Umów wizytę

Tomasz Poboży

Kategoria: Hip (EN)

English-language patient articles about hip and buttock pain, hip disorders, diagnosis and treatment.

  • Hip Arthroscopy After 40 — What Does the New Review Show?

    A new systematic review suggests that carefully selected patients aged 40 or older can have durable improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). This does not mean that age no longer matters, or that surgery is better than non-operative treatment for every patient.

    What was studied?

    The review, published online on 14 September 2026, included nine studies with 451 patients and 467 hips. Follow-up ranged from 60 to 167 months — five years to almost fourteen years. The studies evaluated people aged at least 40 who underwent hip arthroscopy for FAIS.

    What did the review find?

    Across the included studies, pain and functional outcome scores generally improved and the gains were often maintained at longer follow-up. When comparisons with younger groups were available, age-related differences were not consistent. Some patients nevertheless later underwent total hip arthroplasty; reported conversion rates ranged from 2.9% to 13.2%.

    What should a patient discuss with an orthopaedic surgeon?

    Being over 40 should not, by itself, determine whether hip arthroscopy is appropriate. Symptoms, clinical examination, the condition of the cartilage and labrum, radiographic findings and whether the presentation is actually consistent with FAIS all matter.

    The review did not provide a randomised comparison of arthroscopy with a well-delivered rehabilitation programme. It therefore cannot establish that surgery is the best first option. Rather, it shows that improvement after arthroscopy can be durable in selected patients over 40, while the risk of later joint replacement is not zero.

    Important limitations

    The review combined studies of differing quality and was classified as Level IV evidence. Patient groups, procedures and outcome reporting varied, so the numerical ranges are not a prediction for an individual patient. This summary was prepared from the public abstract and bibliographic record; the full text was not used. The PubMed record showed no correction or retraction when checked on 15 September 2026.

    Source

    Lehman AC, Lee S, Berzolla E, Lezak BA, Youm T. Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Patients Aged ≥40 Years Produces Durable Functional Improvement With Moderate Survivorship Compared With Younger Cohorts: A Systematic Review. Arthroscopy. Published online 14 September 2026. PubMed PMID 42734296.

    More Orthopaedic Updates · Polish version

    This material is for general information and does not replace individual assessment for treatment.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Adult Hip Dysplasia — Symptoms, Diagnosis and Treatment

    Adult hip dysplasia means that the acetabulum provides insufficient coverage of the femoral head. It can cause groin pain, a sense of overload or instability and, over time, contribute to labral and cartilage damage. The diagnosis should not be made from a single X-ray angle alone: symptoms, clinical examination and appropriately performed imaging all matter.

    Polish version: Dysplazja biodra u dorosłych — objawy, diagnostyka i leczenie

    What is adult hip dysplasia?

    In a normally shaped hip, the acetabulum covers enough of the femoral head to distribute load across an adequate joint surface. In dysplasia, that coverage is reduced. This can increase stress at the acetabular rim, labrum and articular cartilage and may contribute to hip microinstability.

    Not every radiographic feature of undercoverage represents a symptomatic condition that requires treatment. Similar morphology can also be found in people without hip pain. Imaging therefore needs to be interpreted together with symptoms and the clinical examination.

    Which symptoms can suggest hip dysplasia?

    • groin pain, especially with prolonged walking, running or deep hip flexion,
    • a sense of fatigue or overload around the hip after activity,
    • pain on the lateral side of the hip or, less commonly, in the buttock,
    • a feeling of instability or that the hip is giving way,
    • catching, clicking or sharp pain during twisting movements, particularly when labral damage is also present.

    These symptoms are not specific to dysplasia. Similar pain can arise from femoroacetabular impingement, the labrum, tendons, the lumbar spine or other soft tissues around the hip. The source of pain therefore needs to be established rather than assumed from one imaging measurement.

    How does an orthopaedic surgeon diagnose hip dysplasia?

    Assessment starts with the history and clinical examination. The location of pain, range of motion, signs of instability or impingement, muscle strength and other potential sources of symptoms are considered. Properly performed radiographs of the pelvis and hip are the basic imaging tests.

    What does the Wiberg angle mean?

    One commonly used measurement is the lateral centre-edge angle, also known as the Wiberg angle or LCEA. An international 2026 consensus considered an LCEA below 20° typical of dysplasia, while values of 20–25° may raise suspicion of possible instability.

