Denervation / Q000379:methods*; D005260:Female; D005615:Freezing; D006801:Humans; D007717:Knee / Q000294:innervation; D007719:Knee Joint / Q000294:innervation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010149:Postoperative Pain / Q000601:surgery*; D010525:Peripheral Nerves / Q000601:surgery; D012189:Retrospective Studies
keywords: Cryoneurolysis; Length of hospital stay; Pain control; Surgical outcomes; Total knee arthroplasty