Efficacy of Nervus Femoralis Radiofrequency Ablation for Persistent GTPS

Overview

In a cross-sectional study of 25 patients undergoing nervus femoralis radiofrequency ablation (NF-RFA) for refractory greater trochanteric pain syndrome (GTPS), over 55% achieved at least 50% pain reduction at an average follow-up of 13 months. Additionally, more than half reported significant global improvement, and the majority would recommend the procedure.

Background

Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain affecting up to 25% of individuals during their lifetime, often impairing quality of life and function. Traditional treatments include physical therapy, corticosteroid injections, and shockwave therapy, but many patients remain refractory. Recent anatomical insights identified the nervus femoralis as a sensory nerve innervating the greater trochanter region, making it a target for radiofrequency ablation (RFA). RFA is a minimally invasive procedure that disrupts nociceptive signals and has shown promise in small case series for treating GTPS.

Data Highlights

Key Findings

• 55.6% of patients reported at least a 50% reduction in Numeric Pain Rating Scale (NPRS) scores at a minimum of 6 months post NF-RFA.
• 70.4% achieved a clinically meaningful ≥2-point reduction in NPRS scores from baseline.
• 51.9% of patients rated their global improvement as “much improved” or “very much improved” on the Patient Global Impression of Change (PGIC) scale.
• The average follow-up duration was approximately 13 months, indicating sustained pain relief.
• Most patients expressed willingness to recommend NF-RFA, although about 25% reported persistent pain or recurrence of symptoms.
• The cohort primarily consisted of elderly females with a mean BMI near overweight range, reflecting typical GTPS demographics.

Clinical Implications

NF-RFA targeting the nervus femoralis appears to be a safe and effective treatment option for patients with recalcitrant GTPS who have failed conservative therapies. Clinicians may consider NF-RFA as a minimally invasive intervention to achieve meaningful and sustained pain relief in this population. Patient selection and counseling should include discussion of potential persistent symptoms and the possibility of incomplete pain resolution.

Conclusion

Nervus femoralis radiofrequency ablation provides significant and durable pain reduction for over half of patients with refractory greater trochanteric pain syndrome, supporting its role as a valuable treatment modality in this challenging condition.

References

1. Abd-Elsayed et al. 2022 -- Case series on NF-RFA for GTPS
2. Vajdi et al. 2023 -- Single patient NF-RFA for recalcitrant GTPS
3. Vieira et al. 2023 -- Bipolar pulsed RF of nervus femoralis in GTPS
4. Genth et al. 2021 -- Anatomical study of nervus femoralis sensory supply