    This is not a rule in which “below 25° means surgery”. Pelvic positioning and radiographic technique can affect the measurement, and acetabular shape is three-dimensional. Other measurements, acetabular version, proximal femoral morphology and the condition of the cartilage may therefore also need to be considered.

    When are MRI or CT useful?

    MRI may be needed to assess the labrum, cartilage and other soft tissues, particularly when surgery is being considered or when symptoms are not adequately explained by radiographs. CT can be useful for a more detailed three-dimensional assessment of acetabular and femoral anatomy and orientation.

    Ultrasound is not the primary test for assessing femoral-head coverage in an adult. It can, however, be useful when tendons or other soft tissues around the hip need evaluation or when a diagnostic injection is to be performed accurately.

    Does hip dysplasia always require surgery?

    No. Management depends on the severity of symptoms, the degree of undercoverage, joint stability, the biological condition of the joint and the presence of osteoarthritis. For some patients, non-operative treatment is a reasonable first step.

    • modifying activities that clearly provoke pain without eliminating movement altogether,
    • exercises aimed at improving hip and trunk strength and control,
    • gradual adjustment of sporting and occupational loads,
    • pain-relieving or anti-inflammatory medication when appropriate and when there are no contraindications.

    In a review that included several non-arthritic causes of hip-related pain, including dysplasia, roughly half of patients achieved a satisfactory response to non-operative treatment. That figure should not be interpreted as the response rate for every form of dysplasia, because the included studies combined several different diagnoses.

    What is periacetabular osteotomy?

    In appropriately selected patients with symptomatic dysplasia and preserved cartilage, periacetabular osteotomy (PAO) may be considered. Controlled bone cuts allow the acetabulum to be mobilised and reoriented so that it provides better coverage of the femoral head. The aim is to improve joint mechanics while preserving the native hip.

    Long-term reviews report improvement in patient-reported outcomes after PAO, but most available evidence comes from observational studies of carefully selected patients. The presence of dysplasia on an X-ray is therefore not, by itself, an indication for osteotomy.

    What about hip arthroscopy?

    Hip arthroscopy can address labral damage or coexisting impingement, but it does not increase bony coverage of the femoral head. In true instability caused by dysplasia, repairing the labrum alone does not correct the underlying biomechanical problem. Borderline cases in particular require assessment of the hip’s overall geometry rather than one isolated measurement.

    When is joint replacement considered instead of joint-preserving surgery?

    If dysplasia is accompanied by advanced osteoarthritis and substantial cartilage damage, the potential benefit of a joint-preserving procedure may be limited. Depending on symptoms and function, total hip replacement may then be considered. More about this pathway: Hip Replacement.

    When does hip pain need more urgent assessment?

    • after an injury, you cannot bear weight or there is an obvious deformity,
    • the joint is very painful and hot, particularly with fever or systemic illness,
    • pain is rapidly increasing at rest or at night, especially with unexplained general symptoms,
    • there is sudden weakness, sensory loss or another new neurological symptom in the limb.

    Key point: treat the symptomatic hip, not an X-ray angle

    Hip dysplasia is a structural problem, but treatment decisions come from the combination of symptoms, examination, properly obtained radiographs and, when needed, MRI or CT. A single angle can support the diagnosis but cannot replace a complete assessment. Non-operative care is sufficient for some people, while selected patients with persistent symptoms and limited degenerative change may be candidates for surgery that preserves the native joint.

    References

    1. Leopold VJ, Rakhra K, Spiker AM, et al. Which Imaging Modalities, Parameters, and Diagnostic Thresholds Best Define Hip Instability? Consensus Statements From a Scoping Review and an International Multidisciplinary Delphi Study. Clinical Orthopaedics and Related Research. 2026;484(5):899–915. DOI: 10.1097/CORR.0000000000003905.
    2. MacLeod JS, Zhu JR, Lee MS, et al. Periacetabular Osteotomy Leads to Improved Long-term Patient-reported Outcomes: A Systematic Review. Orthopedics. 2025;48(3):e113–e123. DOI: 10.3928/01477447-20250409-03.
    3. O’Brien MJM, Semciw AI, Mechlenburg I, et al. Pain, function and quality of life are impaired in adults undergoing periacetabular osteotomy for hip dysplasia: a systematic review and meta-analysis. Hip International. 2024;34(1):96–114. DOI: 10.1177/11207000231179610.
    4. Probst DT, Sookochoff MF, Harris-Hayes M, et al. What is the Rate of Response to Nonoperative Treatment for Hip-Related Pain? A Systematic Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2023;53(5):286–306. DOI: 10.2519/jospt.2023.11666.

