Chemical hip denervation for inoperable fracture hip

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Authors (including presenting author) :
Tony KT NG (1), WS Chan (1), Philip Peng (2), Sumire Sasaki (1), Penelope Sham (1), HF Tsui (3), WY Leung (1), Renee Yip (1), CM Chang (1)
Affiliation :
(1) Pain Management Unit, Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong (2) Department of Anesthesia, Western Toronto Hospital, University of Toronto, Canada (3) Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Hong Kong
Introduction :
Hip fracture is a challenging geriatric problem for the healthcare professionals, especially in patients with multiple comorbidities. In patients with inoperable hip fracture secondary to severe comorbid conditions, the pain can lead to significant challenges in nursing care and rehabilitation. With an advanced understanding of the innervations of hip joint, we are now able to perform selective chemical denervation of the articular branches of femoral and obturator nerves to manage the pain associated with inoperable hip fracture.
Objectives :
The objectives were to analyze the outcomes of chemical hip denervation in patients with hip fracture who were not surgical candidates.
Methodology :
In this retrospective case series, we analyzed 20 consecutive patients with inoperable hip fracture, who received chemical denervation and examined the effect of the denervation on pain and functional outcomes including the maximally tolerable hip flexion and the ability to sitting out during their hospital stay. We also assessed the ambulatory ability as a long-term outcome.
Result & Outcome :
The median of movement-related pain was significantly reduced from severe pain to mild pain at all time points after chemical hip denervation (p < 0.017) and the median of maximally tolerable hip flexion degree was doubled from 43 deg to 86 deg, 73 deg and 80 deg respectively (p < 0.001 at 10 mins postoperatively, p=0.003 on POD1 and p=0.002 on POD5). Fifty percent of the patients managed to sit out of bed within the first 5 days postoperatively and three of them managed to walk with aid 4 months after hip denervation. No procedure-related adverse event was noted. We concluded that this chemical hip denervation could be a safe and effective measure to handle the pain-related and rehabilitation-related challenges for inoperable hip fracture. This innovative technique might have also provided an early evidence of a non-surgical alternative in managing hip fracture cases with severe comorbidities.

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