Hip Radiofrequency Ablation (RFA): Femoral and Obturator Branches

Abstract

The hip joint is innervated by branches of the femoral, obturator, and sciatic nerves (Birnbaum et al., Surg Radiol Anat 19(6):371–375, 1997). Local anesthetic blockade and ablation of these nerves has been used as intervention for hip joint pain that has failed conservative measures (Tinnirello et al., Pain Physician 21(4):407–414, 2018). The anterior innervation of the hip joint is provided by the femoral and obturator nerves, and the articular branches of these nerves can be easily accessed for local anesthetic blockade and ablation (Tinnirello et al., Pain Physician 21(4):407–414, 2018). Targeting the articular nerves as opposed to the parent trunk nerves is important to avoid unwanted sensory and motor loss (Locher et al., Pain Med 9(3):291–298, 2008). The posterior innervation of the hip joint is provided by the sciatic nerve and its articular branches are not easily accessible and hence are not frequently used for blockade or ablation (Tinnirello et al., Pain Physician 21(4):407–414, 2018). Intervention typically begins with trials of local anesthetic blockade as a form of diagnostic testing. Significant reduction of hip pain after two blocks provides a positive diagnostic test for likely positive response to ablation, which is used for longer pain relief (Tinnirello et al., Pain Phys 21(4):407–414, 2018). This treatment is beneficial for patients who are not surgical candidates or those who are awaiting hip joint replacement. Side effects can include neuritis, permanent nerve damage, loss of hip sensation, hematoma, and neuroma formation (Tinnirello et al., Pain Physician 21(4):407–414, 2018; Chye et al., Clin Interv Aging 10:569–574, 2015; Wu and Groner, Pain Pract 7(4):341–344, 2007). Contraindications are similar to those of any local anesthetic blockade such as skin infection at the site of injection, bacteremia, anticoagulation, and patient refusal.