MINIMALLY INVASIVE DIAGNOSTIC BLOCK AND PERCUTANEOUS RADIOFREQUENCY ABLATION IN THE TREATMENT OF CHRONIC HIP PAIN - REVIEW ARTICLE

Abstract

The hyperactive "baby boom" generation is gradually aging, and chronic hip pain has become an increasingly common problem. Most patients with hip pain experience symptoms ranging from mild discomfort to severe pain. They can control the pain with conservative measures, but it inevitably progresses, causing a gradual decline in the quality of life. Conservative therapeutic approaches to hip pain include paracetamol, nonsteroidal anti-inflammatory drugs, narcotics and a variety of physical therapies. Total hip arthroplasty surgery is the only option for patients who experience a gradual decrease in mobility over time and whose pain is unaffected by a conservative approach. For most patients, surgical treatment is a good way to restore quality of life and reduce pain levels, However, this aggressive surgery is not possible in some patients. Many comorbidities in old age limit access to total arthroplasty, while the younger population is at an age where they want to delay surgical treatment. In both of these groups, it is desirable to consider other treatment options and techniques. Minimally invasive percutaneous partial sensory denervation of the hip joint has today become an option that can achieve significant success in providing the desired pain relief without the employment of a surgical knife. Today, there are different modalities for performing this procedure, ranging from diagnostic-pharmacological, radiofrequency (thermal, pulsating and cooled) and cryoablative modes. There is currently broad evidence that suggests that the use of fluoroscopically guided percutaneous radiofrequency ablation of the periarticular branches of the hip joint can provide pain relief for as long as 12-18 months.

Keywords: chronic hip pain; diagnostic block; fluoroscopy; radiofrequency denervation.

Figure 1

Knee innervation. 1. Anterior segment - femoral nerve branches (L1-L4). 2. Anteromedial segment – branches of the obturator nerve (L1-L4). 3. Posterior segment – branches of the sciatic nerve.

Figure 2

Left hip and preparatory marking of the “critical zone” and vascular bundle for safer access to the femoral and obturator branches.

Figure 3

Marking the 12 o’clock position for the femoral branch and A-P projection.

Figure 4

Depiction of the needle entry position for the femoral branch and L-L projection.

Figure 5

View of the needle entry position for the obturator branch (medially from the vascular bundle and below the femoral sulcus).

Figure 6

A-P projection of the obturator branch: a) first position, b) more distal position.