Chronic hip joint pain is a common problem among adults of advanced age.1 Conventional radiofrequency has been reported as a minimally-invasive option for treating chronic hip pain.1-9
Fast and Cost Effective
The Cosman G4 generator can treat multiple nerves innervating a painful hip joint at the same time, thereby reducing procedure time and OR usage. Cosman TCN electrodes and RF cannula are reliable and cost-effective.
By adjusting RF cannula size and generator settings, conventional monopolar and bipolar RF can create ablation zones of different sizes, including those larger than cooled RF.10
Average midline width W, length L, depth D, and volume V of large RF heat lesions for 3:15 minutes total time. This comprises a 15-second ramp plus 3 minutes at the set temperature for conventional lesions, or 45 seconds of pre-treatment cooling plus 2.5 minutes of RF heating for the cooled RF lesions. (A) Monopolar heat lesions. (B) Bipolar heat lesions with tip spacing s, shown in two cross sections. Average lesion size is assessed by color change in fresh bovine liver ex vivo. Ex vivo lesions may differ from clinical lesions.10
Studies on Conventional RF for Chronic Hip Pain2
- The patient is placed in supine position on an x-ray fluoroscopy table. The surgical site is prepared for aseptic technique, and the skin is numbed at the cannula insertion sites using local anesthetic.
- Aseptic technique and fluoroscopic guidance are used throughout cannula placement and during treatment.
- The sensory branch of the obturator nerve innervating the hip joint is targeted for ablation as follows. The femoral artery is located by palpation. An RF cannula is inserted 3cm lateral to the femoral artery, forming a 70° angle with the sagittal plane and a 20° angle with the transverse plane to avoid blood vessels. Using fluoroscopic guidance, the cannula tip is placed at the site below the inferior junction between the ischium and the pubis.
- With the patient awake, cannula position is confirmed by requiring a response to Sensory stimulation (50Hz, 1msec) at less than 0.7 Volts. To prevent inactivation of motor nerves, increasing levels of Motor stimulation (2Hz, 1msec) at less than 0.9 Volts is applied to exclude muscle contractions.
- After ruling out intravascular placement, lidocaine (1cc of 1%) is injected through the cannula.
- A temperature-sensing RF electrode is inserted into the cannula, and radiofrequency is applied for the desired time and temperature. The patient is continuously monitored for signs of discomfort.
- The sensory branch of the femoral nerve innervating the hip joint is targeted as follows. An RF cannula is inserted via an anterolateral approach with the tip below the inferior anterior iliac spine near the anterolateral margin of the hip joint. Steps 4-6 are repeated.
- Following RF procedure, the cannula is withdrawn and a bandage is placed over the skin insertion site.
Clinical Studies and Publications
- Chaiban G, Paradis T, Atallah J. Use of ultrasound and fluoroscopy guidance in percutaneous radiofrequency lesioning of the sensory branches of the femoral and obturator nerves. Pain Pract. 2013 [Epub ahead of print]
- Gupta G, Radhakrishna M, Etheridge P, Besemann M, Finlayson RJ. Radiofrequency denervation of the hip joint for pain management: case report and literature review. US Army Med Dep J. 2014 Apr-Jun:41-51
- Rivera F, Mariconda C, Annaratone G. Percutaneous radiofrequency denervation in patients with contraindications for total hip arthroplasty. Orthopedics. 2012;35(3):e302-5
- Wu H, Groner J. Pulsed radiofrequency treatment of articular branches of the obturator and femoral nerves for management of hip joint pain. Pain Pract. 2007;7(4):341-4
- Shin KM, Nam SK, Yang MJ, Hong SJ, Lim SY, Choi YR. Radiofrequency lesion generation of the articular branches of the obturator and femoral nerve for hip joint pain: a case report. Korean J Pain. 2006;19(2):282-4
- Malik A, Simopolous T, Elkersh M, Aner M, Bajwa ZH. Percutaneous radiofrequency lesioning of sensory branches of the obturator and femoral nerves for the treatment of non-operable hip pain. Pain Physician. 2003;6(4):499-502
- Kawaguchi M, Hashizume K, Iwata T, Furuya H. Percutaneous radiofrequency lesioning of sensory branches of the obturator and femoral nerves for the treatment of hip joint pain. Reg Anesth Pain Med. 2001;26(6):576-81
- Fukui S, Nosaka S. Successful relief of hip joint pain by percutaneous radiofrequency nerve thermocoagulation in a patient with contraindications for hip arthroplasty. J Anesth. 2001;15(3):173-5
- Akatov OV, Dreval ON. Percutaneous radiofrequency destruction of the obturator nerve for treatment of pain caused by coxarthrosis. Stereotact Funct Neurosurg. 1997;69(1-4 Pt 2):278-80
- Cosman et al. Factors That Affect Radiofrequency Heat Lesion Size. Pain Med. 2014;15(12):2020-36 [PDF]
- Locher S, Burmeister H, Böhlen T, et al. Radiological anatomy of the obturator nerve and its articular branches: basis to develop a method of radiofrequency denervation for hip joint pain. Pain Med. 2008;9(3):291-8
- Cohen et al. Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology 2008;109:279-88