A Review of Current Denervation Techniques for Chronic Hip Pain: Anatomical and Technical Considerations.

Abstract

Percutaneous radiofrequency (RF) denervation of articular sensory nerves of the hip joint is a minimally invasive neurotomy technique that can provide pain relief in patients with chronic hip pain. There has been an increase in the number of publications on RF denervation of the hip over the last few years although many questions remain regarding anatomical targets, technical aspects, selection criteria, and evidence for effectiveness. For this updated review, publications were identified by searching MEDLINE and other medical literature databases from inception through November 30, 2018. Existing knowledge of hip joint innervation was reviewed and data on patient selection, prognostication of analgesic benefit from ablation by using local anesthetic blocks, current techniques of performing hip joint ablation, analgesic success, functional outcomes, and adverse effects were critically reviewed and analyzed. Sensory denervation of the anterior hip joint using RF current is a viable treatment option for management of chronic hip pain after conservative methods fails to do so. We have synthesized knowledge from papers on techniques of ablation and from recently elaborated anatomical details. We also provide suggestions regarding anticipated outcomes of the procedure. Our review of existing literature indicates evidence for analgesic benefits, improvement in function, and a low incidence of adverse effects of RF ablation of sensory innervation to the hip joint. Future research should focus on refining the technique of ablation and monitoring of long-term outcomes.