JOA - 2026-05-20 - Journal Article
Cryoneurolysis Reduces Postoperative Opioid Use in Patients Undergoing Total Knee Arthroplasty.
Toavs T, Sudheendra V, Barrett T, Lentine B
Topics
Key Takeaway
Preoperative cryoneurolysis of four anterior knee nerves reduced cumulative postoperative opioid consumption by 27% (362 vs 497 MME, p=0.016) without affecting ROM recovery at 2 weeks, 6 weeks, or 3 months.
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Summary
This retrospective case-control study asked whether preoperative ultrasound-guided cryoneurolysis of the anterior femoral cutaneous nerve, intermediate FCN, medial FCN, and infrapatellar branch of the saphenous nerve reduces opioid use after primary TKA. Sixty cryoanalgesia patients were matched 1:1 by age, sex, and BMI to controls; cumulative postoperative MMEs were compared via independent t-tests. Cryoanalgesia patients consumed significantly fewer MMEs (362.2 vs 497.3, p=0.016) with no difference in knee flexion at any time point and no reported complications.
Key Limitation
Single-institution, two-surgeon retrospective design with no documentation of standardized perioperative analgesic protocols, making it impossible to attribute opioid reduction solely to cryoneurolysis versus unmeasured differences in adjunct analgesia.
Original Abstract
BACKGROUND
Cryoanalgesia is increasingly used in total knee arthroplasty (TKA) as a non-opioid pain control modality. This study evaluated the effect of cryoanalgesia on postoperative opioid use and recovery of range of motion in patients who underwent TKA for end-stage knee osteoarthritis.
METHODS
This retrospective case-controlled study included patients who received cryoanalgesia prior to primary, unilateral TKA by one of two fellowship-trained arthroplasty surgeons at a single institution. Exclusion criteria included unicompartmental knee arthroplasty, bilateral TKA, revision knee arthroplasty, revision or reoperation after index arthroplasty, and history of preoperative opioid use. The cryoanalgesia group received ultrasound-guided cryoneurolysis of the anterior femoral cutaneous nerve (FCN), intermediate FCN, medial FCN, and infrapatellar branch of the saphenous nerve prior to TKA. A total of 60 cryoanalgesia cases were matched with 60 controls using age ± five years, sex, and body mass index (BMI) ± 1.5. The mean age was 69 years (range, 49.5 to 88.1), and the mean BMI was 32.2 (range, 22.9 to 44.3). There were 84 patients (70%) who were women. Independent-sample t-tests were used to compare cumulative postoperative opioid morphine milligram equivalents (MMEs) and recovery of knee flexion between groups.
RESULTS
Patients who received cryoanalgesia required significantly fewer postoperative opioid prescription MMEs compared to matched controls (362.2 ± 267.2 versus 497.3 ± 336.6, P = 0.016). There was no significant difference in mean knee flexion between the cryoanalgesia and control groups at two weeks (94.9 ± 8.5 versus 94.1 ± 7.7°, P = 0.59), six weeks (115.1 ± 8.5 versus 113.9 ± 9.2°, P = 0.47), or three months (120.5 ± 4.8 versus 119.2 ± 5.8°, P = 0.23) postoperatively. There were no complications that occurred.
CONCLUSION
Patients who received cryoanalgesia prior to primary unilateral TKA received significantly fewer postoperative opioid MMEs with no significant difference in knee flexion compared to matched controls.