Introduction: Pain management following total knee arthroplasty (TKA) is crucial for patient care and recovery. While opioid analgesics have traditionally been used, concerns over their adverse effects and the opioid epidemic have driven exploration of alternative pain management strategies. Multimodal (MM) pain control, targeting multiple pain pathways, has emerged as a promising approach, encompassing various medications and administration routes. Cryoneurolysis, a non-opioid therapy, has garnered attention for its potential in acute pain management, including its use before and after TKA. Methods: This study is a systematic review aiming to evaluate the efficacy and safety of cryoneurolysis as a method for managing perioperative pain in TKA. Primary outcomes include a reduction in opioid consumption and length of hospital stay, while secondary outcomes encompass functional and pain-related scores. Results: Seven of 434 studies met inclusion criteria. Published between 2016 and 2023, these included five retrospective studies and two randomized controlled trials, involving a total of 794 patients (38.3% male, 61.7% female). Most studies had a clearly defined control group, and the mean age of participants was approximately 66.6 years. The methodological assessment indicated a moderate to low risk of bias. Results demonstrated that cryoneurolysis reduced opioid consumption and improved pain and functional outcomes compared to control groups, including shorter hospital stays, improved range of motion, and pain score improvements. Conclusion: Cryoneurolysis presents a promising option, with evidence suggesting its potential to reduce opioid consumption and improve patient outcomes in the face of an opioid epidemic. However, challenges and barriers to its widespread use remain, including technical complexities and the need for further high-quality evidence.
