Efficacy of Pre-operative Cryoneurolysis for Reducing Pain and Opioid Use in Patients Undergoing Knee Arthroplasty: A Systematic Review

Pika Krištof  Mirt

doi:10.3889/oamjms.2025.12030

Authors

Pika Krištof Mirt Department of Orthopaedic Surgery, General Hospital Novo Mesto, Novo Mesto, Slovenia https://orcid.org/0000-0002-7051-2955

DOI:

https://doi.org/10.3889/oamjms.2025.12030

Keywords:

cryoneurolysis, pain management, total knee arthroplasty, multimodal analgesia, opioid reduction.

Abstract

BACKGROUND: Pre-operative cryoneurolysis is an emerging analgesic technique that shows promise in managing post-operative pain and reducing opioid use in patients undergoing total knee arthroplasty (TKA). By inducing targeted Wallerian degeneration of sensory nerves, cryoneurolysis provides prolonged analgesia while preserving motor function, making it a valuable addition to multimodal pain management strategies.

METHODS: This systematic review evaluates the efficacy, safety, and clinical utility of cryoneurolysis, synthesizing findings from eight studies, including randomized controlled trials and observational analyses, in adherence to Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 guidelines. Data on pain scores, opioid consumption, functional recovery, and adverse effects were extracted and analyzed to assess clinical outcomes.

RESULTS: Cryoneurolysis consistently reduced post-operative pain scores and opioid consumption, with opioid use reductions up to 72%. Enhanced functional recovery, including improved range of motion and quicker rehabilitation milestones, was also observed. The intervention’s safety profile was favorable, with only minimal transient side effects reported and no long-term complications.

CONCLUSION: Cryoneurolysis offers significant potential as a cornerstone in multimodal pain management strategies for TKA, particularly in addressing opioid-related public health challenges. While current evidence supports its efficacy, variations in study design and sample sizes necessitate further multicenter trials to establish standardized protocols and optimize its clinical application.

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