So we have our our patient here today who has pain in the knee.

Now she's already

had steroid injections in the inside the knee and she's already had hyaluronidase,
Synvisc or or other similar type of medications injected me. We see we still have
pain and and my personal belief and and and it's supported is that you don't want
to put steroid in the knee repeatedly because steroid is great it can reduce
inflammation but repeated use of steroids especially around ligaments in the knee
can cause thinning and degeneration. So that's why we're doing this because we
don't want to put the steroid in the knee. So first of all let's let's identify
which is your bad knee, the right knee and I understand how long has this been
going on the pain about five months. OK. OK. So the pain has been, you know,
getting worse over the past. Yeah, more than five months. So I I always like to
examine these together. You can see that clearly there's swelling on this side and
that happens, you know, whether it's it's a Bony swelling, you know, it's arthritic
or what have you. But I hear I can feel a little fluctuation here. So she does have
a little bit of a, a, a Bursitis and she does have a little bit of a, a probably
some fluid in there and you know we've we've looked at that before. So the the
genicular nerve block is a way of blocking the nerves to the knee without entering
the joint. So entering the joint for example, if we're going to do a steroid
injection, what we would do is we would just go right through, here's the Patella
here, the bone here we would go underneath the bone and we would enter right into
the into the knee joint. However for her we're doing a genicular nerve block. So
the genicular means knee and obviously the nerve block. So the way that we're going
to do this is we're going to have her in the operating room, have the knee just
like this and we're going to find certain points. These points are basically if we
look here, here's the tibia fibula and the lower part of the femur. So the points
where the nerve runs, and I'm just going to put a mark here, the nerve runs here,
here and right about here, OK. And imagine putting a needle near your knee. It is,
it is uncomfortable. So we are going to make her a little bit sleepy so that she
doesn't, you know, have any discomfort. OK. So these are the points. And I just
mark these more for reference than anything else. We're going to put my initials
here, site marking, so I know I'm going to do this knee and one needle is going to
go here, one is about here. OK. And I just, I'm just feeling it. I can feel the
tibial plateau, you know, the top part of the tibia. And I'm going to go right
about here. And that's our general markings for the knee. After we're done, I want
you to walk. So the idea is after I blocked the knee and I made it feel better,
she's going to do all the things that normally would make it hurt. So it's not
going to hurt because I'm making you sleepy. OK. That's why we put a little
intravenous. I'll give you a little bit of medication. You know, like, like you're
having a colonoscopy or something. OK. And, you know, I can feel that crackle.
Yeah, that hurts. I know. I know that hurts. You know why? Why are we doing this?
Because, listen, eventually we're all going to get arthritis. There's no, there's
no way around that, you know? But the idea is she's not a smoker. She's in an ideal
body weight, and this is bothering her. It's now starting to affect her activities
of daily living. So at that point we have a couple of choices. Do we want to rush
and do a total knee replacement? Yes, that's an option. However, if we can extend
that out as far as possible and maybe even avoid it all together, because why would
she need a total knee replacement? Because of pain. And that's the whole thing now.
We've tried so many things. We've tried topicals, We've tried the intraarticular
steroid. So now it brings up the question, well, how long is this block going to
last? And that I know you asked me that before, Well, I don't know. It lasts as
long as it's going to. And we see because if it works and you say, wow, this feels
great, I know. And I'm going to test you afterwards. If you say, wow, this feels
great and the pain comes back, I'm going to see you in about a week or two and you
say, oh wow, you know what, This was so good. Now the pain came back. Don't worry,
we do it again. We do it with a slightly different medication and we test you
again, and if that helps and the pain comes back, don't worry. We've tested you
twice each time it helped, but the pain came back. It's OK now. We we're going to
make it last a long time. We're going to burn the nerve. Everyone goes, Oh my God,
you're going to burn the nerve. I know it sounds pretty harsh. I need to find a
better word for it. The better word is really called radiofrequency ablation, where
we put a very thin needle here again with a high frequency vibration and that
causes the the tissues to get hot. They get hot, the nerve coagulates and it just
splits, splits apart. But just like getting your hair cut, a new nerve grows how
long it takes that new nerve to grow from your spine. A little bit about the speed
of your hair growing. So by the time it grows out, it's about a year. So we're
hoping that we can give you a year of relief. Hey, you know, things can change in a
year because the nerve, as it grows back, and I always say this very colorfully,
the nerve is going back. It's going back. It reaches its old neighborhood and goes,
whoa, look at this neighborhood, look at this, my old head. It looks great. There's
a Starbucks with Dunkin' Donuts, you know. Hey, brain, nothing to report. We're all
good. You know, that can happen or it can go back to its old neighbor and all. Man,
nothing changes in this old place. It's still a dump. You know, we still have, you
know, whatever franchises that were there before or not, you know? And if that's
the case, it's OK, We can do it again. OK. So we, we provide some, some longevity.
OK Do you have any questions? Yeah. Better than surgery. I know, Right. Listen, not
not to, not to criticize any of my orthopaedic colleagues. That's great. If you
need it, you need it. But you know, if we can manage you without it, you know,
excellent. OK, I'm going to take you back. And then we'll, we'll look at how she
does afterwards. I know you said that your pain before was about an 8 out of 10.
Yeah. So we're going to see what our pain scores after the procedure. OK, let's do
this.
So we're back. Remember 3 months ago we did the radiofrequency ablation for the
genicular nerves. Now our patient at that time had severe arthritis of the knee.
She couldn't walk up and down the stairs. A pain score of nine. And she was
debating whether or not to have a knee replacement surgery. We said, yes, that's
certainly an option, a good option, you know, if that's where it comes to it. But
maybe we can extend that time and maybe hold off a little bit and see how much
relief we can get. So she's here. Three months later. Let's have a look at her.
Hello. Hi. How are you? OK, so let's just look at the quick anatomy here. So this
is how this knee would be. This is the outside, here's the the tibia and the fibula
bone here and here's the inside. Now I put these blue marks where the nerve, the
genicular nerves reside. And what we did is we just put a needle down here until we
contacted where we think the nerve should be for the gentle motor stimulation. And
when we found that it was acceptable then we just gently put some local anesthetic
and we did the radio frequency on here, here and over here on the inside. Now this
is to see where we're how we're doing right now. How do you feel? It's. Much.
Better. Excellent. How is the stairs going up and down the stairs that was
bothering you? Going up and down the stairs, that's only time I experience some
degree of fear. Apart from that, I had like 90% improvement. Okay, great, 90%
improvement and that's that's kind of what we see. We see 80 to 90% improvement
over time. And the goal is that this we're expecting this to last at least a year.
And then, you know, hey, in that time things may may get better. You know,
lifestyle may change. She's in great physical health. You know, she's not
overweight. Her BMI is low. All the good things, non-smoker, that's those are all
things that we want anyway, active. Let me have you stand up for a second. Oh wow.
OK, turn good and just kind of squat and get back up. Fantastic that. OK, OK,
great. So I'm just going to, I'm just going to keep an eye on you and we'll we'll
touch base again and like for another three months we'll touch base. And now it's
important while the pain is you know less, she's doing all physical activity,
exercise, getting those quads and hamstrings really strong and that's going to help
her moving forward. Thank you very much. OK, Enjoy your day. OK.