AB270. SOH26AB_0086. Hydrodissection of piriformis muscle in gluteal pain following total hip replacement: a case report

Background: Total hip arthroplasty (THA) is one of the most successful surgical interventions, which offers substantial relief from osteoarthritic pain and substantial improvement in patient function and quality of life. This, however, can sometimes cause a minority of patients to report a new onset of pain in the gluteal or lateral hip region post-operatively. Gluteal pain can affect up to 30% of patients. Mechanism of pain and aligned treatment is the priority. Hydrodissection is a minimally invasive technique involving the injection of fluid to separate fascial layers and release entrapped nerves and tendons.

Case Description: We present the case of a 69-year-old male with refractory right gluteal pain post right total hip replacement. Despite extensive conservative therapies, including medications and physical therapy, he continued to experience right gluteal pain. The patient underwent ultrasound-guided piriformis hydrodissection as a targeted approach to address perineural inflammation and nerve entrapment. A low concentration (5%) dextrose solution (10 mL) was used to free the muscle from surrounding scar tissue and muscle adhesions. The procedure was performed in a theatre setting. Following the hydrodissection procedure, the patient experienced improvement in pain with sustained improvement at 2 months of follow-up. Functional outcomes, including range of motion and daily activities improved substantially. No complications were reported.

Conclusions: This case supports the potential role of piriformis hydrodissection as a safe, minimally invasive treatment option for gluteal pain following hip replacement. Hydrodissection offers an alternative to more invasive interventions and warrants further investigation in the management of gluteal pain following hip replacement.

Keywords: Hip replacement; gluteal pain; hydrodissection; ultrasound; case report