Newswise — Hackensack University Medical Center physicians are now offering ioverao, a handheld device that is applied in the doctor’s office before knee replacement surgery to relieve postoperative knee pain, as well as to reduce the chronic pain of knee osteoarthritis. This cryotherapy treatment has been shown to decrease patients’ use of opioids and restore mobility by reducing stiffness and discomfort.

Knee pain due to osteoarthritis is a very common complaint among adults in the United States. It is a leading cause of disability that impairs quality of life and hinders mobility. Osteoarthritis of the knee is also the number one reason for total knee replacement. “We are continually seeking effective nonsurgical alternatives to opioids to reduce pain in people with chronic knee arthritis and to relieve postoperative pain in those who have had total knee replacement surgery,” explained Gary Panagiotakis, D.O., who specializes in Physical Medicine and Rehabilitation and in Pain Medicine at Hackensack University Medical Center.

The ioverao system is an innovative “cryoneurolysis” approach to blocking pain that relies on the body’s natural response to cold. Here’s how it works:

  1. The physician assesses a patient’s pain before the procedure and uses physical examination and ultrasound to identify the nerves responsible for the patient’s knee pain.
  2. The nerves are marked and the doctor injects a local anesthetic into the areas to be treated.
  3. The ioverao system is a portable handheld device that delivers precise, controlled doses of very cold temperatures to the targeted nerves through a small probe with three tiny needles at its tip. The physician applies the device along each nerve until the nerve is blocked. 
  4. The ioverao treatment temporarily stops the nerve from sending pain signals to the brain without damaging surrounding tissue. 
  5. Pain relief is immediate and lasts until the nerve regenerates. One treatment with the iovera° system can last 90 days.
  6. The treatment areas are cleaned and bandaged, and the patient goes home the same day.

A clinical study showed that patients who received ioverao treatment before total knee replacement surgery requested 45% fewer opioid prescriptions 12 weeks after the operation. They also had less pain two weeks after surgery. Patients with chronic osteoarthritis who received ioverao treatment experienced less stiffness 30 days after the treatment and reported improved physical function at the 90-day mark.

“Traditionally, opioid pain medications have been the first line of defense against knee pain due to osteoarthritis, both before and immediately after surgery, despite causing side effects that can detract from a patient’s recovery,” noted Yair Kissin, M.D., an orthopedic surgeon at Hackensack University Medical Center who specializes in knee replacement. “The iovera° system has provided us with a new approach to enhance the recovery of our patients and improve patient comfort without opioids.”

“Hackensack University Medical Center is committed to ensuring that our patients have access to the latest approaches to relieve pain while reducing the dependence on opioids,” added Michael A. Kelly, M.D., chairman of Orthopedic Surgery. “We are proud to have the ioverao system in our arsenal of tools and look forward to expanding its applications to further enhance the exceptional care we provide to our patients with acute and chronic knee pain.”

About iovera°

The iovera° system is used to destroy tissue during surgical procedures by applying freezing cold. It can also be used to produce lesions in peripheral nervous tissue by the application of cold to the selected site for the blocking of pain. It is also indicated for the relief of pain and symptoms associated with osteoarthritis of the knee for up to 90 days. The iovera° system is not indicated for treatment of central nervous system tissue. It is important to note that iovera° does not treat the underlying cause of pain. Timely remediation is necessary to address and treat the cause of pain. iovera° has been studied in clinical trials of patients prior to total knee arthroplasty and to treat the pain and symptoms of knee osteoarthritis. Additional information is available at


Hackensack University Medical Center, a 781-bed nonprofit teaching and research hospital, was Bergen County’s first hospital founded in 1888. It was also the first hospital in New Jersey and second in the nation to become a Magnet®-recognized hospital for nursing excellence, receiving its sixth consecutive designation from the American Nurses Credentialing Center. The academic flagship of the Hackensack Meridian Health network, Hackensack University Medical Center is Nationally-Ranked by U.S. News & World Report 2022-2023 in four specialties, more than any other hospital in New Jersey. The hospital is home to the state's only nationally-ranked Urology and Neurology & Neurosurgery programs, as well as the best Cardiology & Heart Surgery program. It also offers patients nationally-ranked Orthopedic care and one of the state’s premier Cancer Centers (John Theurer Cancer Center at Hackensack University Medical Center). Hackensack University Medical Center also ranked as High-Performing in conditions such as Acute Kidney Failure, Heart Attack (AMI), Heart Failure, Pneumonia, chronic obstructive pulmonary disease (COPD), Diabetes and Stroke. As well as High Performing in procedures like Aortic Valve Surgery, Heart Bypass Surgery (CABG), Colon Cancer Surgery, Lung Cancer Surgery, Prostate Cancer Surgery, Hip Replacement and Knee Replacement. This award-winning care is provided on a campus that is home to facilities such as the Heart & Vascular Hospital; and the Sarkis and Siran Gabrellian Women’s and Children’s Pavilion, which houses the Donna A. Sanzari Women’s Hospital and the Joseph M. Sanzari Children’s Hospital, ranked #1 in the state and top 20 in the Mid-Atlantic Region in the U.S. News & World Report’s 2022-23 Best Children’s Hospital Report. Additionally, the children’s nephrology program ranks in the top 50 in the United States. Hackensack University Medical Center is also home to the Deirdre Imus Environmental Health Center and is listed on the Green Guide’s list of Top 10 Green Hospitals in the U.S. Our comprehensive clinical research portfolio includes studies focused on precision medicine, translational medicine, immunotherapy, cell therapy, and vaccine development. The hospital has embarked on the largest healthcare expansion project ever approved by the state: Construction of the Helena Theurer Pavilion, a 530,000-sq.-ft., nine-story building, which began in 2019. A $714.2 million endeavor, the pavilion is one the largest healthcare capital projects in New Jersey and will house 24 state-of-the-art operating rooms with intraoperative MRI capability, 50 ICU beds, and 175 medical/surgical beds including a 50 room Musculoskeletal Institute. 


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Newswise: Hackensack University Medical Center Offers Innovative Nonsurgical Treatment for Knee Pain 
Nerve-Freezing Approach Reduces Need for Opioids



Newswise: Hackensack University Medical Center Offers Innovative Nonsurgical Treatment for Knee Pain 
Nerve-Freezing Approach Reduces Need for Opioids