Percutaneous radiofrequency denervation in patients with contraindications for total hip arthroplasty

Abstract

Multiple comorbidities sometimes represent a contraindication for total hip arthroplasty (THA). Major symptoms of patients with hip pain include groin, thigh, and trochanteric pain. Groin and thigh pain arise from sensory branches of the obturator nerve, whereas trochanteric pain arises from sensory branches of the femoral nerve. Between January 2009 and October 2010, eighteen patients with chronic hip pain with several contraindications for THA were selected for a prospective study. Predenervation diagnosis was osteoarthritis in 16 patients and prolonged postoperative hip pain in 2 (1 THA, 1 Girdlestone). Hip joint pain was treated by percutaneous radiofrequency lesioning of the sensory branches of the obturator and femoral nerves. Six-month follow-up data revealed a statistically significant decrease in visual analog scale (VAS) scores and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and a statistically significant increase of Harris Hip Score. Before radiofrequency and at 6-month follow-up, mean VAS scores were 9.52 (range, 7-10; standard deviation [SD], 0.79) and 6.35 (range, 3-10; SD, 2.17), respectively; mean Harris Hip Scores were 28.64 (range, 19-41; SD, 6.98) and 43.88 (range, 23-71; SD, 16.38), respectively; and mean WOMAC scores were 75.70 (range, 92-59; SD, 9.70) and 63.70 (range, 78-44; SD, 11.37), respectively. All values were statistically significant (P<.05) for Student's t test and Wilcoxon signed-rank test. Eight patients reported ≥50% pain relief at 6-month follow-up. No side effects were reported. Use of this technique for hip pain control is controversial. In our experience, percutaneous radiofrequency lesioning of the sensory branches of the nerves innervating the hip joint can be an option for patients with intractable hip joint pain.