    ← Hip Conditions

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Sport After Hip or Knee Replacement — What Can You Do and When?

    Polish version

    After an uncomplicated hip or knee replacement, most patients can gradually return to low-impact activity such as walking, cycling and swimming once the wound has fully healed. There is no single date when every sport becomes safe. Running, jumping, contact sports and activities involving sudden changes of direction require much more cautious assessment because higher loads also increase the consequences of a fall or injury.

    The important question is not only how many weeks have passed since surgery. Healing, muscle strength, balance, range of motion, gait stability, the joint’s response to exercise, the type of replacement and the patient’s previous experience in the sport all matter.

    Do you have to give up sport after joint replacement?

    No. The purpose of joint replacement is to improve function and quality of life, and regular physical activity is an important part of maintaining overall fitness. Current evidence shows that a large proportion of patients return to recreational activity after surgery, particularly low-impact sports.

    In a meta-analysis of knee arthroplasty including 45 studies and 14,498 knees, approximately 85% of patients returned to physical activity or sport, with a median return time of 4.1 months. The authors emphasised, however, that certainty of evidence for the analysed outcomes was very low. These figures describe a population; they are not an individual clearance date for sport.

    A similar pattern is seen after total hip arthroplasty. In a review of 57 studies, the pooled return-to-sport rate was about 85%, with a mean time of approximately 16 weeks. Return to low-intensity activity was much more common than return to high-impact sport.

    Which activities are usually easiest to resume?

    Return is most predictable for activities with lower joint loading and a lower risk of falling. These commonly include:

    • walking and brisk walking;
    • stationary cycling, followed later by outdoor cycling in safe conditions;
    • swimming once the wound is fully healed;
    • water-based exercise;
    • golf;
    • controlled strength training appropriate to the stage of recovery.

    This does not mean that every activity can be restarted immediately. Entering a swimming pool before the wound has fully healed can create wound problems, while cycling in traffic requires substantially more balance and reaction speed than exercising on a stationary bike.

    What about running, tennis, skiing and contact sports?

    The greater the impact, jumping, cutting and risk of falling, the less useful a simple rule such as “you can return after this many weeks” becomes. High-intensity sports are resumed much less often after joint replacement than low-impact activities.

    This is particularly relevant to regular running, contact sports, games with frequent changes of direction, intensive tennis, combat sports and activities with a substantial risk of falling. The issues are not limited to implant wear: dislocation, periprosthetic fracture and an injury requiring another operation also need to be considered.

    This does not amount to an automatic ban on every demanding sport. A patient who has skied recreationally for years and regains full control of the limb after surgery is different from someone planning to start a high-fall-risk sport only after joint replacement. The decision should be individual.

    Is return to sport the same after hip and knee replacement?

    Not entirely. After hip replacement, early limitations may relate to tissue healing, muscle weakness, pelvic control and fall risk. After knee replacement, swelling, limited flexion, stiffness and quadriceps weakness often remain relevant for longer.

    After unicompartmental knee arthroplasty, some patients return to activity more readily than after total knee arthroplasty. In the recent meta-analysis, the probability of returning to physical activity or sport was higher after unicompartmental replacement, but the certainty of this finding was rated very low. It should not be treated as a guarantee of faster return for an individual patient.

    How does an orthopaedic surgeon assess readiness to increase the load?

    Before moving to more demanding activity, function is more useful than the calendar. Favourable conditions for increasing load generally include:

    • a fully healed wound;
    • no increasing pain at rest;
    • stable walking without a pronounced limp;
    • enough range of motion for the planned activity;
    • adequate strength in the operated limb;
    • good balance and movement control;
    • no marked increase in swelling after the current level of exercise.

    If a higher load produces a clear increase in pain or swelling that does not return to the previous level, progression may have been too rapid.

    How should return to sport be progressed in practice?

    A staged return is the safest approach. First rebuild basic function: walking, range of motion, strength and balance. Then increase exercise duration and intensity. More complex sport-specific movements should be introduced later.

    Avoid increasing duration, intensity and technical difficulty all at once. For sports requiring rapid reactions, it is useful to regain movement control first in a safer environment. Patients returning to more demanding disciplines may benefit from physiotherapy assessment and an agreed plan with the operating surgeon.

