Doing genicular RF on young people

[Timeoutofmind]

I get a lot of referrals for geniculars on patients ages 40-50 or so whose knees are sort of bad but not end stage by any means.

Have failed steroids/HA.

Would you offer these people geniculars? I am hesitant...what is the end game? How many times am I going to repeat? Is the joint going to wear out faster as it is insensate?

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[ampaphb]

Personally I think that's the optimal population. TKAs currently need to be replaced after ~20yrs. You really don't have enough bone stock to undergo more than one revision.

If you can forstall the initial total knee several years, it may allow the patient to not have to suffer with painful components in their twilight years

 

[drpainfree]

try HA injection, even PRP/BMC if patient can afford it.

just so you know, we have seen denials of genicular nerve blocks for medicare and private insurance. check with steve. I have stopped doing genicular nerve blocks.

 

[bedrock]

I think it's funny you call a 45 year old "young people"...... I'm thinking you are possibly middle-aged yourself?

Seriously though. I agree with Ampa that that age range of 40-55 is ideal, because you don't want a knee replacement before 55.

Also agree that if they've failed steroids/HA injections, to try PRP. I would offer that before genicular RFA these days now that many insurances don't cover RFA, PRP cost is similar to cash for RFA, and you might get a longer effect from PRP/stem cells than RFA.

 

[Taus]

Personally I think that's the optimal population. TKAs currently need to be replaced after ~20yrs. You really don't have enough bone stock to undergo more than one revision.

If you can forstall the initial total knee several years, it may allow the patient to not have to suffer with painful components in their twilight years

Concur.


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[drusso]

Agree with the above. Genicular RFA and PRP is similar cost to the patient in most cases.

 

[painfree23]

Agree with the above. Genicular RFA and PRP is similar cost to the patient in most cases.

Really?? How much you charge for geniculars??

 

[drusso]

Really?? How much you charge for geniculars??

We get paid between $30-$90 per RVU depending upon the payer.

 

[PapaDosh]

During fellowship had a 26 year old patient w/ bilateral moderate-severe arthritic changes in her knees who orthopedic surgeon (rightly) said was not a surgical candidate for TKA given her young age. 90% pain relief with genicular on one side and 100% on the other side. Total worth it for these patients. Of course, I'm not sure how many times the RFA will have to be repeated before she gets her knees replaced...

 

[Timeoutofmind]

Agree with the above. Genicular RFA and PRP is similar cost to the patient in most cases.

Thanks for your comments guys.

it seems though to me that while the cost of genicular RF and PRP are similar, many practitioners perform quite a few PRP injections. Its not sort of "one and done" like genicular RF is. Therefore it seems like cash pay for PRP would be way more expensive?

As an aside, what are you guys' PRP "protocols"? Just perform an injection and wait and see how they do and repeat as needed? A series of injections? Some maximum amount of injections in a year?

Also, I do hesitate to offer PRP. I have looked at the literature. Closely, and it is definitely somewhat spotty as in terms of actual quality evidence.

 

[lobelsteve]

Thanks for your comments guys.

it seems though to me that while the cost of genicular RF and PRP are similar, many practitioners perform quite a few PRP injections. Its not sort of "one and done" like genicular RF is. Therefore it seems like cash pay for PRP would be way more expensive?

As an aside, what are you guys' PRP "protocols"? Just perform an injection and wait and see how they do and repeat as needed? A series of injections? Some maximum amount of injections in a year?

Also, I do hesitate to offer PRP. I have looked at the literature. Closely, and it is definitely somewhat spotty as in terms of actual quality evidence.

Do a credit check to see how much they can afford then rip 'em off as much as possible.

 

[bedrock]

Thanks for your comments guys.

it seems though to me that while the cost of genicular RF and PRP are similar, many practitioners perform quite a few PRP injections. Its not sort of "one and done" like genicular RF is. Therefore it seems like cash pay for PRP would be way more expensive?

As an aside, what are you guys' PRP "protocols"? Just perform an injection and wait and see how they do and repeat as needed? A series of injections? Some maximum amount of injections in a year?

Also, I do hesitate to offer PRP. I have looked at the literature. Closely, and it is definitely somewhat spotty as in terms of actual quality evidence.

Varies. Some patients need several injections, some do well for several years after one.

RFA isn't "one and done" as most patients need it repeated annually.

I would do one PRP and then consider further PRP vs RFA procedures depending on how long the first PRP lasts.