Phenol Neurolysis Versus Local Anesthetic Plus Steroid Genicular Nerve Block in Knee Osteoarthritis

Knee osteoarthritis (gonarthrosis) is a major cause of chronic pain and disability. Patients who fail to respond to conservative treatments such as medications, physical therapy, and exercise often require interventional options for pain relief.

This prospective observational cohort study compares two ultrasound-guided procedures targeting the genicular nerves of the knee:

Genicular nerve neurolysis with phenol - phenol induces protein denaturation and Wallerian degeneration in nerve fibers, providing long-term analgesia.

Genicular nerve block with local anesthetic (bupivacaine) and corticosteroid (triamcinolone acetonide) - this combination offers immediate pain reduction from nerve blockade and potential prolonged relief due to the anti-inflammatory action of the steroid.

A total of 42 patients with Kellgren-Lawrence grade 3-4 knee osteoarthritis and moderate-to-severe pain (VAS ≥ 4 for ≥ 3 months) are prospectively followed. Interventions are performed under ultrasound guidance at the superomedial, superolateral, and inferomedial genicular nerves.

The primary outcome is change in pain severity (VAS). Secondary outcomes include functional improvement assessed by the WOMAC Index and Oxford Knee Score (OKS), joint range of motion, need for nonsteroidal anti-inflammatory drugs (NSAIDs), and procedure-related adverse events. Assessments are performed at baseline, 2 weeks, and 3 months post-procedure.

The study aims to provide comparative evidence on the effectiveness and safety of phenol neurolysis versus triamcinolone acetonide-local anesthetic block, helping to guide clinical practice in the management of knee osteoarthritis.

Inclusion criteria

• Age ≥ 40 years
• Diagnosis of knee osteoarthritis (Kellgren-Lawrence grade 3-4) confirmed by radiographic evaluation
• Moderate to severe knee pain for at least 3 months (VAS ≥ 4)
• Inadequate response to conservative treatments (e.g., medications, physical therapy, exercise)
• Ability to provide informed consent

Exclusion criteria

• History of knee surgery (e.g., total knee arthroplasty) on the affected side
• Intra-articular injection (hyaluronic acid, corticosteroid, PRP, etc.) within the last 6 months
• Secondary arthritis (e.g., rheumatoid arthritis, gout, septic arthritis, trauma-related arthritis)
• Severe coagulopathy or current use of anticoagulant therapy contraindicating injection
• Local skin infection at the injection site
• Known allergy or contraindication to phenol, bupivacaine, or triamcinolone acetonide
• Severe uncontrolled systemic disease (e.g., advanced cardiac, hepatic, or renal failure)
• Pregnancy or breastfeeding