Iovera Cryoablasion Therapy for Knee Pain

ATX Orthopedics in Austin, TX offers iovera° cryotherapy nerve block treatment — a non-opioid, targeted cold therapy approach to managing pain before and after joint replacement surgery.

Anatomical Study of the Innervation of Anterior Knee Joint Capsule: Implication for Image-Guided Intervention. John B. Tran, Philip W. H. Peng, Karen Lam, Ehtesham Baig, Anne M. Agur, Michael Gofeld.  Tran J, Peng PWH, Lam K, Baig E, Agur AMR, Gofeld M.  Reg Anesth Pain Med. 2018 May;43(4):407-414. doi: 10.1097/AAP.0000000000000778. PMID: 29557887.

Cryoneurolysis before Total Knee Arthroplasty in Patients With Severe Osteoarthritis for Reduction of Postoperative Pain and Opioid Use in a Single-Center Randomized Controlled Trial  William M. Mihalko MD, PhD, Anita L.Kerkhof, RN, MS, CCRP, Marcus C. FordMD, John R. Crockarell Jr. MD, MBA, James W. Harkess, MD, James L. Guyton M.  Department of Orthopedic Surgery & Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, Received 13 July 2020, Revised 5 November 2020, Accepted 6 November 2020, Available online 14 November 2020.

What Is iovera° Cryotherapy?

The iovera° system uses focused cold therapy (cryoneurolysis) to temporarily deactivate specific sensory nerves around the knee joint. A small probe is placed near the targeted nerve under ultrasound guidance, and a precise zone of cold is created to interrupt pain signal transmission. The effect is entirely reversible — the treated nerves regenerate naturally over a period of weeks to months. Unlike steroid injections, which address inflammation, iovera° works directly on the nerve pathway responsible for transmitting pain, offering a different and complementary mechanism of pain relief.

How Is iovera° Used Before Knee Replacement Surgery?

One of the most well-studied applications of iovera° cryotherapy is preoperative pain management for total knee replacement (TKR). Clinical research has demonstrated that patients who receive iovera° treatment to the genicular nerves of the knee one to two weeks before total knee arthroplasty experience significantly reduced pain scores in the first days and weeks after surgery, require less opioid pain medication during their hospital stay, and achieve earlier functional milestones in physical therapy. For patients and surgeons alike, reducing early post-operative opioid requirements is a meaningful goal — opioids carry risks of side effects including nausea, constipation, sedation, and dependency, all of which can slow recovery.

Who Is a Candidate for iovera° Treatment?

Patients preparing for total knee replacement surgery who wish to minimize opioid use and maximize early pain control are typically excellent candidates for iovera° cryotherapy. It is also appropriate for patients with severe knee osteoarthritis who are not yet ready for surgery and are seeking non-opioid pain relief options. iovera° is not typically used in patients with certain nerve conditions, bleeding disorders, or local skin infections at the injection site. Dr. Gallagher will review your medical history and imaging to determine whether iovera° is appropriate for your situation during your consultation.

What to Expect During the iovera° Procedure

The iovera° treatment is performed in the office and takes approximately 30 to 45 minutes. The skin over the treatment area is cleaned and a local anesthetic is applied to minimize any discomfort. Using ultrasound guidance, the iovera° probe is placed adjacent to the targeted genicular nerves around the knee. You may feel a brief sensation of cold and pressure during the treatment. Most patients tolerate the procedure well and are able to drive home afterward. Mild swelling or bruising at the treatment site is possible and typically resolves within a few days.

How Long Does iovera° Last?

The pain-relieving effect of iovera° cryotherapy typically lasts between 30 and 90 days. Because the treatment is designed to carry patients through the most painful early phase of recovery following knee replacement surgery, this duration aligns well with the typical post-operative pain trajectory. Most patients find that by the time the nerve effect wears off, they have progressed through the intensive early rehabilitation phase and their overall pain levels have naturally improved. In some cases, a second treatment may be considered for patients with ongoing pain who are not yet surgical candidates.

Schedule a Consultation

If you are preparing for knee replacement surgery in Austin, TX, or are managing knee osteoarthritis and seeking non-opioid pain relief options, contact ATX Orthopedics at 512-960-4590 to schedule a consultation with Dr. Sean Gallagher. Our team will review your imaging, discuss your goals, and help determine whether iovera° cryotherapy is a good fit for your treatment plan.

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