Image-guided alcohol neurolysis for treatment of chronic hip pain secondary to avascular necrosis

This case series aims to assess the analgesic effectiveness and safety of percutaneous chemical denervation of the articular branches on anterior hip capsule in patients with refractory hip pain secondary to avascular necrosis (AVN).

Nine patients with refractory chronic hip pain secondary to AVN underwent image-guided chemical neurolysis with 100% ethanol. Average pain scores were recorded at baseline, 1, 3 and 6 months after chemical neurolysis.

The average baseline pain score was 6.7±1.2 on the Numerical Rating Scale (NRS). Two out of the nine patients did not respond to chemical neurolysis. For the seven patients who responded, the average NRS decreased to (2.9±1.2) at 1 month and (3.0±1.4) at 3 months. Five out of these seven patients maintained 50% or greater pain relief at both 1 and 3 months. For the five patients who completed the 6-month follow-up, the average NRS pain score was (3.0±1.7), with three of these patients maintaining 50% or greater pain relief. No one reported side effects or complications during the follow-up period.

In conclusion, alcohol neurolysis of the hip joint can be offered as an effective and safe modality for pain control in patients with AVN who failed conservative management. This small case series serves as a pilot for future large cohort studies.