Treatment of coxalgia in patients with grades 3–4 hip osteoarthritis

Abstract

Hip osteoarthritis (OA) is an important public health issue. Nonsurgical treatments including changes in lifestyle, physiotherapy, pharmacological therapy can be effective for patients with coxalgia at early stages of hip osteoarthritis. Objective To evaluate the effectiveness of percutaneous radiofrequency (RF) denervation (neuroablation) of articular sensory nerves of the hip joint for pain relief in patients with chronic hip pain. Material and methods The review included 46 patients (47 joints) with hip OA who were classified as Kellgren-Lawrence grade 3 (n = 37) and Kellgren-Lawrence grade 4 (n = 9). Quantitative and qualitative assessment of pain was produced with VAS scale. The Harris Hip Score (HHS) was used to measure functionality. All patients underwent radiofrequency ablation of the articular branches of the femoral and obturator nerves. The results of treatment were evaluated at 2 weeks, 1, 3, 6 and 12 months. Results VAS scores showed significant pain relief immediately after the procedure that persisted in 69.5 % of patients at 6 months and in 56.5 % at 12 months with 43.5% of patients reporting dissatisfaction. HHS scores demonstrated improved quality of life in 85.2 % of patients at 6 months, with patient satisfaction recorded in 58.6 % at 12 months, and 41.3 % reported significant deterioration. Conclusions Percutaneous RF denervation of articular sensory nerves of the hip joint was shown to be effective for pain relief in patients with severe hip OA at a short term (up to 6 months). The technique can be recommended for patients who have contraindications to hip replacement surgery.