Optimizing Knee Pain

Chronic axial neck and back pain have long been the domain of radiofrequency ablation (RFA), and in my clinical practice, I’ve seen countless patients benefit from this evidence-based technique. Over the past decade, we have refined and expanded our RFA protocols not only for axial spine pain, but also for chronic joint pain with a growing focus on the knee joint.

The Evolving Landscape of Knee Pain Management

In recent years, traditional treatments for knee osteoarthritis have come under scrutiny. Corticosteroid injections, once a first-line option, are increasingly discouraged in many painful knees due to concerns over cartilage degradation and systemic effects. Meanwhile, hyaluronic acid injections have lost favor in several guidelines, offering limited long-term benefit for many patients.

That has prompted a needed shift toward recovery-oriented, rehabilitation-focused care. At OSSO HEALTH, we emphasize a multi-modal, nonoperative approach for knee pain. But we also recognize that for patients with end-stage osteoarthritis, the definitive treatment remains total knee arthroplasty (TKA).

Where It All Began

My journey with genicular nerve ablation started where many pain stories end: after surgery.

We began treating patients experiencing persistent knee pain after total knee replacement. Many had exhausted conservative options and were not surgical candidates for revision. Using targeted thermal RFA of the genicular nerves, we were able to achieve meaningful pain relief and restore function for these patients without additional surgery or long-term medications.

Encouraged by these outcomes, I extended the same treatment to patients with end-stage osteoarthritis who were delaying surgery for medical, logistical, or personal reasons. The results were similar offering them a bridge to maintain mobility, reduce medication reliance, and delay surgery with modest improvements in pain.

A Forward-Looking Protocol: Preoperative RFA

Now, we’re advancing a proactive approach: performing radiofrequency ablation of the genicular nerves before total knee arthroplasty. Early evidence supports this strategy, showing:

• Improved postoperative pain control

• Enhanced rehabilitation and early mobilization

• Shorter hospital stays

• Fewer postoperative complications

• Little to no added surgical risk, including no increased risk of infection

By addressing the nerve pathways responsible for chronic pain before surgery, patients arrive in better condition mentally and physically for recovery. This preop-focused protocol is an exciting frontier in collaborative perioperative care.

Cryoneurolysis: A Novel Addition

In addition to thermal ablation, we now offer cryoablation (cryoneurolysis) a technique that applies subzero temperatures to desensitize peripheral nerves. Cryo offers similar pain relief with a potentially favorable sensory profile and may be particularly useful in patients with post-TKA discomfort or those seeking temporary relief prior to surgery.

A Collaborative Mission

Throughout my career, including time at large health systems including Baptist Health South Florida, Icahn School of Medicine at Mount Sinai and University of Miami Miller School of Medicine, I’ve worked closely with surgeons across specialties from spine to total joint, upper extremity, and foot and ankle. I understand the nuances of perioperative musculoskeletal care and deeply value interdisciplinary collaboration.

Most recently, I served as Medical Director for Interventional Pain and Spine Medicine at the University of Miami. Now in private practice at OSSO HEALTH, my focus remains the same: providing advanced, nonoperative musculoskeletal care with image-guided precision, timely access, and a patient-centered approach.

We welcome referrals for patients experiencing complex joint pain before or after surgery. Whether it’s optimizing function before total joint replacement or managing persistent pain after, our goal is aligned with yours: supporting surgical success and long-term recovery.