THA and continued hip pain

[Bsb2015]

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Treatment recommendations?


Sent from my iPhone using SDN

 

[soccrwz]

Reimage for hardware issues

Here is a simplistic run down

Illiopsoas if anterior, bursa if lateral
SIJ if posterior

PT/Neuropathic for central sensitization

Could consider ABFON

 

[lobelsteve]

If not loose or infected block articular branches.

 

[painfree23]

If not loose or infected block articular branches.

how do you bill for this?

 

[lobelsteve]

Pnb other x2

 

[soccrwz]

 

[Dawkter]

Reimage for hardware issues

Here is a simplistic run down

Illiopsoas if anterior, bursa if lateral
SIJ if posterior

PT/Neuropathic for central sensitization

Could consider ABFON

Had this case recently post hip revision. Ordered X-Rays and ESR/CRP/CBC to r/o infection. Sent to ortho to ensure there was no missed hardware issue and found the hardware was not aligned appropriately requiring another revision.

If all is normal, move on to injections. I would definitely refer to ortho prior to this.

 

[painfree23]

View attachment 282795

Nice, do you have a procedure note or anything on the trajectory of the needle prior to ending up at this spot?

 

[soccrwz]

Many different ways to do it

Blocks
You can go AP to the targets with a 25G spinal needle with fluoroscopy, smaller needle less risk of significant hematoma/hitting the nerve because the nerve/artery/vein is sometimes in the pathway. So using a combo technique (palpate artery, and mark) confirm with U/S and mark where your needles will go through the skin can be helpful so your not going through these structures

here is a good one for RFA with a finder needle:

Radiological Anatomy of the Obturator Nerve and Its Articular Branches: Basis to Develop a Method of Radiofrequency Denervation for Hip Joint Pain

ABSTRACT. Objective. A previous study of radiofrequency neurotomy of the articular branches of the obturator nerve for hip joint pain produced modest resul

academic.oup.com

 

[Bsb2015]

Reimage for hardware issues

Here is a simplistic run down

Illiopsoas if anterior, bursa if lateral
SIJ if posterior

PT/Neuropathic for central sensitization

Could consider ABFON

How are you doing your iliopsoas bursa injections?


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[soccrwz]

I do it higher more proximal on acetabulum, could also do lesser trochanter at attachment with fluoroscopy. US can be used as well. I've had good results, don't go more medial Vessels are there.

 

[Baron Samedi]

I put it right at about 12 o'clock on the acetabular rim, starting more lateral than the picture I've attached and walking medial to avoid NV bundle.