Ultrasound-guided Radiofrequency Lesioning of the Articular Branches of the Femoral Nerve for the Treatment of Chronic Post-arthroplasty Hip Pain.
Total hip arthroplasty (THA) is a common surgical treatment for several conditions of the hip. While the majority of patients obtain satisfactory results, many develop chronic post-arthroplasty hip pain that can be difficult to treat.



We evaluate the effectiveness of cooled (60°C) radiofrequency lesioning of the articular branches of the femoral nerve (ABFN) as a minimally invasive treatment for patients suffering from chronic post-arthroplasty hip pain. This treatment has never been described previously in this population.



Case report.



Center for Pain Medicine, Massachusetts General Hospital, Harvard Medical School.



A 59-year-old woman with long-standing osteoarthritis of the right hip who underwent primary total hip arthroplasty and presented with chronic post-arthroplasty hip pain Intervention: Cooled (60°C) radiofrequency lesioning of the ABFN under ultrasound guidance Outcome Measure: Functional ability and numeric rating scale (NRS) scores at rest and with activity.



Prior to intervention, the patient reported severe disruption in daily activities, sleep, and relationships; NRS scores at rest and with activity were 4/10 and 10/10, respectively. At 4 weeks following intervention, the patient reported significant improvement in functional ability and NRS scores decreased to 1/10 and 2/10, respectively. At 6 months, the patient's NRS scores at rest and with activity were 0/10 and 1/10, respectively. At 24-month follow-up, the patient continued to endorse significant pain relief with NRS scores at rest and with activity of 0 - 1/10 and 1 - 2/10, respectively. There were no side effects or complications including motor weakness, sensory loss, and neuralgias.



Although the patient obtained good results from the intervention, the description of the study is from a single case report. Further study is necessary to investigate the widespread use of this technique and its outcomes.



Cooled (60°C) radiofrequency lesioning of the ABFN under ultrasound guidance is both an effective and minimally invasive intervention for chronic post-arthroplasty hip pain. Key words: Radiofrequency lesioning, articular branches, femoral nerve, post-arthoplasty, total hip arthoplasty, hip pain, chronic pain.
Massachusetts General Hospital, Harvard Medical School, Boston, MA.
David J
DJ
Kim
Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Shiqian
S
Shen
Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA; Massachusetts General Hospital, Harvard Medical School, Boston, MA.
George M
GM
Hanna
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D018084:Ultrasonography, Interventional / Q000379:methods