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

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.