    When should activity be stopped and medically reviewed?

    New severe pain after a fall, sudden inability to bear weight, obvious deformity, a sensation that the joint has moved out of position or a sudden loss of function requires urgent assessment. Fever, increasing redness, warmth or wound drainage also warrants prompt review.

    New calf pain and swelling may require assessment for deep-vein thrombosis. Shortness of breath, chest pain, coughing up blood or fainting requires immediate medical attention.

    The key principle

    Returning to activity after joint replacement is desirable, but the type of sport should match the stage of healing, current function and the risk of injury. Average time points from studies are useful for planning recovery, but they do not replace assessment of the individual patient.

    In a publication by Tomasz Poboży and Maciej Kielar on selection of hip prostheses, everyday activity and the patient’s future plans were highlighted as relevant elements in treatment planning. That paper does not define the timing of return to sport, but it illustrates why activity level should already be considered when planning surgery and selecting an implant strategy.

    Back to: Before and After Orthopaedic Surgery

    References

    1. Poboży T, Kielar M. The use of various types of hip prostheses depending on the patient’s age and level of everyday activity. Medical Studies/Studia Medyczne. 2015;31(3):213–222. DOI: 10.5114/ms.2015.54763.
    2. Braz R, Gomes E, Valente C, et al. High rate of return to low-impact physical activity or sports after total and unicompartmental knee arthroplasty: A systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2026;34(9):3415–3428. DOI: 10.1002/ksa.70267. PMID: 41527885.
    3. Pasqualini I, Emara AK, Rullan PJ, et al. Return to Sports and Return to Work After Total Hip Arthroplasty: A Systematic Review and Meta-analysis. JBJS Rev. 2023;11(8). DOI: 10.2106/JBJS.RVW.22.00249. PMID: 37549241.
    4. Pasqualini I, Emara AK, Rullan PJ, et al. Return to Sports and Return to Work After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev. 2023;11(7). PMID: 37499045.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • When Can You Stop Using Crutches After Hip or Knee Replacement?

    Polish version

    After an uncomplicated hip or knee replacement, the decision to stop using crutches should not be based on the number of days since surgery alone. What matters most is whether you can walk safely, without a clear limp or giving way of the operated leg, with adequate balance and muscle control. Many patients begin weight-bearing very early, often as tolerated, but progression from two crutches to one and then to unaided walking should reflect the operation performed and the individual postoperative instructions.

    Can you put weight on the operated leg immediately after joint replacement?

    After a typical, stable primary hip or knee replacement, contemporary recovery programmes favour early mobilisation and getting out of bed as soon as practical. ERAS recommendations for hip and knee replacement support early mobilisation, while current physical therapy guidance after total knee arthroplasty emphasises early recovery of walking, balance and efficient movement patterns.

    For uncemented total hip arthroplasty, a meta-analysis of 17 studies found no evidence that immediate unrestricted weight-bearing increased excessive stem micromotion, failure of bone integration or revision risk compared with partial weight-bearing. This does not mean, however, that every patient after every operation may load the leg without restriction.

    When may the instructions be different?

    Temporary weight-bearing restrictions may be needed after revision surgery, an intraoperative or periprosthetic fracture, bone grafting, an osteotomy, repair of additional soft-tissue structures, or whenever the reconstruction needs protection while healing. For that reason, the operating surgeon’s discharge instructions take priority over any general rehabilitation timetable.

    How do patients usually progress from two crutches to one?

    A common sequence is a walking frame or two crutches, followed by one crutch or a walking stick, and finally unaided walking. There is no requirement for every patient to move through each stage at the same time.

    • Two crutches or a walking frame are useful while gait remains uncertain, the leg is weak, pain limits loading or there is a meaningful risk of losing balance.
    • One crutch or a walking stick may be the next step when the patient can safely transfer weight onto the operated leg without clearly increasing the limp.
    • Unaided walking is best introduced when removing support does not worsen gait quality.

    When one crutch or a walking stick is used after hip or knee surgery, it is usually held on the side opposite the operated leg. This reduces the demand on the muscles that stabilise the pelvis and can help maintain a better gait pattern.

    How can you tell when it is reasonable to try walking without crutches?

