Radiofrequency denervation of the hip joint for pain management: case report and literature review.
BACKGROUND
A 55-year-old male presented with severe pain and functional limitations as a result of left hip osteoarthritis. He had failed multiple treatments while waiting for a hip arthroplasty, including physical therapy, medications, and various intra-articular injections. Thermal radiofrequency lesioning of the obturator and femoral articular branches to the hip joint was offered in the interim.


OBJECTIVE
To our knowledge, this is the first report to describe an inferior-lateral approach for lesioning the obturator branch, the clinical application of successive lesions to increase denervation area, and outcomes in a patient receiving a second treatment with previously good results.


METHODS
To discuss relevant and technical factors for this specific case, we reviewed previous literature on hip joint radiofrequency and critically evaluated previous anatomic studies in the context of radiofrequency.


RESULTS
The first treatment provided significant benefit for a period of 6 months. A second treatment was employed providing only mild to moderate benefit until his joint replacement surgery 4 months later. Literature review revealed studies of low quality secondary to small sample sizes, patient selection methodology, inclusion of patients with heterogenous etiologies for pain, variable needle placement techniques, and lack of measurement of functional outcomes.


CONCLUSIONS
Case report and low quality studies in existing literature.


CONCLUSIONS
Hip joint radiofrequency denervation is a promising avenue for adjunctive treatment of hip pain. Further cadaveric studies are required to clarify a multitude of technical parameters. Once these are well defined, future clinical studies should consider pain, functional, and economic outcomes in their design.
Alan Edwards Pain Management Unit, Dept of Anesthesia, Montreal General Hospital, Montreal, Quebec, Canada.
Gaurav
G
Gupta
Mohan
M
Radhakrishna
Paul
P
Etheridge
Markus
M
Besemann
Robert J
RJ
Finlayson
D018771:Arthralgia / Q000601:surgery*; D003714:Denervation / Q000295:instrumentation / Q000379:methods*; D005267:Femoral Nerve / Q000601:surgery; D006621:Hip Joint / Q000294:innervation* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000295:instrumentation / Q000379:methods*
articular branch; coxalgia; femoral nerve; hip joint; joint denervation; nerve to quadratus femoris; obturator nerve; osteoarthritis; pain; radiofrequency; sciatic nerve; superior gluteal nerve