Nerve-Targeted Interventions Provide Meaningful Short-Term Pain and Functional Improvement in Refractory Hip Pain: A Systematic Review.

Abstract

Importance: The management of chronic hip pain in patients not amenable to surgical treatment remains challenging. Increasing evidence suggests that targeted denervation may reduce hip pain by disrupting nociceptive input.

Aim: To synthesize available evidence on patient-level outcomes following nerve-targeted interventions for hip pain; to summarize procedural techniques, patient selection criteria, and reported clinical outcomes associated with these interventions EVIDENCE REVIEW: A comprehensive search of MEDLINE, EMBASE, and PubMed was performed following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies reported pain-related or functional outcomes after nonpharmacological, nerve-targeted interventions for hip pain. Inter-reviewer agreement was assessed using the kappa (κ) statistic and study quality was appraised using Methodological Index for Non-Randomized Studies (MINORS) criteria. Descriptive statistics summarized study characteristics, patient demographics, procedural details, and outcomes.

Findings: Ten studies (358 patients, 370 hips) were included (one level II, one level III, eight level IV studies). Eight studies evaluated radiofrequency ablation and two examined pericapsular alcohol neurolysis. Most interventions targeted the femoral and obturator nerves. Across studies, 60-80% of patients achieved >50% pain relief at 3-6 months, with some reporting sustained benefits to 12 months. Significant improvements were also observed in functional outcomes and reductions in opioid use were reported in some studies, although statistically significant reductions were demonstrated in only one study. Complications were rare and minor, limited to transient neuritis, hematomas, or sensory changes without lasting sequelae.

Conclusion: and Relevance: Nerve-targeted interventions may provide meaningful short-term improvements in pain, function, and analgesic use in patients with refractory hip pain. These interventions may represent a potential therapeutic option in patients not amenable to surgical treatment or with persistent symptoms despite prior surgical management. However, the evidence base remains limited by heterogeneity and study design, highlighting the need for high-quality randomized controlled trials to establish optimal techniques and long-term effectiveness.

Level of evidence: IV, systematic review of level II, III, and IV studies.