    Functional criteria are more useful than a fixed date. Reducing support is reasonable when:

    • you can walk on a level surface without a pronounced limp;
    • the operated leg does not feel as though it is giving way or suddenly buckling;
    • your balance allows you to turn, stop and rise from a chair safely;
    • pain and swelling remain controlled after increasing your step count;
    • after knee replacement, quadriceps control is sufficient to keep the knee stable during weight-bearing;
    • after hip replacement, pelvic control is sufficient and walking without a crutch does not produce marked trunk leaning;
    • the orthopaedic surgeon has not prescribed a temporary weight-bearing restriction.

    Is it better to keep one crutch for longer or stop using it as soon as possible?

    If walking without the crutch produces a clear limp, shorter steps, trunk leaning or reluctance to load the operated leg, it is usually more sensible to continue using support for a while and work on strength and gait quality. The goal is not to “get rid of the crutches” as quickly as possible, but to regain safe and reasonably symmetrical walking.

    Conversely, there is no benefit in continuing with two crutches purely out of habit when there are no loading restrictions, walking is stable and the patient can reduce support without deteriorating gait. Current guidance after knee replacement emphasises functional training, balance and gait retraining rather than the passage of time alone.

    What if pain or swelling increases after reducing support?

    A temporary increase in muscle fatigue after greater activity can occur. If changing the way you walk clearly increases pain, swelling or limping, reduce the load and briefly return to the previous level of support. Symptoms that worsen from day to day should prompt assessment of the cause rather than continued attempts to push through them.

    When should you seek urgent assessment rather than wait for a routine review?

    Urgent assessment is particularly important if there is:

    • sudden shortness of breath, chest pain or fainting;
    • markedly increasing one-sided calf swelling with pain or tenderness;
    • fever accompanied by increasing redness, warmth or wound drainage;
    • sudden severe pain after a fall or twisting injury;
    • a new deformity, obvious limb shortening or inability to bear weight after previously making progress;
    • a sudden substantial loss of function instead of gradual improvement.

    Stopping crutches is only one stage of recovery

    Independent walking does not mean rehabilitation is complete. Strength, balance and tolerance of longer periods of activity continue to improve. Readiness for driving, returning to work and returning to sport should be assessed separately rather than inferred simply from the ability to walk without a crutch.

    Back to: Before and After Orthopaedic Surgery

    References

    1. Bove AM, Carroll LA, Cone S, et al. Clinical practice guideline for physical therapist management of total knee arthroplasty: revision 2026. Physical Therapy. 2026;106(7). DOI: 10.1093/ptj/pzag058.
    2. Huang L, Han W, Qi W, et al. Early unrestricted vs. partial weight bearing after uncemented total hip arthroplasty: a systematic review and meta-analysis. Front Surg. 2023;10:1225649. DOI: 10.3389/fsurg.2023.1225649.
    3. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Acta Orthop. 2020;91(1):3–19. DOI: 10.1080/17453674.2019.1683790.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Deep Gluteal Syndrome — When Buttock Pain Mimics Sciatica

    Polish version · Explore Hip Conditions

    Deep gluteal syndrome can cause buttock pain that radiates into the back of the thigh, particularly when symptoms worsen with sitting. It refers to irritation or entrapment of the sciatic nerve outside the spine, within the deep tissues of the buttock. Not every case is “piriformis syndrome”, however, and diagnosis requires excluding more common causes arising from the lumbar spine, hip and pelvis.

    What is deep gluteal syndrome?

    The sciatic nerve leaves the pelvis and enters the lower limb through a space deep beneath the gluteal muscles. In this region it may be irritated by fibrous bands, abnormal muscle tension or anatomy, scar tissue after injury or surgery, a space-occupying lesion, or conflict between bony and soft-tissue structures.

    “Piriformis syndrome” describes only one possible mechanism. The broader term deep gluteal syndrome does not assume in advance which structure is responsible for the compression. This helps prevent the diagnostic process from being reduced to one muscle and one clinical test.

    What symptoms are typical?

    • deep, usually one-sided buttock pain;
    • radiation into the back of the thigh, sometimes farther down the leg;
    • worsening with prolonged sitting, especially on a hard surface;
    • pain during certain hip movements, running or walking uphill;
    • deep tenderness in the buttock;
    • sometimes tingling or altered sensation along the course of the sciatic nerve.

    In a systematic review of 14 studies involving 853 patients, recurring features included posterior hip pain, sciatica-like symptoms and difficulty sitting for about 30 minutes. None of these features, on its own, confirms the diagnosis.

