Preoperative cryoneurolysis for peri- and postoperative pain in total knee arthroplasty: a systematic review and pooled analysis.

Abstract

Background: Cryoneurolysis is seeing increased implementation in total knee arthroplasty (TKA), providing postoperative analgesia through preoperative cryoneurolysis of peripheral nerves. Thus, we are conducting this systematic review and meta-analysis to determine cryoneurolysis' efficacy in providing analgesia and improvements in recovery times for patients undergoing TKA.

Methods: We conducted a comprehensive search using five databases including PubMed, Cochrane Library, Web of Science, Embase, and Scopus. The screened articles were assessed for inclusion of primary outcomes: pain scores before nerve cryoablation, peri- and post-operative pain scores in TKA, length of pain relief, patient demographics, and type of pain score employed. The Higgins I² test served to discern the degree of heterogeneity between included studies. Cohen's d was utilized to interpret the pooled effect size of the studies.

Results: Our search yielded six articles that met our inclusion criteria. The overall effect size illustrated a d = 1.468 (95% CI: 1.084-1.851; p < 0.001) for the Visual Analog Score (VAS), Numerical Rating Score (NRS), and Patient-Reported Outcomes Measurement Information System (PROMIS) pain subscore. Each individual study possessed a large effect size.

Conclusion: Our comprehensive review and meta-analysis indicated that cryoneurolysis provides effective pain management, providing TKA patients with significant pain reduction for 6-12 weeks post-surgery. Furthermore, improvements were observed in patient-centered outcomes: mobility, return to routine activities, and overall satisfaction. Future studies should be conducted to determine the long-term efficacy of cryoneurolysis and the appropriate timing and duration of cryoneurolysis to maximize its analgesic abilities.

Protocolregistration: www.crd.york.ac.uk/prospero identifier is CRD42024542005.