Administration of Preoperative Cryoneurolysis is Associated with Continued and Persistent Opioid Reduction and Improved Outcomes in Primary Total Knee Arthroplasty.

Abstract

Cryoneurolysis, a percutaneous technique applying targeted cold therapy to sensory nerves, has emerged as a non-opioid adjunct that may provide sustained analgesia after total knee arthroplasty (TKA). This study aimed to (1) determine whether preoperative cryoneurolysis reduces postoperative opioid use, (2) evaluate its effect on pain severity, and (3) assess functional recovery after TKA. There were 351 consecutive patients undergoing unilateral primary TKA across eight centers in the Innovations in Genicular Outcomes Research registry identified. Patients receiving cryoneurolysis within 30 days of surgery (N = 171) were compared with controls (N = 180). The primary endpoint was opioid use postoperatively, while secondary endpoints included the pain severity subscale of the Brief Pain Inventory Short Form questionnaire and function via the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR). Outcomes were assessed with linearized mixed-effects regression models, adjusting for demographic/clinical covariates. Cryoneurolysis patients used opioids less frequently across all intervals: 61 versus 89% in the first week (relative risk [RR], 0.69; P < 0.001), 27 versus 47% post first week to three months (RR, 0.57; P < 0.001), and 2 versus 4% in the persistent period (RR, 0.40; P = 0.012). Pain severity was lower with cryoneurolysis from two weeks to three months (mean difference, 0.37; 95% CI [confidence interval], -0.52 to -0.22; ; P < 0.01) and from three to six months (mean difference, -0.42, 95% CI, -0.67 to -0.17; P < 0.01). The KOOS, JR scores were modestly higher at six months (75.9 versus 73.4; mean difference, 2.5; 95% CI, 0.43 to 4.50; P = 0.018). Preoperative cryoneurolysis was associated with reduced opioid utilization and lower pain scores following TKA. Our findings support cryoneurolysis as an opioid-sparing adjunct within multimodal perioperative pathways.