Occasionally pain develops on the buttock quite spontaneously or perhaps after having had a hip replacement performed via a posterior approach. This pain is caused by pressure on the sciatic nerve where it traverses the muscles and tendons of the short external rotators. When scaring is dense, chronic pain results and is often worse while sitting or driving.
If you have buttock pain and trochanteric pain which persist after you have had an otherwise successful total hip replacement, it is likely that the pain will not settle with physiotherapy or exercises alone. If the pain is due to compression of the sciatic nerve in scar tissue or your hip tendons are still separated from the trochanter you will be helped by a sciatic neurolysis and possibly a hip tendon reconstruction.
No specific preparation is required for this surgery and it is undertaken when it is clear the pain is unlikely to settle spontaneously so can be done at short notice.
The sciatic nerve can be approached through your original incision so it is generally not necessary to make another new incision. The nerve is dissected from scar when it emerges from the pelvis to the upper third of the back of the thigh. No structures are cut in this operation so your operation pain settles quite quickly and you may be able to go home on the day.
You may commence full weight-bearing on the day of surgery and as long as you keep the wound covered and dry it should be healed in about 10 days. It is beneficial to move immediately to ensure the nerve remains mobile and that new adhesions do not form. At about that time you will return for your first post-operative visit.
There are all the risks of any surgery such as clots and infection but with this operation these problems are rare and to date we have not seen either of these problems. There is always the possibility of injury to the sciatic nerve while it is being dissected from dense scar but there has been no nerve injury to date.
The only alternative treatment to this problem is simply to put up with it and treat the pain symptomatically with pain medication. As this is a mechanical problem of the nerve, it is best to relieve the pressure to deal with the problem definitively.