Discomfort is expected after a knee replacement procedure. For some patients, however, a new therapy using cold injections prior to surgery may help lessen their pain during recovery.
Focused Cold Therapy
Cryoanalgesia uses cold injections to block targeted sensory nerves, preventing them from sending pain signals. This type of treatment has been around for decades, but a new injection system specifically for knee replacements, called iovera®, was only introduced within the last few years.
“I started using iovera for patients in the fall of 2019 and by spring of 2020 we had established it fully across our practice,” says Thomas Chu, DO, Primary Care Sports Medicine, UPMC West Shore Orthopedics.
To give iovera injections, the health care provider uses a handheld device to apply extreme cold through a substance similar to liquid nitrogen that freezes the nerves. The cold applied to the nerves is temporary and causes no permanent damage.
The provider uses the small-gauge needles at the end of the device to make a series of tiny punctures over the upper front of the patient’s thigh and inside the knee to target the two different nerve branches that send pain signals to the knee.
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Proactive Pain Relief
The procedure is usually done 1 to 2 weeks prior to a knee replacement surgery. The idea is to minimize post-recovery pain while the patient is in rehab, but the overall goal, according to Dr. Chu, is to reduce the need for pain medications and other pharmaceuticals post-op. The iovera injections have been shown to reduce knee pain for up to 3 months.
“I tell my patients that the post-op pain they’re anticipating will exist, but when they’re in the recovery period, that is where they’ll really benefit from the pain relief,” Dr. Chu says. “Overall, their iovera experiences have been effective and positive, and we have seen reductions in pain medication use.”
Side effects from the injections are minimal and may include bruising, redness, and minor local pain at the puncture sites. Since the skin is broken, there is a slight risk of infection. The biggest side effect is a superficial frostbite-like burn. With this type of reaction, it can lighten the skin as an adverse reaction to the cold.
Who Can Benefit?
Almost anyone can receive iovera injections, but patients with certain conditions—such as specific blood vessel disorders or other hematologic diseases—may not be candidates for this therapy. Those who have been diagnosed with Raynaud’s syndrome (a condition that causes some areas of the body to feel numb from constricted blood supply in response to cold) or who may have certain blood disorders that interfere with temperature-based feeling also are not good candidates.
“I also would not perform this procedure on anyone with obvious signs of infection or open wounds,” Dr. Chu says.
While commonly performed as a single procedure prior to knee replacement surgery, it also can serve as an alternative form of treatment to alleviate pain related to knee osteoarthritis. Patients may consider it for pain relief if they have not achieved adequate relief from steroid injections or other types of injections.
“I’ve seen really good results from iovera,” Dr. Chu says. “UPMC continues to deliver cutting-edge, advanced treatment options for orthopaedic care right here in Central Pennsylvania.”
For more information about orthopaedic conditions and treatments, visit UPMC.com/CentralPaOrtho.
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About UPMC Orthopaedic Care
As a national leader in advanced orthopaedic care, UPMC treats a full range of musculoskeletal disorders, from the acute and chronic to the common and complex. Whether you have bone, muscle, or joint pain, we provide access to UPMC’s vast network of support services for both surgical and nonsurgical treatments and a full continuum of care. As leaders in research and clinical trials with cutting-edge tools and techniques, UPMC Presbyterian Shadyside appears on U.S. News & World Report’s rankings of the top hospitals in the country for orthopaedics.