Efficacy of preoperative genicular nerve radiofrequency ablation for postoperative pain after total knee arthroplasty: a systematic review

Total knee arthroplasty (TKA) treats end-stage knee osteoarthritis effectively, although acute postoperative pain and persistent pain is important barriers to recovery. Preoperative genicular nerve radiofrequency ablation (GNRFA) aims to interrupt peripheral nociceptive transmission before surgical tissue injury. This systematic review evaluated postoperative pain after primary TKA in adults receiving preoperative GNRFA. PubMed/MEDLINE, Scopus, Web of Science Core Collection, Cochrane CENTRAL, and reference lists were searched from inception to 31 Jan 2026, with independent screening, data extraction, and risk-of-bias assessment by two authors. Primary outcomes were postoperative pain at rest and with movement; secondary outcomes were opioid consumption, function, length of stay, and adverse events. Four original studies met eligibility, three randomized sham-controlled trials and one retrospective claims cohort. Each randomized trial found no significant reduction in postoperative pain, opioid consumption, length of stay, or functional scores after conventional or cooled RFA. The claims cohort reported lower adjusted odds of prolonged postoperative opioid use after prior GNRFA and no increase in two-year surgical outcomes, although its design did not establish causation. Heterogeneity in timing, technique, comparators, outcome instruments, and follow-up precluded meta-analysis. Current data does not support routine preoperative GNRFA to improve postoperative pain or recovery after primary TKA; standardized, adequately powered trials in defined high-risk pain populations are needed.