What is COOLIEF?
COOLIEF is a brand name for cooled radiofrequency ablation (CRFA). It is a treatment for chronic knee pain from osteoarthritis. Rather than masking the pain with medication or replacing the joint surgically, the procedure interrupts the small sensory nerves around the knee — the genicular nerves — that carry pain signals to the brain. Most patients begin to feel meaningful relief within 1 to 2 weeks, and the benefits can last up to 12 months. The procedure is FDA-cleared for moderate to severe knee osteoarthritis and is covered by Medicare and most major insurers.
Why this approach
COOLIEF was designed to fill a specific gap: patients who have outgrown anti-inflammatories, cortisone injections, and gel injections, but aren’t yet ready — medically or personally — for total knee replacement. It buys time, restores mobility, and avoids the long recovery of major surgery.
How the procedure works
Standard radiofrequency ablation uses heat to disrupt nerve signaling. COOLIEF is different in one important way: water circulates internally through the probe to keep the tip cool while it works. Cooling the probe lets it treat a larger volume of tissue without overheating the surrounding area, which translates into more thorough coverage of the targeted nerves and, in published trials, longer-lasting relief than standard RFA.2
What to expect
The treatment is delivered across two appointments — a brief diagnostic visit followed by the procedure itself.
Diagnostic genicular nerve block
A small numbing injection is placed near the genicular nerves. If your pain meaningfully improves over the next several hours, those nerves are confirmed as the source — and you’re a strong candidate for COOLIEF.
The COOLIEF procedure
After local anesthesia at each site, cooled radiofrequency probes are placed at three to four points around the knee under live image guidance. The full procedure typically takes about 45 minutes.
Same-day discharge
You go home the same day. Mild soreness at the injection sites is common for a few days and is usually managed with over-the-counter pain relievers — no opioids required.
Onset and duration of relief
Most patients notice steady improvement over 1 to 2 weeks. In the largest randomized trial comparing CRFA to corticosteroid injection, CRFA produced more pain relief and better function at every follow-up through 12 months.3 The procedure can be repeated when symptoms return.
Who is a good candidate?
COOLIEF isn’t right for every knee, and that’s part of why the diagnostic step matters. You may be a candidate if any of the following apply:
- Knee osteoarthritis that affects your daily activities or sleep
- Conservative treatments have stopped working — physical therapy, NSAIDs, cortisone injections, or gel (hyaluronic acid) injections are no longer giving adequate relief
- You’re not yet ready for, or not a surgical candidate for, total knee replacement
- You’d like to avoid long-term opioid pain medication
- Persistent pain after a previous knee replacement, when the genicular nerves are confirmed as the source4
The decision is always made together with your pain management, orthopedic surgeon, or rheumatology team, depending on who is helping manage your knee.
Cost and insurance
COOLIEF is covered by Medicare and most major commercial insurers when standard criteria are met — typically documented osteoarthritis on imaging, a trial of conservative treatments, and a positive response to the diagnostic genicular nerve block. Our office handles the prior authorization process and will tell you, before the procedure, exactly what to expect to pay out of pocket.
Risks and what the procedure feels like
COOLIEF has a strong safety profile. Most reported side effects are mild and short-lived — temporary soreness or bruising at the needle sites and brief numbness in a small patch of skin around the knee. Serious complications are rare. During the procedure, the local anesthetic numbs each site before the probe is placed; most patients describe pressure rather than pain. Light sedation can be arranged if you’d prefer additional comfort. Most people drive themselves home.
Who performs COOLIEF
COOLIEF is performed by interventional radiologists, interventional pain medicine physicians (anesthesiology pain), and physiatrists (physical medicine and rehabilitation). Success depends on hitting small, specific nerves, which is why image guidance matters. At Florida Interventional Specialists, every COOLIEF procedure is delivered under direct imaging — verified in real time rather than estimated by feel — and integrated into your broader plan of care across pain management, orthopedics, and rheumatology.
References
- Deshpande BR, Katz JN, Solomon DH, et al. The number of persons with symptomatic knee osteoarthritis in the US: impact of race and ethnicity, age, sex, and obesity. Arthritis Care Res (Hoboken). 2016;68(12):1743–1750.
- McCormick ZL, Korn M, Reddy R, et al. Cooled radiofrequency ablation of the genicular nerves for chronic pain due to knee osteoarthritis: six-month outcomes. Pain Med. 2017;18(9):1631–1641.
- Davis T, Loudermilk E, DePalma M, et al. Prospective, multicenter, randomized, crossover clinical trial comparing the safety and effectiveness of cooled radiofrequency ablation with corticosteroid injection in the management of knee pain from osteoarthritis. Reg Anesth Pain Med. 2018;43(1):84–91.
- Hunter C, Davis T, Loudermilk E, Kapural L, DePalma M. Cooled radiofrequency ablation treatment of the genicular nerves in the treatment of osteoarthritic knee pain: 18- and 24-month results. Pain Pract. 2020;20(3):238–246.
Frequently asked questions
Is COOLIEF FDA approved?
Yes. The COOLIEF cooled radiofrequency system is FDA-cleared for the treatment of moderate to severe chronic knee pain caused by osteoarthritis, and it is covered by Medicare and most major insurers when criteria are met.
How is COOLIEF different from a cortisone or gel injection?
Cortisone (corticosteroid) and gel (hyaluronic acid/viscosupplementation) injections deliver medication into the knee joint. They can help many patients but tend to give shorter-duration relief. COOLIEF does not put medication into the joint — it interrupts the genicular nerves carrying pain signals from the knee. A successful treatment can give relief for up to 12 months, and the procedure can be repeated.
Will I still need a knee replacement eventually?
COOLIEF does not replace, repair, or change the underlying osteoarthritis. It is designed to control pain. For some patients it postpones knee replacement; for others — especially those who are not surgical candidates — it may be a long-term pain management strategy. Whether and when knee replacement makes sense for you is a decision made together with your orthopedic surgeon.
How long does the relief last?
Pain relief from a successful COOLIEF treatment typically lasts up to 12 months. Some patients have relief well beyond that. The procedure is safely repeatable when symptoms return.
Is the procedure painful?
The procedure is performed with local anesthesia at each site. Most patients describe it as well tolerated. Mild soreness at the needle entry sites is common for a few days afterward and is usually managed with over-the-counter medication — no opioids required.
Who performs COOLIEF?
COOLIEF is performed by interventional radiologists, interventional pain medicine physicians (anesthesiology pain), and physiatrists (physical medicine and rehabilitation). Success depends on accurate placement of the probes, which is why image guidance is essential.
