Objective: The purpose of this article is to understand the principles of cooled radiofrequency ablation (C-RFA) and the description of the procedure of hip CRFA. Cooled radiofrequency ablation uses a constant flow of ambient water circulated through the electrode via a peristaltic pump to maintain a lower tissue temperature by creating a heat sink, but still allowing neurolysis to occur. Cooled radiofrequency ablation lesions are spherical and project several millimeters beyond the electrode tip as compared to thermal-radiofrequency ablation (T-RFA), thereby increasing the probability of successful denervation of the target nerve. Cooled radiofrequency ablation is a preferred technique for ablation of articular branches of the hip joint. Chronic pain in the hip occurs mainly due to osteoarthritis along with other causes like rheumatoid arthritis, osteonecrosis, chronic infectious coxarthrosis, posttraumatic pain, and persistent postoperative pain following total hip arthroplasty (THA).
Rosomoff HL, Brown CJ, Sheptak P. Percutaneous radiofrequency cervical cordotomy: technique. Neuromrg 1965;23(6):639–644. DOI: 10.3171/jns.1965.23.6.0639.
Sweet WH, Wepsic JG. Controlled thermocoagulation of trigeminal ganglion and root for differential destruction of pain fibers. part I:trigeminal neuralgia. Neurosurg 1974;39(2):143–156. DOI: 10.3171/jns.1974.40.2.0143.
Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet 2011;377(9783):2115–2126. DOI: 10.1016/S0140-6736(11)60243-2.
Battaglia PJ, D’Angelo K, Kettner NW. Posterior, lateral, and anterior hip pain due to musculoskeletal origin: a narrative literature review of history, physical examination, and diagnostic imaging. J Chireopr Med 2016;15(4):281–293. DOI: 10.1016/j.jcm.2016.08.004.
Lorentzen T. A cooled needle electrode for radiofrequency tissue ablation: thermodynamic aspects of improved performance compared with conventional needle design. Acad Radiol 1996;3(7):556–563. DOI: 10.1016/s1076-6332(96)80219-4.
Watanabe I, Masaki R, Min N, et al. Cooled-tip ablation results in increased radiofrequency power delivery and lesion size in the canine heart: importance of catheter-tip temperature monitoring for prevention of popping and impedance rise. J Interv Card Electrophysiol 2002;6(1):9–16. DOI: 10.1023/a:1014140104777.
Goldberg SN, Gazelle GS, Solbiati L, et al. Radiofrequency tissue ablation: increased lesion diameter with a perfusion electrode. Acad Radiol 1996;3(8):636–644. DOI: 10.1016/s1076-6332(96)80188-7.
Malik K, Benzon HT, Walega D. Water-cooled radiofrequency: a neuroablative or a neuromodulatory modality with broader applications? Case Rep Anesthesiol 2011;2011:263101. DOI: 10.1155/2011/263101.
Kawaguchi M, Hashizume K, Iwata T, et al. Percutaneous radiofrequency lesioning of sensory branches of the obturator and femoral nerves for the treatment of hip joint pain. Reg Anesth Pain Med 2001;26(6):576–581. DOI: 10.1097/00115550-200111000-00016.
Birnbaum K, Prescher A, Hessler S, et al. The sensory innervation of the hip joint – an anatomical study. Surg Radiol Anat 1997;19(6):371–375. DOI: 10.1007/BF01628504.
Bhatia A, Hoydonckx Y, Peng P, et al. Radiofrequency procedures to relieve chronic hip pain: an evidence-based narrative review. Region Anesthe Pain Med 2018;43(1):72–83. DOI: 10.1097/AAP.0000000000000694.
