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

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