Radiofrequency Ablation for Knee Pain

A non-surgical treatment option to help manage knee osteoarthritis symptoms

Cooled Radiofrequency ablation (RFA) is a minimally invasive, non-surgical procedure that may help relieve persistent knee pain, particularly in people with osteoarthritis who are not yet ready for knee replacement surgery, or who may not be suitable surgical candidates. The procedure is typically performed in a hospital theatre or specialist clinic using real-time imaging for accuracy and is often considered when other ‘non-surgical approaches’, such as physiotherapy, pain relief medications, or joint injections, have not provided sufficient relief.

While not a cure for arthritis, radiofrequency ablation may form part of a comprehensive pain management plan aimed at improving quality of life and maintaining function.

Around 2.1 million Australians (1 in 11 people) have osteoarthritis, with a 58% increase expected by 2032 due to population ageing and rising obesity rates

How radiofrequency ablation works

Radiofrequency ablation (RFA) works by disrupting the sensory nerve pathways that transmit pain signals from the knee joint to the brain. The procedure specifically targets the genicular nerves, which are responsible for carrying pain messages from within the knee. Because these nerves are the focus of treatment, the procedure is also known as genicular nerve ablation.

In individuals with knee osteoarthritis, these sensory nerves can become overactive due to ongoing inflammation, cartilage wear, and changes in joint mechanics. This can result in persistent, hard-to-manage pain, even after trying physiotherapy, medications, or injections.

During the procedure, Dr Hockings uses real-time imaging (typically X-ray or ultrasound) to guide the placement of a thin, needle-like probe near the genicular nerves. Once accurately positioned, the tip of the probe delivers a controlled dose of radiofrequency energy, which generates heat to create a small lesion on the nerve. This temporarily interrupts the nerve’s ability to transmit pain signals.

Importantly, RFA does not change the structure of the joint itself. Instead, it helps reduce pain perception, allowing for improved mobility, greater comfort, and the ability to participate more easily in daily activities, all without the need for incisions, stitches, or surgical recovery.

What Is Cooled Radiofrequency Ablation, and how Is It different?

Cooled radiofrequency ablation (CRFA) is an advanced variation of traditional radiofrequency ablation (RFA), designed to treat chronic knee pain. COOLIEF® is one of the most well-known CRFA systems, developed by Avanos Medical, Inc. It uses a water-cooled probe to regulate the temperature at the tip of the electrode. This cooling mechanism allows a larger treatment area (called a lesion) to form around the nerve, which may lead to broader nerve coverage and potentially longer-lasting pain relief for some patients.

In addition to cooled RFA COOLIEF® ,other radiofrequency systems that could also be used in clinical practice include:

Conventional (non-cooled) RFACo: This is the standard form of radiofrequency ablation. It uses thermal energy to create a small, targeted lesion around the nerve without water cooling. It remains a widely used option and can be effective in appropriate cases.
Monopolar vs Bipolar RFA: Monopolar systems use a single active probe to deliver energy, while bipolar systems use two electrodes to create a larger lesion. Each has different technical advantages, depending on the location and extent of nerve involvement.
Emerging alternatives: Techniques such as cryoneurolysis (which freezes the nerve rather than heating it) are being researched as non-thermal alternatives however, these are not yet widely approved or routinely used for treating knee osteoarthritis.ghtness in the muscles that control the kneecap may contribute.

Dr Hockings will consider your individual circumstances, including your pain pattern, imaging findings, previous treatment responses, and overall health, to recommend the most appropriate technique for your knee pain management.

Is RFA a cure for knee osteoarthritis?

No, radiofrequency ablation does not cure osteoarthritis or reverse joint damage. It is designed to manage pain and support mobility. For some patients, it may delay the need for knee replacement surgery or improve their ability to engage in other treatments like physiotherapy.

It is typically offered as part of a broader joint preservation and pain management plan, which may include:

Who might benefit from radiofrequency ablation?

Radiofrequency ablation (RFA) may be a helpful option for certain individuals living with ongoing knee pain due to osteoarthritis. It is not suitable for everyone, but for the right patient, RFA can offer meaningful relief from discomfort and support improved daily function.

