Innervation of the hip joint

Question 1

What three ligaments stabilise the hip joint?

Answer 1

• Iliofemoral: Stabilises superoanteriorly
• Pubofemoral: Inferior and anterior
• Ischiofemoral: Posterior

Question 2

Nerve supply to the anterior hip capsule

Answer 2

• Femoral Nerve
• Obturator Nerve
• Accessory Obturator Nerve

Question 3

Nerve supply to the posterior hip capsule

Answer 3

• Sciatic Nerve
• Nerve to quadratus femoris
• Superior and inferior gluteal nerve

Question 4

Types of regional anaesthesia for hip surgery

Answer 4

• Femoral Nerve Block
• Fascia Iliaca Block- Femoral nerve, obturator nerve +/- Lateral cutaneous nerve
• Pericapsular nerve group (PENG) Block- Articular branches of femoral, obturator and accessory obturator
• Iliopsoas Plane Block- Like PENG but not as effective
• Quadratus Lumborum- ? usefulness
• Lumbar erector spinae plane block - poor spread of LA
• Posterior pericapsular deep gluteal block - Covers posterior capsule

Question 5

Methods of producing hip joint denervation

Answer 5

• Radiofrequency ablation
• Chemical neurolysis (Alcohol 100% or Phenol 6%) generally use PENG approach +/- post hip capsule
• Cryoablation

Question 6

Indications for hip joint denervation

Answer 6

• Palliative analgesia in cancer patients with hip joint metastases
• Inoperable hip fracture