Dual-Modality Nerve Ablation: Preoperative Radiofrequency and Cryoneurolysis for Enhanced Pain Relief in Total Knee Arthroplasty

Background Post-operative pain management following total knee arthroplasty often fall short in addressing deep and superficial pain sources effectively. Cryoneurolysis and radiofrequency ablation (RFA) are established techniques that induce Wallerian degeneration to disrupt pain pathways but are rarely used in tandem. This study aims to investigate a novel dual-modality preoperative pain management technique combining RFA and cryoneurolysis to improve patient outcomes and reduce opioid dependence postoperatively. Methods A prospective observational study was performed on patients undergoing cryoneurolysis and radiofrequency ablation before primary TKA from March 2025 – December 2025. Primary outcome measures were obtained through surveys investigating pain through numerical rating scores (0–10) and functionality through Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR) scores. All information was collected from patients undergoing standard of care TKA. Pre-operative data was obtained during the first cryoneurolysis and radiofrequency ablation visit while post-operative data was electronically through Qualtrics 12 weeks post cryoneurolysis and radiofrequency ablation. Results 25 patients completed baseline surveys and 16 provided 120-day post-procedure data. Mean numeric pain scores decreased from 4.6 ± 2.4 to 1.9 ± 1.6 (p = 0.0001); in the 16 patients with paired data, pain decreased by 2.5 ± 3.2 points (paired t = − 3.14, p = 0.007). KOOS JR scores improved from 49.3 ± 17.8 to 72.3 ± 16.7 (p = 0.0002); among paired patients, KOOS JR increased by 26.1 ± 20.6 points (paired t = 5.08, p = 0.0001). These findings demonstrate large, statistically and clinically significant improvements in knee pain and function 120 days after preoperative cryoneurolysis and radiofrequency ablation. Conclusion The integration of these two individually successful techniques capitalizes on their respective strengths and facilitates an effective postoperative pain management strategy: reduced pain, decreased opioid consumption, and increased range of motion. The implementation of this dual approach offers significant progress in orthopedics and pain management while addressing the opioid epidemic and rising healthcare costs that come with longer hospital stays and complications. Further research is warranted to investigate long-term efficacy.