Table 1 The literature review summary

Sarwar U, 2017 [11]: Postoperative gluteal compartment syndrome following microsurgical free-flap hand reconstruction

51yo F

PMH: diabetes, obesity, hypertension, GERD

Microsurgical free-flap for hand - 8 h

General anesthesia

Supine

Contralateral (left buttocks)

No

Unremitting pain with radiation down the posterior thigh and leg. Restless and writhing in the bed unable to get comfortable. Localized tenderness. Passive movement, extension, flexion, abduction, and adduction, worsened the pain. Active extension and abduction of the hip were weak. Clinical diagnosis

Fasciotomy. A lumbar epidural provided much relief of sciatica type pain. It was removed after 2 day

3 h post-op.

Sciatica-type pain persisted along the right leg/foot after surgery, but the patient made a complete recovery

Krysa J, 2002 [14]: Gluteal compartment syndrome following PCL repair

31yo M

PCL repair - 1 h

n/a

Modified lithotomy

Contralateral

No

Increasing pain in his contralateral buttocks despite stronger analgesia. Exacerbated by passive muscle stretching. The gluteal region was swollen, tense, and tender. Neuro/vascular normal. Intracomparemtneal pressure 58 mmHg while diastolic pressure at 40

fasciotomy

24 h post-op

Uneventful recovery with no neurological sequelae

Osteen, 2012 [15]: Bilateral gluteal compartment syndrome following right total knee revision

52yo M PMH: obesity, HTN, HLD

Revision TKA - 3 h 20 min

Combined spinal-epidural

Supine

Bilateral

No

Agitation, severe distress from bilateral buttock pain. Left-sided buttock numbness. R/L gluteal region tense, hard, and erythematous. CPK/LFTs elevated. No passive movement toleration. Clinical diagnosis

Fasciotomy. Discontinued simvastatin POD 4. Vancomycin + Zosyn POD2

POD 2

No signs of necrosis during fasciotomy; discharged 5 days after fasciotomy with no neuro deficits or residual pain in the gluteal region

Pacheco; 2001 [12], Gluteal compartment syndrome after TKA with epidural postoperative analgesia

Case 1

47yo M PMH: obesity, HTN

BMI: 41.66

TKA - 2 h and 15 min

Epidural

Supine

Bilateral

No

Back pain and difficulty in finding a comfortable position. Pyrexia (38.4 °C). swollen, tender, and painful buttocks. Not relieved by non-opioid analgesia. Compartment pressure results were at the borderline upper limit, clinically diagnosed

Fasciotomies

44 h post-op

Good recovery Discharged 9 days after admission; one year later, complained of gluteal discomfort on sitting

Case 2

71yo M weight: 81 kg BMI: 26.44

TKA (right) - 2 h 25 min

Epidural

Supine

ipsilateral

No

Right foot drop was noticed about 4.5 h after the epidural anesthesia had been discontinued. Examination showed loss of sensation in the distribution of the right sciatic nerve with no active movement of the ankle (foot drop). Swelling and tenderness of the right buttock and skin in the right gluteal area were indurated and discolored. The serum levels of urea and creatinine were elevated. Clinical diagnosis

Fasciotomy, sciatic nerve neurolysis. The necrotic muscle was excised from beneath the fascia lata and from vastus lateralis and rectus femoris

47.5 h postop

No change in motor or sensory function distal to knee; nerve conduction studies showed abnormalities in the sciatic nerve. Inability to obtain sensory or motor responses in the common peroneal and posterior tibial nerves.

Rudolph, 2011, [16], Bilateral gluteal compartment syndrome and severe rhabdomyolysis after lumbar spine surgery

65yo M height 178 cm, weight 124 kg, BMI 39.1

PHM: Obesity, DM2, HTN

bilateral decompression L3-L5–4 h

endotracheal anesthesia

Knee-chest position cushioned bar supporting the buttocks and soft side supports against the femoral trochanters

Bilateral

Yes

Pain in the buttocks had increased. Oliguria with darkened urine. Severe stiffness, tenderness, and painful swelling of gluteal muscles on both sides. Sciatic nerve palsy was absent. Creatine phosphokinase (CPK) level at 91,000 IU/l (normal 30–240 IU/l). Clinical diagnosis.

