Rehabilitation After Hip Femoroacetabular Impingement Arthroscopy

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Principles of hip arthroscopy rehabilitation

The following are the key principles of rehabilitation after hip arthroscopy: (1) rehabilitation is an individualized and evaluation-based (not time-based) program designed to be able to address specific findings of the surgeon, the procedures performed, and the patient’s individual characteristics; (2) circumduction is critical for early mobility to provide an environment in and around the joint to reduce the risk of scar tissue; and (3) sport-specific functional rehabilitation should be

Rehabilitation protocols

Phase 1 of the rehabilitation program is shown in Table 1. Hip arthroscopy is a package of several to all procedures listed in Table 2. Patients who undergo a microfracture for the treatment of full-thickness chondral injuries are restricted to foot-flat weight bearing (FFWB, 9 kg) for 6 to 8 weeks.2, 16 Patients who do not undergo a microfracture are restricted to FFWB for 3 weeks to decrease postoperative inflammation and reduce the risk of a stress fracture due to the osteoplasty. Patients

Postoperative therapy modalities

Pain and inflammation is decreased with ice, compression, and lymphatic massage. As the initial swelling decreases, other soft tissue techniques are used, including effleurage, petrissage, myofascial release, and active release techniques. Emphasis is placed on the tensor fasciae latae (TFL), gluteus medius, iliotibial band, adductors, iliopsoas, and lumbar spine.

Mobility within the ROM restrictions is achieved with the continuous passive motion machine, stationary bike, aquatic therapy, and

Musculature restoration

Restoration of normal muscle performance is critical to reestablish dynamic hip joint congruency after surgery. Correct motor function is achieved through careful selection of exercises for muscular strength (capacity to actively develop tension), work (force × distance), power (rate of work output), or endurance (ability to delay onset of fatigue).18 Isometric (static), isotonic (eccentric or concentric), slow- and fast-speed dynamic, and functional exercises are used depending on the phase of

Rehabilitation progression

Weaning off crutches depends on the patient’s tolerance to the gradual increase in weight bearing and demonstration of proper firing of the gluteal muscles without a Trendelenburg gait (phase 2 as listed in Table 3). Progressive increases in weight bearing of 10% to 25% every 1 to 3 days or slower is recommended. Aquatic therapy may assist in the patient’s ability to wean off crutches. Restoring normal gait without using a standard or underwater treadmill is recommended because the authors

Musculature balance

Assessment of the entire lumbar-pelvic-hip complex and lower extremity kinetic chain helps to address muscle imbalances, sacroiliac joint, lumbar spine articular dysfunctions, and restrictions in the fascial planes. Treatments to facilitate normal mechanics of these functional units include manual mobilization and/or manipulations of the thoracic or lumbar spine, sacroiliac joint, and soft tissue work as previously described.22, 23, 24, 25 Manual mobilization of the hip capsule is performed

Rehabilitation: mind and body

Rehabilitation after hip arthroscopy can be a challenge for many patients who are otherwise very active individuals. The long period of inactivity after surgical procedures can be difficult on the athlete/patient both mentally and physically. There are many options available for athletes that concurrently address the rehabilitation of the hip while maintaining or minimizing the loss of fitness. These activities can be performed in compliance with all weight-bearing and ROM restrictions.

Advancing rehabilitation beyond the hip

Cardiovascular fitness activities are generally started during phase 1 after postoperative day 7. Intensity and duration can be progressed throughout phase 1 and can continue into phase 2 of the hip rehabilitation program.

Upper extremity strengthening is efficiently, effectively, and safely performed during phase 1 using suspension-type training. This setup allows the patient to perform a multitude of exercises using body weight resistance rather than attempt to carry dumbbells or other weights

Return to play

Sport progressions during this stage are performed within a pain-free ROM, with a duration and intensity that does not result in an increase in soreness of the joint or musculature. A progressive plan involves beginning with simple, slow, and short-duration activities. As the athlete gains strength, endurance, and confidence in the hip, more complex and faster movements of increasing volume can be performed. A predictable plan means beginning only with movements that are known to the athlete.

Summary

Rehabilitation after FAI arthroscopy is different for different patients. By following the restrictions set by the physician while performing early circumduction, using the minimal criteria to advance through each subsequent phase, and allowing patients to perform functional sport progressions throughout the rehabilitation athletes will be able to return to sport smoothly and effectively with positive outcomes.

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References (25)

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    Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: a preliminary report

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  • N.V. Bardakos et al.

    Early outcome of hip arthroscopy for femoroacetabular impingement: the role of femoral osteoplasty in symptomatic improvement

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    The authors have no conflicts of interest.

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