A Novel Multisite Peripheral Nerve Stimulation Approach for Chronic Hip Pain in Avascular Necrosis: A Case Report.

BACKGROUND: Avascular necrosis (AVN) is a progressive disease, commonly leading to joint collapse and severe pain. Peripheral nerve stimulation (PNS) to the lumbar plexus and articular nerves innervating the hip can be a viable option for treatment of hip pain in patients who are not eligible for surgery. CASE REPORT: A patient with AVN-induced hip pain received bilateral lumbar plexus PNS at the level of L2, resulting in a > 90% relief of bilateral posterolateral aspects of the hip and 50% to 60% reduction in overall hip pain, respectively, at his 2-week follow-up. He subsequently underwent PNS placement to the articular branches of the femoral nerves bilaterally, resulting in improved coverage of the anterior groin leading to a 75% reduction in overall bilateral hip pain. CONCLUSIONS: Our case supports the utility of PNS to the lumbar plexus and articular nerve branches innervating the hip joint as a safe and novel treatment for chronic hip pain, despite limited evidence available for lumbar plexus neuromodulation.