Fasciotomy,

Hemodialysis despite the aggressive fluid replacement

7 h post-op

The patient required five courses of hemodialysis. Continued to have pain and was discharged dependent on a wheelchair due to moderate gluteal pain and bilateral insufficiency of gluteal muscles

Polacek, 2009 [6]: Gluteal compartment syndrome after lumbar laminectomy

65yo M BMI 38, PMH: obesity, CKD III, DM2, HTN

Lumbar laminectomy

Elbow - 4 h

Inhalation anesthesia

The elbow-knee position with side and buttock support

Left gluteal compartment

Yes

Increasing pain in both gluteal regions, especially on the left side. The pain did not respond to analgesic treatment. Both gluteal regions were abnormally firm and painful. Both feet had decreased capillary filling and felt cold. Palpable pulsation was found in the arteria dorsalis pedis (ADP) and arteria tibialis posterior (ATP), verified by Doppler ultrasound. No abnormal neurological findings were noted. Clinical diagnosis

Fasciotomy; Necrotic parts of gluteus muscles were removed

27 h post-op

Discharged 12 days after the initial operation (doesn’t say how the patient was doing or if walking)

Somayaji, 2005 [13]: Bilateral gluteal compartment syndrome after THA under epidural anesthesia

39 yo M Congenital Hip Dysplasia

THA - 2 h

Epidural & general anesthesia

Left lateral position

Bilateral

No

Severe pain and discomfort in both buttocks 8/10. Continued to worsen and developed blisters in both buttocks during the night (second-night postop). Bilateral sciatic nerve palsy. Pedal pulses in both limbs. Sensation and power in both lower limbs failed to return to normal 24 h after cessation of epidural analgesia. Elevated creatinine kinase (31,000). Clinical diagnosis.

Fasciotomy with debridement of necrotic tissue

50 h post-op

Full-thickness skin grafts applied bilaterally, walks with a walking stick with minimal abduction and weak external rotation (the article doesn’t state if weakness in both sides or one side)

Kumar V, 2007 [10]: Gluteal compartment syndrome following joint arthroplasty under epidural anesthesia: 4 cases

Case 1

46yo F 101 kg, BMI: 38 PMH: obesity

L total knee arthroplasty - 2 h

Epidural

Supine

ipsilateral

No

Pain in the left buttock. Tense, tender swelling but no abnormal neurological findings. Clinical diagnosis.

Fasciotomy

48 h post-op

Complete recovery

Case 2

71yo M weight: 94 kg; BMI: 28

Left THA - 2 h 20 min

epidural

Right lateral position

contralateral

No

Severe right buttock pain. Firm, tense, tender swelling with erythema overlying the right buttock. Clinical diagnosis.

Fasciotomy

44 h post-op

Complete recovery

Case 3

55yo M weight: 86 kg BMI: 30

Right hip resurfacing arthroplasty - 3 h

epidural

Left lateral position

contralateral

No

Left buttock pain. Erythematous, tense, and tender area over the left buttock. Pain on passive flexion at the hip, Clinical diagnosis.

Fasciotomy

28 h post-op

Complete recovery

Case 4

72yo M weight: 81 kg BMI: 26

Right TKA - 2 h 25 min

Epidural

Supine

ipsilateral

No

Right foot drop. Loss of sensation along with the distribution of the sciatic nerve and no active movements at the ankle. Swelling and tenderness over the right buttock and serum potassium, urea, and creatinine were raised. Clinical diagnosis.

Fasciotomy

47 h post-op

Weak hip abductors with positive Trendelenburg sign and residual limp when walking at 18 months post-op but complete recovery of the sciatic nerve

Mohanty, 2019 [17]: Gluteal compartment syndrome a rare complication of lithotomy position and continuous postoperative analgesia

27yo M BMI 36 PMH: obesity

R PCL repair - 2 h 30 min

Combined spinal-epidural

Modified Lithotomy position

Ipsilateral

No

severe pain in the right buttock whilst there was a recovery of sensory block. On examination, we noticed a tense, tender swelling in the right buttock. Clinical diagnosis

fasciotomy

18 h post-op

Uneventful recovery with a prolonged hospital stay