This particular patient has had a total hip arthroplasty and the pathology in piriformis syndrome is primarily compression of the sciatic nerve by the piriformis muscle. When you have a hip replacement, they will often disconnect the piriformis muscle, and then when they’re done putting the new hip in they will try and reconstruct that muscle to the femur bone and oftentimes that can cause pressure on the sciatic nerve.
The alternative option is to just not worry about the piriformis muscle. It’s not really an important muscle, you can do well without it, and so they’ll just not worry about reconstructing it and that can cause the muscle to settle down and scar down and wrap around the sciatic nerve itself, which can be a problem too. Not everybody who has a hip replacement gets these problems but it’s certainly something to consider after a hip replacement and somebody comes back with sciatica pain.
