Hip denervation: an approach for relieving pain, restoring function, and reducing inflammation in juvenile idiopathic arthritis patients

Abstract

Background: Juvenile idiopathic arthritis (JIA) frequently involves the hip joint, leading to significant pain, functional impairment, and long-term joint damage. Conventional treatment strategies, including pharmacologic therapy and intra-articular injections, may not provide adequate control. Hip denervation (HD) has emerged as a potential interventional approach for pain management in various musculoskeletal conditions, but its role in JIA-associated hip arthritis remains unclear. This study aimed to evaluate the effect of HD in JIA patients with unilateral hip arthritis on pain, function, and inflammatory parameters.

Methods: One hundred twenty JIA patients were diagnosed according to the ILAR criteria with unilateral hip arthritis. They were assigned randomly into three groups: group 1 received hip denervation, group 2 received subcutaneous saline, and group 3 received intra-articular triamcinolone. Visual analog scale (VAS), sonography of large joints in rheumatology (SOLAR) score, tenderness, and Harris Hip score (HHS) were assessed at 0-, 2-, and 16-week intervals. Tenderness was evaluated by a semi-quantitative score at the same intervals. Juvenile Arthritis Disease Activity Score (JADAS) was assessed at baseline.

Results: Over the 16-week study period, HD delivered remarkable outcomes, with VAS dropping from 5.48 ± 2.04 at baseline to 0.83 ± 0.50 (p < 0.0001), tenderness scores decreasing from 1.80 ± 0.82 to 0.80 ± 0.41 (p < 0.0001), and SOLAR score significantly reduced from 1.38 ± 0.59 to 0.15 ± 0.06 (p < 0.0001). Functional recovery was equally impressive, as HHS soared from 59.60 ± 9.89 to 83.27 ± 6.42 (p < 0.0001), surpassing outcomes seen with intra-articular steroids and placebo. Favorable responses were strongly associated with shorter disease duration, higher baseline VAS and SOLAR scores, and the oligoarticular subtype, while RF positivity predicted diminished improvement.

Conclusion: Hip denervation showed promising results in regaining functions, alleviating pain, tenderness, and inflammation of the hip joint in JIA patients. Key Points • This study is the first to evaluate HD in JIA, showing its potential to alleviate pain, improve function, and reduce inflammation. • HD demonstrated sustained benefits at 16 weeks, surpassing intra-articular steroids in controlling symptoms and modifying the inflammatory cascade. • It offers a minimally invasive, effective alternative for JIA-related hip arthritis, addressing the limitations of conventional therapies.

Keywords: Hip denervation; Juvenile idiopathic arthritis.

Fig. 1

Flowchart of the study groups

Fig. 2

Outcome measures during follow-up in the study groups: A VAS, B tenderness score, C HHS, and D SOLAR score

Fig. 3

The sonoanatomical landmarks of the hip articular branches, highlighting the femoral bracn at the level of the iliopectineal eminence (A) and the accessory obturator nerve at the level of the inferomedial acetabulum (B). Key anatomical structures labeled in the figure include the anterior inferior iliac spine (AIIS), psoas tendon (PT), iliopectineal eminence (IPE), femoral vein (FV), femoral artery (FA), and inferomedial acetabulum (Inf acetab)