Denervation of the knee joint

Changes can occur at the level of the knee joint due to wear and tear (osteoarthritis), inflammation, surgery or an accident. As a result, nerves can become irritated and subsequently cause pain. For this, genicular denervation can be useful. Using radiofrequency current, heat is generated at the level of the well-defined nerve bundles around your knee. This heat acts on the nerves and changes the pain impulses that are directed to the brain. The (temporary) denervation can reduce the pain over a longer period of time.

Preparation for treatment

On the day of treatment, you will come to the hospital. You do not have to be sober for the treatment, so you can eat and drink. By law, you may not drive a vehicle or operate machinery until the morning after the treatment. Therefore, it is best to provide someone to transport you to and from the hospital. The doctor or nurses will provide you with the necessary certificates.

It is important to inform the doctor if you have:

• have diabetes (diabetes) or a heart condition;
• are (possibly) pregnant;
• are allergic to certain medicines, contrast medium, iodine (disinfectant), latex, etc ...;
• use blood thinners (you can find when to stop them in the table);
• have a pacemaker, defibrillator or neurostimulator;
• have been ill or had an infection. If this is the case, it is better to postpone the procedure.

If you have impaired kidney function, recently suffered a thrombosis or heart attack or had a stent implanted, it is important to contact your treating physician before making an appointment.

Medication	Stop	Notes
Asaflow®, Aspégic® Cardioaspirin®, Aspirin® Dispril®, Sedergine®	Stop if >500 mg/day
Marcoumar®, Sintrom® Marevan®	7 days before treatment	Replace with injections (see further e.g. Clexane®) Coagulation control before treatment
Ticlid®	10 days before treatment
Plavix®, Clopidogrel Brilique®, Efient®	7 days before treatment
Xarelto®, Rivaroxaban Eliquis®, Lixiana®, Pradaxa®	48 hours before treatment
Fraxiparine®, Clexane® Fraxodi®	24 hours before treatment	Restart at least 6 hours after treatment Continue for 3 days together with regular blood thinners After one week coagulation check by GP

The treatment

The nurse will ask to be seated on your back on the treatment table. A small pillow will be placed under the knee to be treated. The skin is disinfected, which may feel cold for a while. The exact puncture site is determined using ultrasound and an X-ray machine. The doctor injects a fast-acting, local anaesthetic. This may cause slight pain in the area of the symptoms.

After the local anaesthetic, needles are inserted with their tip in the correct place. The tip of the needle may warm up. We know that placing and warming these needles can feel uncomfortable. For this reason, light sedative medication will be administered through an infusion during this treatment. This will calm you down and make your muscles relax more. You will become somewhat sleepy so that the treatment is less stressful for you. Your heart rhythm, blood pressure and oxygen in the blood are constantly monitored during the treatment.

When the needles are in the right place, two tests are performed to confirm the position.

• in the first test, you get a 'thrilling' feeling
• in the second test, you feel rather knocking

As soon as you feel this, you should mention it immediately. This is not meant to be painful but it gives us an idea of the position of the needle(s) in relation to the nerve. It is very important that you cooperate well and answer the doctor's questions properly.

When the needles are exactly in the right place, the nerve is locally anaesthetised and treatment begins. Using a radiofrequency current, a heat of 80 °C is generated for one and a half to three minutes. This alters the pain conduction of the nerves of the knee joint.

The amount of X-rays used in this study is so small that the chances of harmful effects are very low, even if you have undergone multiple infiltrations.

After treatment

After the infiltration, you will stay in the recliner for an hour without getting up. If you need help, you can always call a nurse. During this time, your blood pressure, heart rate and pain will be monitored. You may experience more pain in the first two weeks. This is because a burn was made at the level of the nerve of the knee joint.

In the brochure located at the bottom of this page, you will find more explanations on:

• the course of the nerve blockade
• the course of admission and treatment
• possible side effects and complications