Case Presentation
Volume 4 Issue 6
Tolgay Satana* and Ali Ihsan Isik
November 26, 2024
DOI : 10.56831/PSSRP-04-151
Abstract
This report mention that offset inbalances of hip arthroplasty could be leading deep gluteal syndrome (DGS) related with neglected piriformis tension and further fibrosis. It could be listed as a late complication after hip replacement surgery. Posterior approach of hip arthroplasty compromised pirfiormis integrity which is performed tenotomy and than repaired will be leading comorbidity of this situation.
Material And Methods: A 65-year-old male, who underwent bilateral Total hip arthroplasty in 2004, applied to the our outpatient clinic with progressive hip and leg pain during sitting which is started to complain since 2017.
Prifomis and facet injections and radio-frequency blocks were applied to the patient at least twice. The complaints that increased but could not sitting more than 15 minutes than deceased office working forced to retirement.
The patient has not benefited from conservative treatments like injection, block therapy, physical therapy fro 6 years. EMG findings of the patient with nonspecific findings on MRI support obturator impingement syndrome.
Surgical Technique: Arthroscopic piriformis release was performed via posterior proximal portal and accessory proximal portal lateral decubitus position or prone position. The piriformis tendon is separated from insertion which is near the gluteus medius neighborhood with a total tenotomy. Neurolysis performed from obturator foramina output to external rotator site.
Result: The patient was mobilized painlessly two hours after the operation. All hip movements was actively free. During the sitting, the pain completely disappeared. The first week he was allowed to work in the office. The exercise was carried out without weight for three weeks, and then we started weight lifting and active resistive exercises. After the tenth day of stretching and ROM exercises, strengthening exercises were made. After the first three weeks of exercise, the pain gradually decreased. In the third and sixth months, the complaints were observed to completely diminished than the patient clinical follow-up was terminated.
Conclusion: Arthroscopic tenotomy and decompression therapy in Piriformis syndrome are safe and effective method. Arthroscopic piriformis release results consistently showed improvement pain and function and lowest incidence of complications. Priformis should be well evaluated in long-term ipsilateral sciatalgia in patients undergoing hip prosthesis, and arthroscopic tenotomy should be considered a safe option in patients who do not respond to conservative treatment related DGS.
References