Knee, Hip and Shoulder Joint Denervation

TOPICS
1. What is Joint Denervation?
2. Who is suitable candidate for Joint Denevation?
3. How is Joint Denervation performed?
4. How safe is Joint Denervation procedure?
5. Are the effects permanent?

What is Joint Denervation?
Joint denervation, also known as joint nerve ablation or denervation therapy, is a medical procedure used to relieve chronic pain in the joints. It involves disrupting or ablating the nerves responsible for transmitting pain signals from the affected joint to the brain.

The procedure typically begins with the identification of the nerves that innervate the painful joint. Once these nerves are located, they are treated using minimally invasive techniques such as chemical ablation and radiofrequency ablation (RFA).

Who is a suitable candidate for Joint Denervation?
Joint denervation is commonly used to manage chronic pain in joints affected by osteoarthritis. It may be considered when other conservative treatments, such as medication, physical therapy, or corticosteroid injections, have failed to provide adequate pain relief. It is often considered a bridge to surgery (when the patient is too young or the arthritis is not severe enough) or in patients who decline surgery due to various reasons. 

How is Joint Denervation performed?
This procedure is performed in a Day Surgery Unit under sedation. The most common technique that is used to denervate joint is with Radiofrequency Ablation. 

During radiofrequency ablation, a special needle is inserted near the nerves, guided by imaging techniques such as fluoroscopy or ultrasound. The needle then emits radiofrequency energy, heating up the nerve tissue and disrupting its function. This prevents the nerves from transmitting pain signals to the brain, providing relief from joint pain. 

How safe is Joint Denervation procedure?
​Overall, joint denervation is considered a relatively safe procedure. However, there is no procedure with zero risk. Common side effects include mild swelling around the injection site and increase in pain lasting 2 weeks after the procedure. Rare complications include infection, inadvertent injury to other nerves, bleeding and skin burns. 

Are the effects permanent?
​It is important to understand that the effects of joint denervation is not a completely insensate joint. Current techniques do not allow for complete joint denervation. The aim of the treatment is reduction of pain. 

The duration of effect following a joint denervation is currently still being studied. In one study, investigators tracked patients for up to 24 months after knee denervation and reported continued benefits at 24 months. However, in clinical practice, the duration of action varies significantly between patients. Recurrence of pain after knee denervation is most often due to progressive disease or regrowth of the nerves. A repeat procedure may be performed it the pain recurs. 

Dr Christopher Liu is a Pain Specialist based in Singapore who offers joint denervation procedures. He has lectured on this topic locally & internationally.

Knee joint denervation is a commonly performed procedure. It is done in the operating room under local anesthesia and sedation. 

Learn more about RFA of the knee joint