Denervation, hip joint, intrapelvic or extrapelvic intra-articular branches of sciatic, femoral, or obturator nerves
CPT4 code
Name of the Procedure:
Denervation of the Hip Joint
Common names: Hip joint denervation, Nerve ablation of the hip
Medical terms: Denervation of intrapelvic or extrapelvic intra-articular branches of sciatic, femoral, or obturator nerves
Summary
Hip joint denervation is a minimally invasive procedure that involves disrupting nerve signals from specific nerves (sciatic, femoral, or obturator) to alleviate chronic hip pain. This is typically done using techniques such as radiofrequency ablation or nerve blocks.
Purpose
Hip denervation aims to reduce chronic hip pain that hasn't responded to conservative treatments like medications or physical therapy. By interrupting pain signals from the targeted nerves, the procedure seeks to improve the patient's mobility and quality of life.
Indications
- Chronic hip pain due to osteoarthritis, rheumatoid arthritis, or other degenerative conditions.
- Pain not adequately managed by medications, physical therapy, or intra-articular injections.
- Patients who are not candidates for hip replacement surgery or opt to avoid surgical intervention.
Preparation
- Fasting for at least 6-8 hours before the procedure.
- Adjustments or temporary cessation of certain medications (e.g., blood thinners).
- Pre-procedure diagnostic imaging such as MRI or CT scans to map the nerves and evaluate the hip joint.
Procedure Description
- The patient is positioned comfortably, and the area around the hip is sterilized.
- Local anesthesia is applied to minimize discomfort.
- Using imaging guidance (e.g., fluoroscopy or ultrasound), a fine needle is inserted near the targeted nerves.
- The exact position is confirmed, and nerve stimulation may be tested.
- Once confirmed, radiofrequency ablation or another nerve-blocking technique is applied to disrupt the nerve signals.
- The needle is removed, and the site is cleaned and bandaged.
Duration
The procedure typically takes between 30 to 60 minutes.
Setting
Performed in a hospital, outpatient clinic, or surgical center.
Personnel
- Interventional radiologist or pain management specialist
- Supporting nurses and technicians
- Anesthesiologist, if deeper sedation is required
Risks and Complications
- Common: Temporary pain during and after the procedure, infection at the injection site, swelling, or bruising.
- Rare: Nerve damage, bleeding, or inadvertent damage to surrounding tissues. Complications are usually manageable with appropriate medical interventions.
Benefits
- Reduction in chronic hip pain.
- Improved mobility and quality of life.
- Minimally invasive with a quick recovery time.
- Benefits may be observed shortly after the procedure, with pain reduction lasting for several months to years.
Recovery
- Post-procedure monitoring for a few hours to ensure there are no immediate complications.
- Pain management may include over-the-counter pain relievers or prescribed medications.
- Resume normal activities gradually, avoiding strenuous activities for a few days.
- Follow-up appointments to evaluate the efficacy of the procedure and discuss further treatment if necessary.
Alternatives
- Physical therapy and rehabilitation exercises.
- Medications such as NSAIDs or corticosteroids.
- Intra-articular injections (e.g., corticosteroids or hyaluronic acid).
- Surgical options such as total hip replacement.
- The choice among these alternatives depends on patient-specific factors, potential benefits, and associated risks.
Patient Experience
Patients might feel slight pressure or discomfort during the needle insertion and initial ablation. Local anesthesia helps minimize pain. Post-procedure, patients may experience temporary soreness or swelling at the injection site, which typically resolves within a few days. Pain relief is usually noticeable within a few weeks following the procedure, improving the patient's overall comfort and mobility.