Ultrasound-guided radiofrequency lesioning of the articular branches of the femoral nerve for the treatment of chronic post-arthroplasty hip pain

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. © 2017,american society of interventional pain physicians. all rights reserved.