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PONOS illustration of the hip joint and sensory nerve supply for hip radiofrequency treatment

Hip
radiofrequency

Denervation of the capsular branches

AI-generated illustration in the PONOS style; this is not a radiological image.

Radiofrequency and hip pain

Radiofrequency denervation of the hip capsular branches

Hip radiofrequency is an interventional procedure targeting pain arising from the joint capsule. In the clinical pathway offered by Evangelos Panagiotakos, it may be considered when hip pain persists despite conservative treatment and injections provide only brief relief or no longer help.

Anatomical illustration of the nerve supply to the hip joint
Hip innervation and the main structures involved in capsular pain.

Before considering denervation

The assessment should establish the cause of pain and distinguish pain arising from the hip joint from radiculopathy, sacroiliac pain, myofascial pain and other extra-articular conditions. MRI can help identify conditions that require priority orthopaedic assessment or specific treatment, such as avascular necrosis of the femoral head, insufficiency fractures, infection, aggressive lesions or other abnormalities requiring a dedicated pathway.

A step-by-step pathway

  1. Clinical and imaging assessment: medical history, physical examination and imaging, including MRI when indicated.
  2. Ultrasound-guided injection: high-molecular-weight hyaluronic acid may be used when considered appropriate for the degree of osteoarthritis.
  3. Capsular denervation: if the benefit from hyaluronic acid becomes short-lived or absent, radiofrequency treatment of the articular branches of the femoral and obturator nerves may be considered, with assessment of the accessory obturator branch where appropriate.

Why an extra-articular approach?

In this clinical practice, intra-articular neuromodulation is not routinely performed. When the aim is to control capsular pain, an extra-articular approach avoids entering the joint, with the aim of minimising infection risk and preserving options for subsequent orthopaedic procedures, including those planned in the near term.

Fluoroscopic image during radiofrequency treatment of the hip capsular branches
Fluoroscopic image of a procedure targeting the hip capsular branches.

The procedure

Treatment is performed under ultrasound and/or fluoroscopic guidance, using local anaesthesia. After confirming the target and performing sensory and motor testing where indicated, radiofrequency is applied to the selected articular branches. Parameters, the number of targets and the technique are tailored to the anatomy, the cause of pain and the person’s overall health.

Read the clinical case of right hip pain treated by Evangelos Panagiotakos (in Italian).