Genicular Nerve Block & Ablation

Good candidates have moderate to severe knee osteoarthritis with pain for at least three months despite exercise, medicines and injections, and clear relief from a test genicular nerve block^[1]. It is often chosen by people who cannot have, or do not want, a knee replacement. It is less suited to inflammatory arthritis, a recently injected knee, or pain that actually comes from the hip or back.

No. A cortisone shot puts a steroid inside the knee joint to calm inflammation. A genicular nerve block places numbing medicine — sometimes with a steroid — next to the nerves outside the joint that carry pain signals^[10]. Before RFA, the block is mainly a test: strong, short-term relief suggests that ablating those nerves is likely to help.

Usually little preparation is needed. Tell us about blood thinners and supplements — guidelines give advice based on the procedure and the medicine^[4], and you should never stop one without the prescribing doctor. If sedation is planned, you will need to fast beforehand and bring a driver^[10]. For the test block, arrive with your usual pain so you can judge the effect.

Most people find it uncomfortable rather than painful. The skin is numbed first, and each nerve site is numbed again before heating, so you mainly feel pressure, warmth or brief aching. Light sedation is optional, and you stay awake enough to answer questions^[10]. The knee may be sore for a few days afterward.

Recovery is usually quick. You can walk out of the office, rest for the remainder of the day and return to normal activities within a few days^[10]. Use ice for soreness or swelling. Relief may start right away or take up to about three weeks^[11]. Call us for fever, spreading redness, or new weakness in the foot or leg.

Relief typically lasts months rather than years, and research results vary. Cleveland Clinic reports RFA relief commonly lasts 6 to 12 months^[11]. A 2025 meta-analysis found the clearest benefit over sham at 4 to 12 weeks, with no clear difference at 24 and 48 weeks^[5], while an industry-funded trial of cooled RFA reported benefit at six months^[9]. Your own result depends on your arthritis and how fully the nerves are treated.

Yes. Because the nerves regrow, pain can return, and RFA can be repeated if it helped the first time^[11]. Medicare in New York pays for no more than two genicular RFA sessions per knee in a rolling 12 months^[1]. Your physician will check that your pain pattern has not changed before repeating treatment.

The main downsides are temporary soreness and bruising, a chance that relief is modest or short-lived, and a small risk of infection or bleeding^[10][5]. Rarely, medicine or heat near the peroneal nerve can cause temporary foot weakness^[10]. Some people also feel numbness around the knee. Sham-controlled trials have reported no serious adverse events, although they were small^[6].

Yes, for selected patients. Under a New York Medicare policy effective October 25, 2026, coverage requires grade 3–4 knee arthritis on X-ray, three months of failed conservative care, at least 50% relief from a test block, and documentation that you are a poor surgical candidate or decline surgery; RFA after knee replacement is not covered^[1]. Commercial plans vary and often need prior authorization. New York workers’ compensation knee guidelines do not specifically address genicular RFA^[2], and no-fault follows its own rules.

Exercise or physical therapy, anti-inflammatory medicines and weight loss when needed are the core treatments, all supported by orthopedic guidelines^[3]. Steroid knee injections can give short-term relief^[3]. Other options include PRP injections, subchondroplasty for bone marrow lesions, peripheral nerve stimulation, and knee replacement surgery when appropriate.

It can help some people, but the evidence is weaker than for arthritis. A systematic review found positive responses in 30–100% of patients across small studies and rated the overall evidence low certainty^[7]. Your surgeon should first rule out infection, loosening or other implant problems. Medicare in New York does not cover genicular RFA for pain after knee replacement^[1].

Not clearly. Cooled RFA keeps the probe tip cooler so it can make a larger lesion^[1], and a well-known cooled-RFA trial reported good six-month results compared with steroid injection^[9]. But head-to-head evidence is limited, and a 2026 meta-analysis of sham-controlled trials found results favored conventional RFA^[6]. Your physician will recommend a technique based on your anatomy and the nerves being treated.