Hip nerve blocks

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
P

Papa Lou

Full Member
Verified Member
10+ Year Member
Joined
Jul 7, 2013
Messages
295
Reaction score
72
Anybody actually get good results from the articulating femoral/obturator nerve blocks and RFA? Real results?
Members don't see this ad.
 
In my extensive series of 2 patients, both have gotten good (>85%) short term relief s/p 1 block

Sent from my SAMSUNG-SM-G920A using SDN mobile
 
1 month post ablation my patient says he's 100% better. He says his hip feels better than the relief he got from the standard steroid injection.
 
Members don't see this ad :)
Papa Lou said:
something else I'm a little bit skeptic about.
the percentages are less valuable than actual (or roundabout) numbers.
Click to expand...
I agree, but I don't have a good way of reporting pain score reductions using the actual pain scores in a meaningful way.

People who started as a 10 were reduced, on average, to a 4. People who started as a 4 were reduced, on average to a 2.5.

Interesting, but then how do I assess for statistical significance, minimal clinically important difference, or confidence intervals?
 
lobelsteve said:
Ive done 50 hip rf or so. 37.5 were able to return to professional rodeo or dance competition.
Click to expand...

steve, so have you done a fair number of hip RF on young patients? So not just failed THA or elderly to sick for surgery?

have you done hip RFA for pain from labral tears, early hip OA, under 50 years old?

Ever tried it for congenital hip dysplasia? I wonder if the nerves might be few mm displaced in that situation.
 
bedrock said:
steve, so have you done a fair number of hip RF on young patients? So not just failed THA or elderly to sick for surgery?

have you done hip RFA for pain from labral tears, early hip OA, under 50 years old?

Ever tried it for congenital hip dysplasia? I wonder if the nerves might be few mm displaced in that situation.
Click to expand...

4:1 failed hips to non-operative old ladies due to medical comorbidities.
Have not tried labral tear, impingement, or congenitals.
 
lobelsteve said:
4:1 failed hips to non-operative old ladies due to medical comorbidities.
Have not tried labral tear, impingement, or congenitals.
Click to expand...

I've seen a rash of somewhat middle aged labral tears lately, and I'm debating what to do with them. I'm not talking labral tears in 16-26 year old athletes, those I would send for hip arthroscopy with the 2-3 top hip surgeons in the country.

What I've been seeing a lot lately is several hip labral tears on patient in their forties, and treatment options are limited. The vast majority of orthopedic surgeons (even those that advertise for this), aren't that good at hip arthroscopy and didn't have much training with it as residents/fellows. I've seen far more patients made worse by hip arthroscopy than helped by it, particularly if they are not a rather young 16-26 yr old high-level athlete.

I've seen plenty of these late thirties to early fifties patients that get hip arthroscopy, end up worse afterwards and then get hip replacements at 40-45 yrs old and many of these also don't do very well after THA at 40 years old, particularly if they are still active as many 40-45 year olds are.

So I'm considering my options for these patients. PT is basically useless for labral tears, trying steroid injection once is reasonable, but it rarely lasts for months like it does for hip OA. PRP/Stem cells are a consideration, but the studies to date, are much more strongly in support of stem cells for knee OA, than for hip OA, let alone a hip labral tear.
Still, I would try PRP/stem cells for my own hip if I was in the same situation, however I don't like charging other patients cash for a procedure that no one knows might work for primary pathology of the hip labrum, although in this age group, mild OA often coexists.

Which leads me to hip RF, it seems that after failing basic meds and steroid injection, that hip RF should be considered for labral tears for 35-50 year olds, as it seem much less likely than hip arthroscopy to make the patient worse, and possibly might help them.

Thoughts ?
 
Last edited:
Not much of a downside. But recommend a protocol and outcome measures with 6 mo follow up data. Get 10 and publish a case series as gateway for getting funding for dbrct.
 
Thank you Steve for your comments. I may just publish a paper on this.

Anyone else besides Steve have any comments on hip RF for middle-age labral tears?

Does anyone else here besides Steve do hip RF?
 
Members don't see this ad :)
bedrock said:
Thank you Steve for your comments. I may just publish a paper on this.

