Genicular Nerve Ablation for Persistent Knee Pain

Radiofrequency and Alcohol Chemical Neurolysis

Targeted pain relief for persistent knee pain when other treatments have not provided lasting benefit

Persistent knee pain can make walking, climbing stairs, exercising and even sleeping uncomfortable. While physiotherapy, medication and knee injections help many people, some continue to experience significant pain despite these treatments.

Genicular nerve ablation is a minimally invasive procedure that aims to reduce pain by treating the small sensory nerves supplying the knee joint. Depending on your individual circumstances, this may be performed using radiofrequency ablation (RFA) or chemical neurolysis using alcohol.

A detailed consultation is essential to determine whether either treatment is appropriate for your condition.

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What is genicular nerve ablation?

The genicular nerves are small sensory nerves that carry pain signals from the knee joint to the brain. These nerves do not control the muscles responsible for moving the knee.

Genicular nerve ablation aims to interrupt these pain signals while preserving normal movement of the joint.

Treatment is performed using image guidance to accurately target the nerves surrounding the knee.

The two main techniques are:

Radiofrequency ablation (RFA)
Alcohol chemical neurolysis

Both techniques are designed to reduce pain and improve function in carefully selected patients.

Radiofrequency Ablation (RFA)

Radiofrequency ablation uses specialised needles to apply controlled heat to the targeted genicular nerves.

This creates a small, carefully controlled lesion that interrupts pain transmission while minimising damage to surrounding tissues.

The procedure is performed under local anaesthetic using X-ray or ultrasound guidance.

Potential benefits

Minimally invasive
Day-case procedure
No surgical incision
May reduce pain for several months
May improve walking and mobility
May reduce reliance on pain medication

Alcohol Chemical Neurolysis

Chemical neurolysis involves injecting a carefully measured amount of alcohol around the targeted genicular nerves.

The alcohol disrupts the nerve's ability to transmit pain signals. As with radiofrequency treatment, the procedure is performed under image guidance to ensure accurate placement and reduce the risk of affecting nearby structures.

Chemical neurolysis may be considered in selected patients, particularly when longer-lasting denervation is desired or when radiofrequency ablation is not the preferred option.

Who may benefit?

Genicular nerve ablation may be appropriate for carefully selected patients with:

Knee osteoarthritis
Persistent knee pain despite physiotherapy and medication
Pain that has returned after previous injections
Persistent pain following knee replacement (selected patients)
Patients wishing to delay knee replacement where appropriate
Patients who are not suitable for surgery because of other medical conditions

Treatment is only recommended after confirming that the knee joint is the most likely source of pain.

Am I suitable?

You may be suitable if you:

Have persistent knee pain lasting several months
Have not achieved sufficient improvement with conservative treatment
Have experienced only temporary benefit from injections
Are seeking alternatives to surgery
Have knee arthritis affecting your daily activities

Not everyone with knee pain is suitable for nerve ablation, and a detailed assessment is important before deciding on treatment.

What happens during the procedure?

The procedure usually takes 30–45 minutes and is performed as a day-case.

It typically involves:

Cleaning the skin and administering local anaesthetic.
Using X-ray or ultrasound guidance to identify the target nerves.
Positioning the treatment needles accurately.
Confirming correct placement.
Performing radiofrequency ablation or alcohol chemical neurolysis.
Applying a small dressing before discharge home.

Most patients are able to walk immediately after the procedure and return home the same day.

Recovery

It is common to experience mild soreness around the injection sites for a few days.

Most patients can:

Walk immediately after treatment
Resume light daily activities within 24–48 hours
Gradually increase activity over the following weeks

Pain relief is not always immediate and may develop gradually over several weeks.

Continuing strengthening exercises and physiotherapy is encouraged where appropriate.

What are the benefits?

For carefully selected patients, genicular nerve ablation may:

Reduce knee pain
Improve walking tolerance
Improve sleep
Increase participation in exercise and rehabilitation
Improve quality of life
Reduce reliance on pain medication

The degree and duration of benefit varies between individuals, and no procedure can guarantee complete pain relief.

What are the risks?

Genicular nerve ablation is generally considered a low-risk procedure, although complications can occur.

Possible risks include:

Temporary soreness
Bruising
Bleeding
Infection
Temporary numbness around the knee
Temporary increase in pain
Failure to improve symptoms
Very rarely, injury to nearby nerves or blood vessels

Alcohol chemical neurolysis may produce a temporary burning sensation during injection despite the use of local anaesthetic.

These risks will be discussed in detail during your consultation before any procedure is undertaken.

Frequently Asked Questions

Will this cure my knee arthritis?

No.

Genicular nerve ablation reduces pain but does not reverse arthritis or repair the joint.

How long does pain relief last?

The duration of pain relief varies.

Many patients experience improvement for several months, although individual responses differ.

Is radiofrequency better than alcohol neurolysis?

Both techniques aim to interrupt pain signals from the genicular nerves.

The most appropriate option depends on your diagnosis, previous treatments and individual clinical circumstances.

Will I still be able to walk normally?

Yes.

The treated nerves are sensory nerves that carry pain signals and do not control movement of the knee.

Can the procedure be repeated?

In some cases, repeat treatment may be appropriate if pain returns and you previously responded well.

Can I have this after a knee replacement?

Some people with persistent pain after knee replacement may benefit from genicular nerve ablation, although careful assessment is required to ensure there is no treatable surgical cause for the pain.

Why choose Dr David Crabtree?

As a Consultant in Pain Medicine, I provide comprehensive assessment and evidence-based treatment for persistent knee pain.

My aim is to identify the underlying cause of your symptoms and recommend the treatment most likely to improve your pain, mobility and quality of life.

Where genicular nerve ablation is appropriate, procedures are performed using image guidance to maximise precision and safety.

Ready to explore your treatment options?

If persistent knee pain is limiting your mobility, exercise or enjoyment of everyday life, a consultation can help determine whether genicular nerve ablation or another treatment is the most appropriate option for you.