EP3.5 Nerve-Targeted Interventions Provide Meaningful Short-Term Pain and Functional Improvement in Refractory Hip Pain: A Systematic Review

Abstract Purpose The management of chronic hip pain in patients not amenable to surgical treatment remains challenging. Increasing evidence suggests that targeted denervation, whether incidental during arthroscopy or deliberate via radiofrequency ablation or neurolysis, may reduce hip pain by disrupting nociceptive input. This systematic review synthesized available evidence on patient-level outcomes following nerve-targeted interventions for hip pain. Methods A comprehensive search of MEDLINE, EMBASE, and PubMed from inception to June 18, 2025 was performed following PRISMA guidelines. Two reviewers screened 3,001 titles/abstracts and 45 full-texts. Eligible studies reported pain-related or functional outcomes after nonpharmacological, nerve-targeted interventions for hip pain. Case reports with <10 patients, nonclinical or pharmacologic studies, and interventions unrelated to the hip joint were excluded. Inter-reviewer agreement was assessed using the κ statistic and study quality was appraised using the MINORS criteria. Descriptive statistics summarized study characteristics, patient demographics, procedural details, and outcomes. Results Ten studies comprising 358 patients and 370 hips were included (one level II, one level III, eight level IV studies). Eight studies evaluated radiofrequency ablation and two examined pericapsular alcohol neurolysis. Most interventions targeted the femoral and obturator nerves. Across studies, 60-80% of patients achieved >50% pain relief at 3-6 months, with some reporting sustained benefits to 12 months. Significant improvements were also observed in functional outcomes (HOOS, WOMAC, OHN, EQ-5D-5L) and reductions in opioid use were documented in several cohorts. Complications were rare and minor, limited to transient neuritis, hematomas, or sensory changes without lasting sequelae. The average MINORS score was 9.6, indicating fair quality of the included evidence. Conclusion Nerve-targeted interventions, including radiofrequency ablation and neurolysis, provide meaningful short- to mid-term pain relief, functional improvement, and reduced analgesic use in patients with refractory hip pain. These findings support hip denervation as a promising therapeutic avenue when surgical treatment fails. However, the evidence base remains limited by heterogeneity and study design, highlighting the need for high-quality randomized controlled trials to establish optimal techniques and long-term effectiveness.