You may be considered for RFA if you:

Have moderate to severe knee osteoarthritis
Experience persistent pain that affects your mobility or daily activities
Have not responded well to non-surgical treatments such as physiotherapy, anti-inflammatory medications, or joint injections
Are not ready for, or cannot undergo, knee replacement surgery
Experience good short-term relief from a diagnostic genicular nerve block (a temporary nerve injection used to predict if RFA is likely to work)

When successful, RFA can provide:

Pain relief: Many patients report a significant reduction in knee pain following the procedure
Improved mobility: With less discomfort, walking, climbing stairs, and participating in daily tasks may become easier
Support for physiotherapy and activity: By reducing pain, RFA may help you re-engage in exercise or rehabilitation, which is important for long-term joint health
Delay or avoidance of surgery: For some patients, RFA may delay the need for knee replacement surgery or reduce reliance on medications

RFA also offers several practical benefits as part of a broader pain management plan:

Minimally invasive: No incisions or stitches are required
Convenient day procedure: Typically performed in under an hour, without the need for an overnight hospital stay
Preserves joint structure: The treatment does not change the anatomy of your knee, so all future options remain open
Repeatable: If the nerves regenerate and pain returns, the procedure can often be safely repeated
Works with other treatments: RFA can be used alongside physiotherapy, medications, injections, and weight management strategies for a comprehensive approach to care

Dr Hockings will help determine whether radiofrequency ablation is an appropriate option for your specific situation, based on your symptoms, imaging, medical history, and goals.

What to expect during the RFA procedure

If you’re living with chronic knee pain that hasn’t improved with medications, injections, or physiotherapy and you’re not ready for joint replacement radiofrequency ablation may offer meaningful relief. Before proceeding, Dr Hockings will conduct a thorough consultation to ensure RFA is appropriate for you. This will include:

Reviewing your medical history and previous treatments
Performing a clinical examination and reviewing any relevant imaging
Discussing a trial diagnostic nerve block; a short-acting injection to help determine whether RFA is likely to be effective
Explaining the RFA procedure, benefits, risks, and alternatives
Arranging a suitable date for the procedure, typically performed in a hospital day surgery or procedural suite

On the Day of the Procedure

Here’s a step-by-step overview of what to expect:

Preparation and Positioning: You will be positioned comfortably on the procedure table. Dr Hockings will use real-time imaging (fluoroscopy or ultrasound) to guide accurate needle placement near the targeted genicular nerves.
Local Anaesthesia: A local anaesthetic is injected into the skin and around the treatment area to numb the region and minimise any discomfort during the procedure.
Ablation: Once the needle-like probe is accurately placed, a radiofrequency current is delivered through the tip. This energy heats the surrounding tissue and creates a small lesion to temporarily interrupt the nerve’s ability to transmit pain signals.
Recovery: The procedure usually takes under an hour, and you can typically go home the same day. Most patients experience minimal downtime, with some mild soreness or bruising at the injection sites.

After the Procedure

You can generally return to light activities within a day or two, and resume normal routines shortly thereafter. While individual responses vary, some people begin noticing improvements in pain and mobility within 1–2 weeks.

Dr Hockings will provide detailed aftercare instructions and follow-up to monitor your response to treatment and help you get the most out of your recovery.

How long does the pain relief last?

Most patients begin to notice pain relief within one to two weeks following the procedure. This improvement can allow for greater comfort with walking, exercise, and daily tasks. In many cases, the effects of radiofrequency ablation may last between 6 and 12 months, and in some individuals, even longer. Since the treated sensory nerves can gradually regenerate over time, pain may eventually return. If this happens however, the procedure can often be safely repeated.

It’s important to note that the degree of pain relief varies from person to person. Some individuals experience a significant reduction in pain and improvement in mobility, while others may find the benefits more modest. Dr Hockings will discuss what outcomes you may reasonably expect based on your condition, imaging results, and response to prior treatment.

Limitations and considerations of RFA

Although RFA is generally safe and well-tolerated, it's important to be aware of the following:

Temporary side effects such as localised bruising, swelling, or mild numbness
Pain recurrence as the nerves gradually regenerate over time
Variable outcomes – not all patients respond equally
Not suitable if knee pain is due to causes unrelated to arthritis (e.g. nerve disorders or referred pain)
Does not address joint mechanics, deformity, or instability

Dr Hockings will explain the potential risks and expected outcomes and whether RFA is suitable based on your imaging results, symptoms, and medical history.

During your consultation, Dr Hockings will explain the most appropriate surgical approach based on your condition, anatomy, and individual needs. Many people experience a significant improvement in pain, function, and mobility following hip replacement surgery. Recovery timelines vary depending on the surgical approach and your overall health, but most patients gradually return to walking, driving, and normal activities over the course of several weeks to months.

If you’re living with hip pain or stiffness that’s affecting your quality of life, a thorough assessment can help determine the cause and guide the right treatment path.