Anyone else besides Steve have any comments on hip RF for middle-age labral tears?

Does anyone else here besides Steve do hip RF?
Click to expand...

I do it.

Actually, my hip RF n is low (just over 10 cases). Outcomes not too impressive.

Knee RF n is high, and outcomes are very good in general.
 
haven't done any hips, handful of knees with pretty good results so far
 
lobelsteve said:
Got Synvisc separate from buy and bill. No charge. Just arthrocentesis and injection. No jcodes.
Click to expand...
Who are you choosing for hip visco? Sync One? Steroid first?


Sent from my iPhone using SDN mobile app
 
This guy had Synvisc in pst elsewhere and wanted me to repeat it.
I would offer steroid first. Not sure Synvisc has a role other than it worked for patient in past and he requested it. No down side for him.
 
I did one hip RF. Despite trying to miss the artery the protuberant abdomen tricked me and red gushed up the RF needle. Held pressure for a long while and that was it. Adjusted the angle more acutely and placed the needles.... No improvement in pain. I would try again.


What about the SSN blocks and RFA? Any consistent success stories?
 
Our fellow was suppose to go to WIP and present a poster that described a complete femoral nerve injury after a cooled RF procedure for the hip that happened at my institution. (His trip was cancelled unfortunately so I don't think it will be presented).

Needle placement was done after survellience with ultrasound that identified the nerve and vasculature. Needle was placed as directed by manufacturer. It's a sad story - young girl - now with no quad strength (hip pain is gone though).

Speaking of badness with cooled RF - I had a no-**** positional headache solved with a blood patch after a lumbar cooled RF of medial branches. We presented that poster somewhere too - not sure where. Anyway, I can't explain that dural puncture very well, but it was very timely and would be hard to think it was coincidental.
 
epidural man said:
Our fellow was suppose to go to WIP and present a poster that described a complete femoral nerve injury after a cooled RF procedure for the hip that happened at my institution. (His trip was cancelled unfortunately so I don't think it will be presented).

Needle placement was done after survellience with ultrasound that identified the nerve and vasculature. Needle was placed as directed by manufacturer. It's a sad story - young girl - now with no quad strength (hip pain is gone though).

Speaking of badness with cooled RF - I had a no-**** positional headache solved with a blood patch after a lumbar cooled RF of medial branches. We presented that poster somewhere too - not sure where. Anyway, I can't explain that dural puncture very well, but it was very timely and would be hard to think it was coincidental.
Click to expand...

What was the indication? You said the patient was young. Was it a congenital hip issue, impingement, labral tear ?
 
epidural man said:
Our fellow was suppose to go to WIP and present a poster that described a complete femoral nerve injury after a cooled RF procedure for the hip that happened at my institution. (His trip was cancelled unfortunately so I don't think it will be presented).

Needle placement was done after survellience with ultrasound that identified the nerve and vasculature. Needle was placed as directed by manufacturer. It's a sad story - young girl - now with no quad strength (hip pain is gone though).

Speaking of badness with cooled RF - I had a no-**** positional headache solved with a blood patch after a lumbar cooled RF of medial branches. We presented that poster somewhere too - not sure where. Anyway, I can't explain that dural puncture very well, but it was very timely and would be hard to think it was coincidental.
Click to expand...

Thus is why I'm not a fan of cooled RF for anything other than SIJ RF. I like my RF lesion to be small and precise. Not worth the risk IMHO to do cooled RF other than for SIJ RF.
 
  • Like
Reactions: 1 user
You must log in or register to reply here.
Next unread thread

Similar threads

I
C2 nerve root block lateral
Replies
7
Views
717
NJPAIN
N
D
Suboccipital nerve decompression
Replies
6
Views
523
DrSwede
D
bedrock
Therapeutic genicular blocks ?
Replies
10
Views
648
oreosandsake
oreosandsake
P
Intra-Articular Hip Injections in Obese Patients
Replies
10
Views
103
DoYouEvenLiftBro
D
SpineandWine
cervical selective nerve root block
2 3
Replies
125
Views
4K
SC Tian
SC Tian
Top