Pain management in osteoarthritis of the hip using percutaneous obturator nerve neuromodulation with pulsed radiofrequency ablation under CT guidance.

Abstract

Introduction: The effectiveness of percutaneous neuromodulation of the obturator nerve using pulsed radiofrequency ablation (PRF) in patients with hip osteoarthritis refractory to conservative treatment should be evaluated.

Methods: 33 hips in 30 patients with radiographically confirmed hip osteoarthritis (Kellgren-Lawrence grades 2-4), underwent CT-guided pulsed radiofrequency ablation (PRF), targeting the obturator nerve. The mean age of patients was 69 (range 25-90) years. PRF was applied for 12 minutes. The effectiveness of the procedure was evaluated retrospectively based on a pain analog scale (VAS) prior and 1 week, 1, 3, 6 and 12 months post PRF. Paired samples t-test analysis was used to compare baseline and follow-up VAS scores. CIRSE classification system was used for complication reportingResults:A marked reduction in pain intensity was observed immediately following the procedure, with a mean decrease of approximately 9 points on the VAS scale. Patients with mild osteoarthritis seem to benefit more from the procedure with a reduction in pain scale of an average of 6 points at 6 months and an average of 4 points at 12 months. Cases with end-stage osteoarthritis (stage 4) had recurred pain at an average of 3 months post intervention. No complications were reported during or after the procedure.

Conclusions: Percutaneous neuromodulation of the obturator nerve with the use of PRF ablation is an effective and safe procedure with durable pain relief in patients with mild-to-moderate osteoarthritis up to 12 months, whereas in severe disease (grade 4) disease the effect is predominantly short-term, with recurrence of pain after approximately 3 months.