Rehabilitation After Hip Femoroacetabular Impingement Arthroscopy
Section snippets
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.
References (25)
- et al.
Prospective analysis of hip arthroscopy with 2-year follow-up
Arthroscopy
(2000) - et al.
Rehabilitation following hip arthroscopy
Clin Sports Med
(2006) - et al.
Microfracture of the hip in athletes
Clin Sports Med
(2006) - et al.
Anterior hip joint force increases with hip extension, decreased gluteal force, or decreased iliopsoas force
J Biomech
(2007) - et al.
Neuromuscular hip biomechanics and pathology in the athlete
Clin Sports Med
(2006) - US markets for arthroscopy devices 2009. Report by Millennium Research Group...
- et al.
Outcomes following hip arthroscopy with microfracture
Arthroscopy
(2007) - et al.
Femoroacetabular Impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression
Knee Surg Sports Traumatol Arthrosc
(2007) - et al.
Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up
J Bone Joint Surg Br
(2009) - et al.
Arthroscopically assisted anterior decompression for femoroacetabular impingement: technique and early clinical results
Arch Orthop Trauma Surg
(2009)
Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: a preliminary report
J Pediatr Orthop
Early outcome of hip arthroscopy for femoroacetabular impingement: the role of femoral osteoplasty in symptomatic improvement
J Bone Joint Surg Br
Cited by (70)
Capsulolabral Adhesions After Hip Arthroscopy for the Treatment of Femoroacetabular Impingement: Strategies During Rehabilitation and Return to Sport to Reduce the Risk of Revision
2022, Arthroscopy, Sports Medicine, and RehabilitationCitation Excerpt :Although there is not a standardized rehabilitation protocol for hip arthroscopy, many protocols have been published. Several postoperative strategies for reducing the risk of adhesions are described in the literature.9,10 Several of these will be discussed in the following paragraphs.
Postoperative Weightbearing Protocols After Arthroscopic Surgery for Femoroacetabular Impingement Does Not Affect Patient Outcome: A Comparative Study With Minimum 2-Year Follow-up
2020, Arthroscopy - Journal of Arthroscopic and Related SurgeryIs hip muscle strength normalised in patients with femoroacetabular impingement syndrome one year after surgery?: Results from the HAFAI cohort
2019, Journal of Science and Medicine in SportCitation Excerpt :The standard rehabilitation protocol after surgery included full weight bearing as tolerated and the use of crutches for two to six weeks. The patients followed a home-based rehabilitation program inspired by Wahoff and Ryan.21 The patients were contacted by telephone two to five days after surgery and invited to the Department of Physiotherapy two weeks, six weeks and three months after surgery where they were instructed in progression of the home-training program by a specialised physiotherapist.
Postoperative Rehabilitation for Arthroscopic Management of Femoroacetabular Impingement Syndrome: a Contemporary Review
2023, Current Reviews in Musculoskeletal Medicine
The authors have no conflicts of interest.