Procedure · Knee · Hip · Spine

Radiofrequency Ablation

An image-guided procedure that uses targeted radiofrequency energy to interrupt the pain signals carried by specific nerves around an arthritic joint — turning down the volume on chronic pain without surgery, opioids, or general anesthesia.

Procedure type: Image-guided, minimally invasive

Time at office: ~90 minutes

Recovery: 1–2 days

Performed by: Board-certified IR

~90 min

Total time at our office, including prep and recovery

Incision, no stitches, no general anesthesia

6–12 mo

Typical duration of pain relief, often longer with maintenance

~70%

Of patients in clinical studies report significant pain reduction at 6 months

What is RFA

Pain travels along nerves. RFA interrupts the signal.

Fig. 01The genicular nerves carry pain signals from the knee joint to the brain. RFA delivers controlled radiofrequency energy through fine needles to interrupt those signals at precise locations.

Every joint in your body is wired with sensory nerves that report what's happening locally — including pain. In an arthritic knee, hip, or facet joint of the spine, those nerves fire constantly, sending the brain a steady stream of pain signals that no amount of cartilage healing or anti-inflammatory medication will quiet.

Radiofrequency ablation works by interrupting that signaling. Through fine needles guided by ultrasound or fluoroscopy, we deliver controlled radiofrequency energy that creates a small, precise heat lesion on the targeted nerve — enough to disable its ability to transmit pain signals, but small enough to spare surrounding tissue.

The procedure has been used for decades in pain management, and is now performed at most major academic medical centers. Genicular nerve RFA for the knee is the most common application we offer, but the same technique is used for hip joints, facet joints in the lumbar spine, and the sacroiliac (SI) joint.

The two-stage process

RFA happens in two visits, not one.

Unlike some procedures, RFA includes a built-in test before the treatment itself. This isn't optional — it's a clinical safeguard that confirms you're going to benefit before we proceed with the actual ablation.

one · diagnostic block

First visit · ~45 minutes

The test injection

Using image guidance, we inject a small amount of local anesthetic onto the same nerves we'd plan to ablate. If the injection significantly reduces your pain over the following 24 hours, we know two things: we've identified the right nerves, and you're a good candidate for the longer-lasting RFA procedure.

two · the ablation

Second visit · ~60 minutes

The actual RFA

If the diagnostic block worked, we schedule the RFA itself — typically 1–2 weeks later. Same approach, same nerves, but this time delivering controlled radiofrequency energy to create a longer-lasting interruption of the pain signals. Most patients return to normal activity within 1–2 days.

Candidacy

Who RFA helps most — and who it doesn't.

RFA is a powerful tool for the right patient, but not for everyone. Some patients are better candidates for GAE, others for joint replacement, and some for continued conservative management. Here's the candid version.

Often a good fit for RFA

You have chronic, well-localized joint pain that's been present for at least 3 months
Your pain responded (even briefly) to a prior steroid injection or nerve block
You're not yet ready for, or not a candidate for, joint replacement surgery
You want to avoid long-term opioid pain medication
You have advanced osteoarthritis where pain — not mechanical dysfunction — is the main problem
You've had a knee replacement but still have residual pain

Probably not the right procedure

Your pain is mostly mechanical (locking, catching, instability) rather than constant aching
You have an active infection in or near the joint
You have a bleeding disorder or are on blood thinners that can't be safely paused
The diagnostic block (stage 1) doesn't significantly reduce your pain — we won't proceed
You have unrealistic expectations of permanent cure rather than meaningful temporary relief
Your pain is referred from a different anatomic source (back, nerve root, etc.)

What I tell every patient: the diagnostic block isn't a formality. If it doesn't help your pain, RFA almost certainly won't either, and we'll have a conversation about what might. That two-step approach is what makes this procedure worth doing — it tells us in advance whether we're going to help you.

Dr. Sabeen Dhand · Board-Certified Interventional Radiologist

Frequently asked

What patients usually want to know.

RFA for joint pain is covered by Medicare and most commercial insurance plans, often with documentation of failed conservative treatment and a positive diagnostic block. Coverage for genicular nerve RFA specifically has expanded significantly in recent years. We verify your specific benefits before scheduling and provide written cost estimates in advance.

Cortisone reduces inflammation in the joint itself; RFA interrupts the nerves carrying pain signals away from the joint. Cortisone usually lasts weeks to a few months; RFA typically lasts 6–12 months or longer. RFA is a different mechanism for a different problem — and patients whose cortisone shots used to last but no longer do are often excellent RFA candidates.

No. We target only the small sensory nerves that carry pain signals from the joint capsule — not the nerves that control movement, balance, or normal sensation. Patients don't experience numbness, weakness, or loss of joint awareness. Some report a vague feeling of "lightness" in the joint, which most describe as pleasant.

The needle insertion sites are fully numbed with local anesthetic. During the actual ablation, you may feel mild pressure or warmth, but not sharp pain. Most patients describe the procedure as more comfortable than they expected. Light IV sedation is available for patients who prefer it.

The treated nerves can regenerate over 6–18 months, which is why RFA's effect typically isn't permanent. The good news: it can be repeated. Many of our patients return for repeat treatments every 9–12 months and maintain meaningful relief over many years. There's no limit on how often it can be done.

Yes — and this is actually one of the situations where RFA shines. About 20% of total knee replacement patients have residual pain even after a successful surgery. RFA targets the nerves around the joint that aren't removed during replacement, and can provide meaningful relief for post-surgical knee pain that hasn't responded to other treatments.