Concierge pain medicine · London
Genicular nerve RFA London.
A day-case, image-guided radiofrequency treatment for chronic knee osteoarthritis pain. Six to twelve months of pain relief without surgery, delivered under local anaesthetic and light sedation, with immediate mobilisation.
What genicular RFA is
Image-guided ablation of the knee sensory nerves.
A targeted radiofrequency lesion on three sensory branches that carry pain from the knee capsule.
Genicular nerve radiofrequency ablation, or RFA, is an image-guided pain procedure that deactivates the three sensory branches supplying the knee capsule: the superior lateral, superior medial and inferior medial genicular nerves. Under fluoroscopy or ultrasound, the pain consultant places a fine radiofrequency probe on each nerve and heats a small volume of tissue to interrupt pain transmission.
Only sensory fibres to the capsule are targeted. Motor nerves to the quadriceps, hamstrings and calf are not affected, so walking, bending and stair climbing are preserved. Two RFA modalities are used in London: cooled RFA at 60 degrees, which creates a larger, safer lesion, and conventional RFA at 80 degrees. Both give six to twelve months of relief and can be repeated when symptoms return.
Who it is for
Indications in UK practice.
Best for advanced OA with pain out of proportion to what injections or medication can control.
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Moderate to severe knee OA
Kellgren-Lawrence grade 3 to 4 confirmed on weight-bearing X-ray, with pain unresponsive to at least three months of conservative therapy.
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Not a surgical candidate
Patients unsuitable for total knee replacement due to age, comorbidity, anticoagulation or personal preference to avoid major surgery.
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Wanting to defer TKR
Younger patients keen to postpone joint replacement, or those still weighing timing against work, travel and family commitments.
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Persistent pain after TKR
Around 20% of post-TKR patients report ongoing knee pain despite a technically well-placed implant. Genicular RFA can help this cohort.
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Failed injection therapy
Poor or short-lived response to steroid, hyaluronic acid or PRP injections yet still pain-dominant with reasonable function.
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Clear pain-generator profile
Nocturnal pain, mechanical pain with load and weight-bearing pain that maps to the medial or lateral joint line.
Diagnostic block first
A local anaesthetic test predicts RFA success.
A short diagnostic block on the same three nerves confirms they are the true pain generator.
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Local anaesthetic block
A small volume of local anaesthetic is placed on the three sensory genicular branches under fluoroscopy or ultrasound guidance in an outpatient setting.
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24 hour pain diary
You score pain hourly for 24 hours. A drop of more than 50% confirms the genicular nerves are the dominant pain generator.
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Proceed to RFA
A positive block predicts a good RFA response. A negative block avoids an unnecessary procedure and redirects the pathway.
Procedure
Day-case, local anaesthetic, home the same day.
Around 45 to 60 minutes in the procedure room. Three targeted radiofrequency lesions per knee.
- 01
Day-case outpatient
Local anaesthetic and light sedation. No general anaesthetic and no overnight stay required in the vast majority of cases.
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Fluoroscopy or ultrasound
The pain consultant maps the superior lateral, superior medial and inferior medial genicular nerve branches under live image guidance.
- 03
Three RFA lesions
A radiofrequency probe is placed on each of the three sensory branches. Cooled RFA at 60 degrees or conventional RFA at 80 degrees for 90 to 150 seconds per target.
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Home the same day
Around 45 to 60 minutes in the procedure room in total. You walk out and are driven home. No wound, just three skin punctures covered with plasters.
Efficacy
What the published data show.
Randomised and prospective data across cooled and conventional RFA in knee OA and post-TKR pain.
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6 month response
~65%
Roughly two thirds of patients report over 50% pain reduction at six months in published cohorts.
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12 month response
~45%
Around 40 to 50% still hold a meaningful pain benefit at one year, with function and sleep both improved.
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Duration of relief
6 to 12 mo
Sensory nerve branches regenerate slowly. Most patients see benefit for six to twelve months before symptoms return.
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Repeatable
yes
The procedure can be safely repeated on nerve regrowth. Many patients cycle RFA every 9 to 12 months to defer TKR.
Response is defined as a reduction in pain of more than 50% on a numerical rating scale, with parallel improvements in WOMAC function and sleep quality. Non-responders can revisit intra-articular therapy, gait rehabilitation or proceed to total knee replacement.
