Late hemorrhage after radiofrequency denervation for chronic hip pain: A CASE report

Chemical or thermal hip denervation is a feasible alternative to surgery for pain relief in patients who are at risk for complications after total hip arthroplasty. It is considered to be a minimal invasive intervention with negligible risk of hemorrhagic events. We report on a 68-year-old woman with end-stage bilateral hip osteoarthritis who was not eligible for surgery due to severe underweight and a chronic lymphocytic leukemia. Radiofrequency ablation of the nerve branches innervating the anterior hip capsule was performed. The procedure was ultrasound and fluoroscopy guided. She used acenocoumarin, which was continued in adherence to local guidelines. Nine days after the intervention, the patient presented herself with sudden severe pain in the groin because of an hematoma in the iliac and psoas muscles. An active blush of the femoral circumflex artery was established on angiography and successfully treated by coiling. Pain relief was successfully achieved with ropivacaine infusion through an epidural catheter. Hip denervation can be an alternative, low invasive, treatment modality for frail patients. No other severe hemorrhagic events are reported at the time of this case report. Discontinuation of anticoagulants should be assessed vigorously preprocedural, as both complications due to thrombotic and hemorrhagic events can be severe in this population.