Ultrasound-guided Radiofrequency Lesioning of the Articular Branches of the Femoral Nerve for the Treatment of Chronic Post-arthroplasty Hip Pain

Abstract

Background: 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 postarthroplasty hip pain that can be difficult to treat. Objective: 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. Study Design: Case report. Setting: Center for Pain Medicine, Massachusetts General Hospital, Harvard Medical School. Method: 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. Results: 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. Limitations: 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. Conclusion: 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