Cluneal Neuralgia Post Total Left Knee Replacement

[snookz101]

I am a 48 year old male who underwent left TKR 12 weeks ago and have been hampered with significant left sideed disabling hip and groin pain since this procedure. The pain travels in 3 areas, the anterior portion of my left hip/pelvis/groin area traveling down into quadriceps, lateral portion of left hip and rear top portion of buttocks traveling down side of leg into foot. I have had 4  appointments with my surgeon post surgically as this problem has not improved. Initially I was told it was trochanter bursitis and a cortisone injection was administered with little benefit beyond a couple of days. A second follow up resulted in an MRI of left hip which was unremarkable except for a noted AVN grade a/b on the opposite right hip which has been asymptomatic.
A third visit resulted in prescribing Flector and Lidoderm patches with little improvement after one month of use. I visited my surgeon again today and was told it was cluneal neuralgia and a second cortisone injection was done on the anterior portion of my hip slightly above groin. He said if no improvement was gained he wanted to start treament with Lyrica or Cymbalta and also do a lumbar mri but first wanted to see if I would benefit from todays injection. I am concerned as my doctor said these are very slow to heal. Additionaly I had spinal fusion surgery 14 years ago, a pelvic graft was taken then from the same side and I suffered for years from transient burning nerve pain below that incision traveling down the front of my leg. It was always brought on by long periods of standing or walking.
When the TKR was performed 12 weeks ago a catheter was placed through my left groin into knee for post operative pain management. The catheter pierced femoral blood vessels and I developed a left hip/thigh hematoma which was originally thought to be the cause of this pain. I also suffered a post operative staph infection.
Can any of these post operative complications have resulted in this disabling hip/groin pain? What is the best method of appropriate diagnosis and course of treatment? It is very frustrating as the hip pain is much more debilitating than the post operative knee pain and has hampered my overall recovery.

[JD1963]

Hi! Welcome to MedHelp! I am the Orthopedic Community Leader for this website. I realize this is an old post, but it may be beneficial to others. So, I would like to piggyback on mumanoff's post, which was very impressive. The Cluneal nerve compression normally occurs in it's osteofibrous tunnel against the iliac crest (much like Carpal Tunnel Syndrome). The treatment's I know of are: elimination of inappropriate use such as forward bending or acute twisting of the low back, NSAID therapy and local steroid injection. Surgical treatment by nerve decompression is used for cases of severe pain with failure of conservative treatment. Best of luck to anyone with this condition.

[mumanoff]

Cluneal nerve entrapment syndrome isn't often under appreciated and under diagnosed condition.  The site of entrapment is at the upper aspect of the iliac crest above the buttock, approximately 8 cm from the middle of the spine.  I am not quite sure what was targeted with the injection you had, but it certainly does not cluneal nerve.  If you do an image search online, you will see the actual location of the medial branch of the superior cluneal nerve and the patterns of pain associated with it.  Typical treatment includes diagnostic block on 2 occasions and if indicated radiofrequency lesioning.  Best of luck.