83-year-old lady with constant pain in his right knee of at least 2 years duration. She described the pain as a constant aching sensation, exacerbated by standing and walking. Her walking ability was restricted to less than 25 yards. Rest did not help her pain. The pain would come on at night time and regularly disturb her sleep.
Previous Investigations/ Treatments
Over the last several months patient had input from various specialists including physiotherapists, osteopaths, and the orthopaedic team. X-ray of the right knee performed a few years ago showed complete loss of joint space in the medial compartment with subchondral sclerosis and multiple osteophytes, in keeping with severe osteoarthritis. The orthopaedic team offered her a total knee replacement but surgery was cancelled following an anaesthetic assessment as she was deemed high-risk for surgery due to various other co-morbidities. The patient was recommended conservative management including pain killers and analgesia. Unfortunately, his pain continued to be poorly controlled in spite of regular painkillers. Her quality of life was severely affected due to her lack of mobility and the degree of pain.
The patient was initially reviewed by two other pain clinicians, one of whom performed Genicular nerve blocks without benefit.
Treatment from Dr. Krishna
The patient saw Dr Krishna in his clinic in Bristol, desperate for some pain relief. Dr Krishna discussed various management options including stronger pain killers, steroid injections, visco supplementation, Genicular nerve blocks and Nstride PRP treatment. Dr Krishna felt that steroid injections are unlikely to give her any longer-term pain relief and that viscosupplementation and PRP therapy are unlikely to work due to bone-on-bone pathology. Dr Krishna offered her diagnostic genicular nerve blocks under ultrasound guidance and following a positive response, she underwent Genicular nerve ablation under ultrasound guidance with state-of-the-art Trident needles.
The patient was reviewed 3 months post-procedure and had excellent pain relief from the Genicular nerve ablation treatment. She reported significant improvement in knee pain as well as her function. She was able to walk farther and manage stairs for the first time in many years. She also stopped using most of her painkillers.
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