William M. Mihalko
LAS VEGAS — Preliminary results of cryoneurolysis performed prior to total knee arthroplasty showed the treatment helps reduce patients’ pain and opioid consumption, a presenter said at the American Academy of Orthopaedic Surgeons Annual Meeting.
According to William M. Mihalko, MD, cryoneurolysis works by exposing the sensory nerves around the knee to -20° to achieve axonal loss. The nerve regenerates, but at a slow pace of 1 mm to 2 mm daily.
“The clinical significance, we all know. We’ve heard it throughout the session. The opioid epidemic is focused on nationwide. Anything we can do to add to a multimodal approach and decrease the use of opioids is going to be beneficial,” he said.
In the prospective randomized trial Mihalko and his colleagues conducted at the Campbell Clinic in Memphis, Tennessee, they compared 60 patients treated 5 to 7 days prior to TKA with cryoneurolysis using Iovera Therapy (Myoscience) to 60 control patients who received only the standard of care, which was an adductor canal block and posterior joint capsule injection.
“The primary endpoint was the daily morphine equivalent based on the pill count” of oxycodone, immediate-release 5-mg tablets prescribed at discharge and pills that were counted at 72 hours, 2 weeks, 6 weeks and 12 weeks after surgery, measured in morphine equivalents, Mihalko said.
“You can see that at every timepoint, except the 2-week mark, we had a significantly decreased amount of morphine equivalents in the cryoneurolysis group,” he said, noting that, overall, opioid use also tapered off sooner in the cryoneurolysis group.
“There were three-times more subjects in the control group using opioids at the 6-week mark. That was 46% vs.16% of the treatment group,” Mihalko said. – by Susan M. Rapp
Mihalko WM, et al. Abstract 163. Presented at: American Academy of Orthopaedic Surgeons; March 12-16, 2019; Las Vegas.
Disclosure: Mihalko reports he receives research support from Myoscience Inc., and the study was sponsored by Myoscience Inc.