A chemical denervation intervention may be safe and effective for pain management in avascular necrosis of the hip

1. Chemical neurolysis of the anterior hip capsular branches appears to be a safe and effective analgesic option for AVN-related hip pain refractory to conservative management, with durable benefit in a subset of patients through 6 months.

Evidence Rating Level: 3 (Average) 

Avascular necrosis (AVN) of the hip frequently causes refractory pain that persists despite conservative management, prompting interest in minimally invasive interventional options. This case series evaluated percutaneous chemical denervation of the articular branches innervating the anterior hip capsule using image-guided neurolysis with 100% ethanol in nine patients with chronic AVN-related hip pain refractory to conservative therapy. Pain was assessed via the Numerical Rating Scale (NRS) at baseline and at 1, 3, and 6 months post-procedure. Baseline pain averaged 6.7±1.2. Two patients did not respond to treatment. Among the seven responders, mean NRS scores decreased to 2.9±1.2 at 1 month and 3.0±1.4 at 3 months, with five of these seven maintaining at least 50% pain relief at both time points. Of the five patients who completed 6-month follow-up, mean NRS was 3.0±1.7, with three sustaining 50% or greater relief. No adverse events or complications were reported throughout follow-up.

Click here to read this study in Regional Anesthesia & Pain Medicine

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