JOA - 2026-06-01 - Journal Article; Observational Study; Multicenter Study
Preoperative Cryoneurolysis Improves Pain and Function for at Least 12 Months after Total Knee Arthroplasty: A Multicenter Registry Study.
Ng MK, Lin JH, Spitzer AI, Dasa V, Rivadeneyra A, Rogenmoser D, Concoff AL, DiGiorgi M, Urban J, Mihalko WM, Mont MA
Topics
Key Takeaway
Preoperative cryoneurolysis before TKA reduced opioid utilization at 12 months (24% vs 41%, p<0.001) and improved pain scores (2.0 vs 2.4, p<0.001) compared to controls.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This multicenter observational study from the Innovations in Genicular Outcomes Research registry compared 12-month outcomes in primary unilateral TKA patients who received preoperative cryoneurolysis versus those who did not. Cryoneurolysis patients demonstrated lower BPI-SF pain scores (2.0 vs 2.4), reduced opioid use (24% vs 41%), improved KOOS-JR scores (65.2 vs 63.9), and lower PROMIS sleep disturbance scores (53.3 vs 52.3), all reaching statistical significance. Authors report these differences meet minimally clinically important difference thresholds.
Key Limitation
The non-randomized design with no reported propensity score matching or covariate adjustment for baseline opioid use, pain catastrophizing, or surgeon-level selection bias critically limits causal inference.
Original Abstract
BACKGROUND
With the incidence of total knee arthroplasty (TKA) projected to surpass 1.5 million cases annually in the United States by 2050, optimizing perioperative pain control remains a critical priority. This study investigated the effects of preoperative cryoneurolysis in patients undergoing primary unilateral TKA, focusing on 1) pain intensities, 2) opioid utilizations, 3) functional recoveries, and 4) sleep disturbances over 12 months postoperatively.
METHODS
This observational study utilized data from the Innovations in Genicular Outcomes Research, identifying patients undergoing TKA who did versus those who did not receive cryoneurolysis from September 2021 to December 2024, and following them for 12 months postoperatively. Of 356 patients analyzed, 174 received preoperative cryoneurolysis and 182 served as controls. Baseline demographics were collected or tabulated. Pain level was quantified using the Brief Pain Inventory-Short Form instrument and postoperative opioid use, with sleep disturbance measured using the Patient-Reported Outcomes Measurement Information System questionnaire. Physical function was assessed by the Knee Injury and Osteoarthritis Outcome Score, joint replacement questionnaire. Outcomes were assessed preoperatively and at regular weekly, monthly, and quarterly intervals postoperatively. Comparative analysis was performed using generalized linear mixed-effects regression, with significance set at P < 0.05.
RESULTS
Patients who received cryoneurolysis demonstrated significantly lower pain scores (2.0 versus 2.4, P < 0.001) and reduced opioid utilization across the year (24 versus 41%, P < 0.001). Patients who received cryoneurolysis had improved functional outcomes relative to controls (Knee Injury and Osteoarthritis Outcome Score, joint replacement: 65.2 versus 63.9, P = 0.004). Sleep disturbances were also lower in the cryoneurolysis group (52.3 versus 53.3, P < 0.001).
CONCLUSIONS
Cryoneurolysis administered before TKA is associated with reduced long-term opioid dependence, improved pain control, and decreased sleep disturbance for 12 months postoperatively, reaching a minimally clinically important difference. These findings replicate our prior analysis with growing evidence of continued benefit at extended follow-up.