Compartment syndrome is characterised by an increase in the interstitial pressure within a closed osseofascial compartment. This may be due to a decrease in compartment volume, an increase in compartment content or external pressures. We report 4 patients who required surgical decompression for gluteal compartment syndrome that developed after joint arthroplasty. Gluteal compartment syndrome is rare, has high morbidity, and can be life threatening if not detected early. We emphasise the importance of identifying patients at risk, frequent monitoring of patients with continuous epidural infusions, reporting of motor blockade, and regular changing of the patient's position postoperatively.