Background: Total hip arthroplasty (THA) is a common surgical treatment for several conditions
of the hip. While the majority of patients obtain satisfactory results, many develop chronic postarthroplasty hip pain that can be difficult to treat.
Objective: We evaluate the effectiveness of cooled (60°C) radiofrequency lesioning of the
articular branches of the femoral nerve (ABFN) as a minimally invasive treatment for patients
suffering from chronic post-arthroplasty hip pain. This treatment has never been described
previously in this population.
Study Design: Case report.
Setting: Center for Pain Medicine, Massachusetts General Hospital, Harvard Medical School.
Method: A 59-year-old woman with long-standing osteoarthritis of the right hip who underwent
primary total hip arthroplasty and presented with chronic post-arthroplasty hip pain.
Intervention: Cooled (60°C) radiofrequency lesioning of the ABFN under ultrasound guidance.
Outcome Measure: Functional ability and numeric rating scale (NRS) scores at rest and with
activity.
Results: Prior to intervention, the patient reported severe disruption in daily activities, sleep, and
relationships; NRS scores at rest and with activity were 4/10 and 10/10, respectively. At 4 weeks
following intervention, the patient reported significant improvement in functional ability and NRS
scores decreased to 1/10 and 2/10, respectively. At 6 months, the patient’s NRS scores at rest and with
activity were 0/10 and 1/10, respectively. At 24-month follow-up, the patient continued to endorse
significant pain relief with NRS scores at rest and with activity of 0 – 1/10 and 1 – 2/10, respectively.
There were no side effects or complications including motor weakness, sensory loss, and neuralgias.
Limitations: Although the patient obtained good results from the intervention, the description
of the study is from a single case report. Further study is necessary to investigate the widespread
use of this technique and its outcomes.
Conclusion: Cooled (60°C) radiofrequency lesioning of the ABFN under ultrasound guidance is
both an effective and minimally invasive intervention for chronic post-arthroplasty hip pain.
Key words: Radiofrequency lesioning, articular branches, femoral nerve, post-arthoplasty, total
hip arthoplasty, hip pain, chronic pain
Minimally Invasive Total Hip Arthroplasty in a Patient with Hereditary Multiple Exostoses: A Case Report
