Genicular Nerve Radiofrequency Ablation: Knee

Quick answer

The knee is supplied by several sensory nerves, the genicular nerves, which transmit pain signals from the joint. In chronic osteoarthritis, radiofrequency ablation of these nerves durably interrupts this pain signal, after confirmation by a diagnostic block test.

What is genicular nerve radiofrequency ablation?

The knee is supplied by several small sensory nerves, the genicular nerves, which carry pain signals from the joint capsule to the brain. In chronic osteoarthritis, this signal becomes permanent and disabling.

Radiofrequency consists of precisely heating these nerves (generally the three branches: superomedial, superolateral and inferomedial) using a needle placed under radiological guidance, to durably interrupt transmission of the pain signal, without acting on the joint itself.

Radiofrequency or knee embolization: what is the difference?

These are two distinct techniques, targeting two different mechanisms of osteoarthritic pain:

Criterion	Genicular nerve radiofrequency	Genicular artery embolization
Target	The nerves that transmit the pain	The abnormal vessels that sustain inflammation
Mechanism	Thermal neurolysis (interruption of the signal)	Vascular occlusion (reduction of synovial inflammation)
Approach	Percutaneous needle under fluoroscopy/CT	Arterial catheter (femoral or radial puncture)
Possible combination	Yes: the two techniques can be complementary depending on the clinical and imaging work-up

Genicular nerve radiofrequency at a glance: key figures

Criterion	Data
Level of evidence	Randomised controlled trials (versus corticosteroids, versus sham) confirming short-term efficacy; long-term data (12 months) remain less established according to recent meta-analyses
Indication	Chronic painful knee osteoarthritis resistant to medical treatment (injections, painkillers), in patients not yet candidates for knee replacement or declining one
Anaesthesia / hospital stay	Local anaesthesia, day case
Nerves targeted	Generally 3 branches (superomedial, superolateral, inferomedial); the inferolateral branch is treated case by case depending on the location of the pain
Repeatability	The procedure can be repeated if the pain returns
Cost	Covered by French national health insurance at Cochin AP-HP, no out-of-pocket fees

Sources: double-blind randomised controlled trials comparing cooled radiofrequency ablation (cooled RFA) with corticosteroids and with a sham procedure; meta-analysis confirming short-term efficacy, with long-term data still uncertain (PMC10783354). Not to be confused with the knee cryoneurolysis trials (Nygaard et al. 2021, Mihalko et al. 2021), which concern a different technique: see our dedicated cryoneurolysis page. Data validated by the team of Prof. Anthony Dohan, Department of Interventional Radiology, Cochin Hospital AP-HP, Université Paris Cité.

How is the procedure performed?

Preliminary work-up: a diagnostic block test (injection of local anaesthetic in contact with the genicular nerves) is often performed to confirm that the pain does come from this source
Guidance: the radiofrequency needle is positioned under radiological control (fluoroscopy or CT) in contact with each targeted nerve
Controlled heating: radiofrequency energy is delivered for a few minutes per nerve to create the desensitising thermal lesion
Return home the same day, with gradual resumption of activities

Frequently asked questions

What is genicular nerve radiofrequency ablation?

It is a technique that interrupts the transmission of pain by precisely heating the small sensory nerves surrounding the knee joint (genicular nerves). Unlike genicular artery embolization, which acts on inflammation, radiofrequency acts directly on the pain signal transmitted to the brain.

What is the difference from knee embolization?

These are two distinct techniques that can be complementary. Genicular artery embolization blocks the abnormal vessels that sustain synovial inflammation. Genicular nerve radiofrequency directly desensitises the nerves that transmit the pain. The choice depends on your work-up and, in some cases, both approaches can be combined.

Is its efficacy scientifically proven?

Yes, by several randomised controlled trials versus corticosteroids and versus a sham procedure, showing efficacy on pain in the short term. Long-term data (beyond 12 months) are, however, less well established, according to a recent meta-analysis.

Is the procedure painful?

No. It is performed under local anaesthesia, as a day case, guided by imaging (fluoroscopy or CT) to precisely target each genicular nerve.

Is knee radiofrequency ablation reimbursed?

Yes. At Cochin Hospital AP-HP (public hospital), genicular nerve radiofrequency ablation is covered by Assurance Maladie, with no extra fees.

Is the equipment used (needles, ablation probes, cement) charged extra?

No. At Cochin Hospital AP-HP (public hospital), all interventional radiology procedures, including ablation procedures (radiofrequency, microwave, cryoablation), are billed at the national health insurance rate. The equipment used during the procedure (needles, probes, cement, catheters, etc.) is fully included in this billing. There are therefore never any extra fees or additional charges related to equipment.

Scientific references

Genicular artery embolization for knee osteoarthritis: results of the LipioJoint-1 trial

Sapoval M, Querub C, Pereira H, Pellerin O, Boeken T, Di Gaeta A, et al. Diagn Interv Imaging 2024;105(4):144-150.

Society of Interventional Radiology Research Reporting Standards for Genicular Artery Embolization

J Vasc Interv Radiol 2024.

Musculoskeletal pain: Cochin's PM&R department

Not all joint pain is a matter for interventional radiology. The Physical Medicine and Rehabilitation (PM&R) department of Cochin Hospital, headed by Prof. François Rannou, manages the medical treatment of musculoskeletal conditions: low back pain, neck pain, disc herniation, osteoarthritis, lumbar spinal stenosis, scoliosis, shoulder conditions, sports traumatology, as well as inflammatory rheumatic diseases.

The department has a complete technical platform (balneotherapy, musculoskeletal ultrasound, movement analysis, occupational therapy, podiatry) and offers consultations in physical medicine, sports medicine, manual medicine and rheumatology, as well as spinal injections. Complex cases are discussed at joint medical-surgical meetings.

📅 Book an appointment in PM&R 🇫🇷 → The PM&R department on aphp.fr 🇫🇷

PM&R secretariat, Hardy B Building, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, 75014 Paris

Why this page is trustworthy

Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: July 2026.

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Genicular nerve radiofrequency ablation: knee