These include cases where there are no obturator branches (61); the articular branches arise before the obturator foramen; there is a dominant anterior obturator nerve (occurs in 10% to 30% of patients); or if the branches do not supply the portion of the joint that is affected clinically.
There is considerably less ability to translate previous anatomic studies to develop a denervation protocol for other articular branches to the joints.
Anatomic concerns also include branches from the femoral innervated muscles for whom trajectories are not clear, relative variability in innervation patterns to the anterior capsule in the presence of an accessory obturator nerve, accessory femoral nerve or superior gluteal nerve branches, the possibility of articular branches that start more inferiorly along the course of the femoral nerve and run with vessels, and a scenario where one common trunk supplies the joint, vessels, and muscles.
The wider innervation area of the articular branches could lead to false negatives if the injection volume was too small, or false positives if a larger volume was used, or multiple branches were injected simultaneously.
The future research of this application should validate safe and effective parameters for diagnostic blocks and treatment in cadavers for all articular branches as well as any clinical information relevant to injection selection and/or outcomes, estimate the role of multipolar thermal radiofrequency in denervation of the hip joint, (65,66,75-77) and delineate any associated economic benefits of hip joint thermal radiofrequency.