The Journal of arthroplasty · 2026
Cryoneurolysis Reduces Postoperative Opioid Use in Patients Undergoing Total Knee Arthroplasty.
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Toavs Trevor L, Sudheendra Vijay H, Barrett Thomas, Lentine Brandon
Аннотация
BACKGROUND: Cryoanalgesia is increasingly used in total knee arthroplasty (TKA) as a nonopioid pain control modality. This study evaluated the effect of cryoanalgesia on postoperative opioid use and recovery of range of motion in patients who underwent TKA for end-stage knee osteoarthritis.
METHODS: This retrospective case-controlled study included patients who received cryoanalgesia prior to primary, unilateral TKA by one of two fellowship-trained arthroplasty surgeons at a single institution. Exclusion criteria included unicompartmental knee arthroplasty, bilateral TKA, revision knee arthroplasty, revision or reoperation after index arthroplasty, and history of preoperative opioid use. The cryoanalgesia group received ultrasound-guided cryoneurolysis of the anterior femoral cutaneous nerve (FCN), intermediate FCN, medial FCN, and infrapatellar branch of the saphenous nerve prior to TKA. A total of 60 cryoanalgesia cases were matched with 60 controls using age ± five years, sex, and body mass index ± 1.5. The mean age was 69 years (range, 49.5 to 88.1), and the mean body mass index was 32.2 (range, 22.9 to 44.3). There were 84 patients (70%) who were women. Independent sample t-tests were used to compare cumulative postoperative opioid morphine milligram equivalents (MMEs) and recovery of knee flexion between groups.
RESULTS: Patients who received cryoanalgesia required significantly fewer postoperative opioid prescription MMEs than matched controls (362.2 ± 267.2 versus 497.3 ± 336.6, P = 0.016). There was no significant difference in mean knee flexion between the cryoanalgesia and control groups at 2 weeks (94.9 ± 8.5 versus 94.1 ± 7.7°, P = 0.59), 6 weeks (115.1 ± 8.5 versus 113.9 ± 9.2°, P = 0.47), or 3 months (120.5 ± 4.8 versus 119.2 ± 5.8°, P = 0.23) postoperatively. There were no complications that occurred.
CONCLUSIONS: Patients who received cryoanalgesia prior to primary unilateral TKA received significantly fewer postoperative opioid MMEs with no significant difference in knee flexion than matched controls.
METHODS: This retrospective case-controlled study included patients who received cryoanalgesia prior to primary, unilateral TKA by one of two fellowship-trained arthroplasty surgeons at a single institution. Exclusion criteria included unicompartmental knee arthroplasty, bilateral TKA, revision knee arthroplasty, revision or reoperation after index arthroplasty, and history of preoperative opioid use. The cryoanalgesia group received ultrasound-guided cryoneurolysis of the anterior femoral cutaneous nerve (FCN), intermediate FCN, medial FCN, and infrapatellar branch of the saphenous nerve prior to TKA. A total of 60 cryoanalgesia cases were matched with 60 controls using age ± five years, sex, and body mass index ± 1.5. The mean age was 69 years (range, 49.5 to 88.1), and the mean body mass index was 32.2 (range, 22.9 to 44.3). There were 84 patients (70%) who were women. Independent sample t-tests were used to compare cumulative postoperative opioid morphine milligram equivalents (MMEs) and recovery of knee flexion between groups.
RESULTS: Patients who received cryoanalgesia required significantly fewer postoperative opioid prescription MMEs than matched controls (362.2 ± 267.2 versus 497.3 ± 336.6, P = 0.016). There was no significant difference in mean knee flexion between the cryoanalgesia and control groups at 2 weeks (94.9 ± 8.5 versus 94.1 ± 7.7°, P = 0.59), 6 weeks (115.1 ± 8.5 versus 113.9 ± 9.2°, P = 0.47), or 3 months (120.5 ± 4.8 versus 119.2 ± 5.8°, P = 0.23) postoperatively. There were no complications that occurred.
CONCLUSIONS: Patients who received cryoanalgesia prior to primary unilateral TKA received significantly fewer postoperative opioid MMEs with no significant difference in knee flexion than matched controls.