    Could the symptoms be coming from the spine?

    The presentation can resemble lumbar radicular pain, so an important first step is to determine whether the sciatic nerve or its roots are being irritated by a disc lesion, spinal stenosis or another lumbar condition. Spinal causes are more often accompanied by low-back pain, radiation aggravated by coughing or sneezing, changes in reflexes, or weakness in specific muscle groups. These features are helpful, but none is an absolute rule.

    A similar pattern can also arise from the hip joint itself, the sacroiliac joint, the proximal hamstring origin, ischiofemoral impingement or other pelvic disorders. The overall pattern of symptoms and examination findings therefore matters more than any single test.

    More: hip conditions and causes of hip-region pain →

    How is deep gluteal syndrome diagnosed?

    History and clinical examination

    The examination considers where the pain is felt, its relationship to sitting and movement, hip range of motion, strength, sensation and reflexes. Provocative manoeuvres that tension or activate the deep hip rotators may be used, while the lumbar spine and other possible sources of pain are assessed as well. A positive provocative test can increase suspicion, but it should not determine the diagnosis by itself.

    X-ray, MRI and ultrasound

    X-rays can help assess the bones of the hip and pelvis. Lumbar MRI may be needed to look for disc disease or stenosis, while pelvic MRI can identify a lesion compressing the nerve, oedema, scar tissue or conflict within the deep gluteal space. A normal scan does not always exclude functional or intermittent nerve irritation.

    Ultrasound can show accessible portions of the sciatic nerve, selected muscles and fluid collections, and it allows side-to-side comparison. Its particular advantages are dynamic assessment and accurate guidance for a diagnostic injection. Depth of the structures and individual body habitus can limit the examination, however, so a normal ultrasound does not end the diagnostic process.

    EMG and diagnostic injection

    Nerve-conduction studies and electromyography can help distinguish a local problem from nerve-root injury or a more advanced neuropathy, but a normal result does not exclude local, position-dependent irritation. Temporary pain relief after a targeted image-guided injection can support a diagnostic hypothesis, but it does not replace a complete clinical assessment.

    How is deep gluteal syndrome treated?

    Treatment usually begins without surgery: reducing positions that reliably provoke symptoms, gradually adjusting load, physiotherapy directed at the hip, pelvis and spine, and appropriately selected neural-gliding exercises. Analgesic or anti-inflammatory medication should be matched to the patient’s health, risks and contraindications.

    An ultrasound-guided or otherwise image-guided injection may be considered when there is a specific anatomical hypothesis and the procedure is intended to answer a defined diagnostic or therapeutic question. It should not be performed blindly or repeated without assessing the response and reconsidering the diagnosis.

    More: injection treatments in orthopaedics →

    Surgery is rarely required. It may be considered when there is well-documented compression from a space-occupying lesion or persistent symptoms despite appropriately conducted non-operative treatment. A review of 13 studies involving 508 patients rated the overall quality of the evidence as low and did not show one conservative treatment to be clearly superior to the others.

    When is urgent assessment needed?

    Urgent medical assessment is needed for rapidly progressive leg weakness or foot drop, numbness in the saddle area, new bladder or bowel dysfunction, severe pain after injury with inability to bear weight, fever with worsening pain, or sudden signs of impaired circulation in the leg. These symptoms should not be attributed to the piriformis muscle without further assessment.

    Key point for an orthopaedic surgeon

    Deep gluteal syndrome is a possible, but not the most common, cause of buttock pain and sciatica-like symptoms. The diagnosis should emerge from agreement between the history, examination and appropriately selected investigations. Treatment usually begins conservatively, and a normal result from a single imaging study is not enough either to confirm or exclude the condition.

    References

    1. Kizaki K, Uchida S, Shanmugaraj A, et al. Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2020;28:3354–3364. DOI: 10.1007/s00167-020-05966-x. PubMed.
    2. Hopayian K, Mirzaei M, Shamsi MB, Arab-Zozani M. A systematic review of conservative and surgical treatments for deep gluteal syndrome. J Bodyw Mov Ther. 2023;36:244–250. DOI: 10.1016/j.jbmt.2022.12.003. PubMed.
    3. Park JW, Lee YK, Lee YJ, et al. Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain. Bone Joint J. 2020;102-B:556–567. DOI: 10.1302/0301-620X.102B5.BJJ-2019-1212.R1. PubMed.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.