Regional hip blockade in osteoarthrosis. Effects on pain perception

Our experience in the application of radiofrequency neuroablation in patients with coxalgia against the background of degenerative osteoarthrosis of the hip joint

The article is concerned with the treatment of coxalgia against the background of degenerative-dystrophic diseases of the hip joint. The author carried out an analysis of foreign studies concerning with the application of radiofrequency neural ablation for the hip joint nerves. Based on the results of our own research, the author has proved that radiofrequency neuroablation of articular nervule of obturator and femoral nerves is an effective treatment of coxalgia pain syndrome against the background of degenerative osteoarthrosis

Pulsed radiofrequency treatment of articular branches of femoral and obturator nerves for chronic hip pain

Purpose

Chronic hip pain is a common symptom experienced by many people. Often, surgery is not an option for patients with multiple comorbidities, and conventional drugs either have many side effects or are ineffective. Pulsed radiofrequency (PRF) is a new method in the treatment of pain. We attempt to compare the efficacy of PRF relative to conservative management for chronic hip pain.

RPatients and methods

Between August 2011 and July 2013, 29 patients with chronic hip pain were divided into two groups (PRF and conservative treatment) according to consent or refusal to undergo PRF procedure. Fifteen patients received PRF of the articular branches of the femoral and obturator nerves, and 14 patients received conservative treatment. Visual analog scale (VAS), Oxford hip scores (OHS), and pain medications were used for outcome measurement before treatment and at 1 week, 4 weeks, and 12 weeks after treatment.

Results

At 1 week, 4 weeks, and 12 weeks after treatment initiation, improvements in VAS were significantly greater with PRF. Improvements in OHS were significantly greater in the PRF group at 1 week, 4 weeks, and 12 weeks. Patients in the PRF group also used less pain medications. Eight subjects in the conservative treatment group switched to the PRF group after 12 weeks, and six of them had >50% improvement.

Conclusion

When compared with conservative treatment, PRF of the articular branches of the femoral and obturator nerves offers greater pain relief for chronic hip pain and can augment physical functioning.

[Joint and sensory branch block of the obturator and femoral nerves in a case of femoral head osteonecrosis and arthritis]

The sensory innervation of the hip joint is complex. The joint and sensory branch block of the obturator and femoral nerves is effective for treating the pain caused due to different hip diseases. This could be an option to be considered in certain circumstances such as, being a surgical-anaesthetic high risk, or if there is significant overweight, It could also be useful on other occasions if the traumatoligist considers that it is better to delay hip replacement for a limited period.

Local anesthetics injection therapy for musculoskeletal disorders: a systematic review and meta-analysis

OBJECTIVES

Therapeutic injections with local anesthetics (TLA) are widespread and are used for various symptoms of the musculoskeletal system. The aim of the present project was to evaluate the efficacy and safety of TLA in the treatment of musculoskeletal disorders.

METHODS

Systematic literature search for controlled clinical trials (Medline, Cochrane, CAMbase, hand search of references) without language limitation; independent screening of the search results (n=3200 hits), abstract reading, and full-text analysis by 2 reviewers. Two authors independently extracted the data and assessed study quality. Meta-analysis was calculated for studies using a continuous scale for pain assessment.

RESULTS

Twenty-four controlled trials were included in this review. In almost all studies no primary outcome measure was defined and the overall study quality was low. The qualitative data analysis revealed no clear trend for or against TLA. The meta-analysis of 12 studies showed no significant difference in pain reduction for TLA compared with control treatments consisting of saline injections or other substances, oral analgesics, or nonpharmacological interventions (standardized mean difference -0.31, 95% confidence interval, -0.75 to 0.14). Minor adverse side effects were reported in 7 studies in both the TLA and the control groups with no trend for one of the groups to be safer.

DISCUSSION

Despite the widespread use of TLA for musculoskeletal disorders in daily practice, available data are sparse and of low quality and, therefore, do not allow a final recommendation. High-quality studies are needed to close the gap between common practice and research.

Percutaneous radiofrequency denervation in patients with contraindications for total hip arthroplasty

Multiple comorbidities sometimes represent a contraindication for total hip arthroplasty (THA). Major symptoms of patients with hip pain include groin, thigh, and trochanteric pain. Groin and thigh pain arise from sensory branches of the obturator nerve, whereas trochanteric pain arises from sensory branches of the femoral nerve. Between January 2009 and October 2010, eighteen patients with chronic hip pain with several contraindications for THA were selected for a prospective study. Predenervation diagnosis was osteoarthritis in 16 patients and prolonged postoperative hip pain in 2 (1 THA, 1 Girdlestone). Hip joint pain was treated by percutaneous radiofrequency lesioning of the sensory branches of the obturator and femoral nerves. Six-month follow-up data revealed a statistically significant decrease in visual analog scale (VAS) scores and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and a statistically significant increase of Harris Hip Score. Before radiofrequency and at 6-month follow-up, mean VAS scores were 9.52 (range, 7-10; standard deviation [SD], 0.79) and 6.35 (range, 3-10; SD, 2.17), respectively; mean Harris Hip Scores were 28.64 (range, 19-41; SD, 6.98) and 43.88 (range, 23-71; SD, 16.38), respectively; and mean WOMAC scores were 75.70 (range, 92-59; SD, 9.70) and 63.70 (range, 78-44; SD, 11.37), respectively. All values were statistically significant (P<.05) for Student's t test and Wilcoxon signed-rank test. Eight patients reported ≥50% pain relief at 6-month follow-up. No side effects were reported. Use of this technique for hip pain control is controversial. In our experience, percutaneous radiofrequency lesioning of the sensory branches of the nerves innervating the hip joint can be an option for patients with intractable hip joint pain.