Recovery
Walk immediately, back to work in two days.
A short window of soreness, no dressings, no restrictions on load or bending.
You walk out of the procedure room and are driven home the same day. Some soreness and low-grade bruising at the puncture sites is normal for three to seven days and responds to paracetamol, a short course of NSAIDs where safe, and simple ice. There are no wounds and no stitches.
Most office workers return the next working day, and physical roles two to three days later. There are no restrictions on walking, driving, stairs or gym work once soreness settles. Full RFA benefit typically emerges over the first two to four weeks as sensory transmission stops, and a review appointment at four to six weeks confirms response.
Cost in London
£2,500 to £4,500 all inclusive.
Indicative self-pay pricing per knee. Insurer-covered pathways widely available.
In short
Genicular RFA in London: £2,500 to £4,500 per knee, day-case.
The range covers the diagnostic block, radiofrequency ablation, consultant fees, image guidance, sedation, procedure room and follow-up review. Cooled RFA is generally at the higher end of the range. Insurer-authorised pathways are widely available with BUPA, AXA, Vitality and Aviva.
Where it is performed
London centres offering genicular RFA.
Consultant-led interventional pain units with fluoroscopy or ultrasound guidance.
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London Pain Clinic
Consultant-led interventional pain service on Harley Street with fluoroscopy and cooled RFA capability.
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HCA Wellington Pain Service
The Wellington Hospital pain service offers diagnostic blocks and conventional or cooled genicular RFA.
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Fortius Clinic
Musculoskeletal specialists across central London with integrated orthopaedics and pain medicine pathways.
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London Orthopaedic Clinic
Harley Street group offering ultrasound-guided diagnostic blocks and radiofrequency ablation for knee OA.
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London Bridge Hospital Pain
HCA pain unit with consultant anaesthetist-led interventional service including genicular RFA.
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Cromwell BUPA
Cromwell Hospital pain team accepts BUPA and other insurers for diagnostic block and RFA pathways.
Related
Related pathways.
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Total hip and knee replacement
When RFA is not enough and TKR is on the horizon.
Learn more -
Knee arthroscopy
Keyhole knee surgery for meniscal or mechanical pathology.
Learn more -
Ultrasound guided HA knee injection
Hyaluronic acid viscosupplementation for knee OA.
Learn more -
BMAC bone marrow aspirate
Regenerative injection therapy for cartilage-poor knees.
Learn more -
Back pain injections
Facet, epidural and medial branch blocks for spinal pain.
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Arthritis
Condition guide covering OA, inflammatory and post-traumatic arthritis.
Learn more
Frequently asked
Genicular RFA, honestly answered.
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Is genicular nerve RFA painful?
The procedure itself is well tolerated under local anaesthetic and light sedation. Most patients describe pressure rather than pain during the lesioning phase. Post-procedure soreness at the puncture sites lasts three to seven days and settles with simple analgesia.
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How long does the pain relief last?
Sensory nerve regrowth means the benefit is not permanent. In published series, 60 to 70% of patients report over 50% pain reduction at six months and 40 to 50% still benefit at twelve months. The procedure can be repeated when symptoms return.
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Will RFA weaken my leg or affect walking?
No. Only the three sensory genicular branches to the knee capsule are targeted. Motor nerves supplying the quadriceps, hamstrings and calf are not treated. Walking, stairs and knee bending are preserved.
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Do I need a diagnostic block first?
Yes, most UK pain consultants require a positive local anaesthetic block before proceeding to RFA. A drop of over 50% in pain during the 24 hours after the block predicts a good RFA response and avoids an unnecessary procedure.
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Is genicular RFA covered by private medical insurance?
Most UK insurers including BUPA, AXA, Vitality and Aviva cover genicular nerve blocks and radiofrequency ablation with preauthorisation when conservative therapy has failed and the patient is unsuitable or unready for TKR.
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Can I have RFA on both knees?
Yes. Bilateral RFA can be performed in the same sitting or in staged sessions two to four weeks apart. Staging is often preferred to keep one leg fully weight-bearing during the initial recovery.
Speak to a knee pain consultant
Assess for genicular RFA in London, with the right team.
We match you to a UK GMC registered pain consultant who performs genicular RFA regularly, at a CQC registered London unit with fluoroscopy or ultrasound guidance. Insurer preauthorisation handled.