Ultrasound-Guided Hip Joint Cooled Radiofrequency Denervation

Ultrasound-Guided Hip Joint Cooled Radiofrequency Denervation: A Prospective Pilot Study

Hip osteoarthritis (HOA) is a common cause of pain and disability in aging population. Conservative treatment is based on lifestyle modifications, physical therapy, analgesic and anti-inflammatory medications and intra articular injections. This Prospective Pilot Study aims at investigating the efficacy of Ultrasound-Guided Cooled Radiofrequency Hip Denervation as a treatment offered to patients with HOA.

Radiological prevalence of HOA is very high. Hip denervation (HD) is a known palliative procedure that was initially performed as an open surgery. The role of the obturator, femoral and sciatic nerves in hip joint innervation was discovered. Several small clinical and anatomical studies addressed feasibility and benefits of the radiofrequency hip denervation (RFHD). Ultrasound guidance may eliminate equivocality of previously published techniques and provide precise image guidance as it a is logical and anatomically sound approach when procedural targets include soft tissue, such as nerves, tendons and joint capsule. None of these structures can be localized under routine fluoroscopy. Ultrasound is a bedside imaging tool that has been accepted as safe and reliable. In two meta-analyses, the use of real-time two-dimensional ultrasound for the placement of CVCs substantially decreased mechanical complications and reduced the number of attempts at required cannulation and failed attempts at cannulation compared with the standard landmark placement. Pertinent to the proposed study, recent systematic review and meta-analysis of the accuracy of US-guided versus landmark-guided hip joint injections revealed that US-guided injections are significantly more accurate than those that are landmark-guided. The significance of this study lies in its potential to improve functional activity and pain control in patients with HOA. Also, it may eventually lead to a decrease in patients resorting to Total Hip Arthroplasty (THA) as an ultimate end solution for HOA.

Inclusion Criteria:

• Primary degenerative osteoarthritis of hip joint
• Pain pre-intervention qualified as at least moderate with functional limitation moderate/severe.
• Radiological confirmation of hip osteoarthritis
• Failure of conservative therapy to control symptoms, defined as the persistence of at least moderate with functional limitation moderate/severe pain that has been refractory to prescribed medications, and other modalities, such as physical therapy and intraarticular injections. Intolerable side effects of medications and contraindications to specific methods will be also considered as a failure of the conservative therapy.
• Positive articular branches analgesic block, defined as >50% improvement in pain and function for at least 2 hours

Exclusion Criteria:

• Non-English speakers
• Daily dose of opioids more than 90 MEQ
• Body Mass Index (BMI) > 30
• Uncorrectable coagulopathy
• Local and systemic infection
• Inability to obtain ultrasound image of ventral acetabulum
• Documented prior Anaphylactic Reaction to Contrast Agent
• Pregnancy