Hip Arthroscopy Rehabilitation

Sample Hip Arthroscopy Rehabilitation Protocol

Hip arthroscopy is becoming more and more common.  As hip joint problems are being better identified, and surgical treatments are being refined, more patients are turning towards hip arthroscopy as a solution to their symptoms of hip pain.  The benefit of hip arthroscopy is that the recovery is much simpler than for open hip surgery. Patients can typically put as much weight as tolerated on the hip immediately following surgery (check with your doctor as some procedures may limit weight bearing).

In the first weeks after surgery, patients work on regaining motion around the joint, and gentle strengthening exercises. Typically, patients work with a physical therapist for assistance with these exercises and stretches.

Most patients can begin light activities (cycling, swimming) within a few weeks. Athletes most often take about 12 weeks for recovery. Again, there are specific procedures that may require a more lengthy rehabilitation, so check with your doctor about the specific plans for your recovery.

Phase I - Initial Phase Post Hip Arthrscopy

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Goal: Regain range of motion within tolerance, decrease pain and swelling, neutralize muscle atrophy.  Early phases should be guided by a therapist to ensure athletes maintain a proper pace of rehab and allow their body to heal from surgery.

  • Day of surgery
    • Isometric gluteal sets
    • Ankle pumps
    • Heel slides
  • Post-operative days 1-7
    • Weight bearing with crutches
    • Isometric quadriceps, gluteals, hamstrings, adductors, and abductors
    • Active assist range of motion all planes
    • Hip mobilization and gentle joint distraction techniques
    • Closed chain bridging, balance drills

Phase II - Intermediate phase

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Goal: Regain and build muscle strength, focus on symmetry/core strength.  Core strength can help to decrease the burden on the hip joint and improve the mechanics of lower extremity movements.

  • Post-operative weeks 2-3
    • Wean crutches and normalize gait pattern
    • Increase range of motion limits
    • Gentle progressive resistive exercises
    • Closed chain single leg bridging
    • Open chain hip 4-way
    • Mobilization with movement
    • Proprioceptive/balance work
    • Stationary bike/aqua therapy

Phase III - Advanced phase

hip groin stretch
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Goal: Improve functional strength and endurance, core strength & stability.  While returning to sports activity is the ultimate goal, it is important to continue to focus on rehabilitation in this phase, rather than getting distracted by specific sports activities.

  • Post-operative weeks 4-6
    • Continue flexibility exercises
    • Progressively increase resistive and functional strengthening exercises
    • Initiate sport specific exercises
    • Gradual return to sport

Note: Weight bearing may be limited after some surgical procedures with a hip arthroscopy, including:

  • Labral repair
  • Iliopsoas release
  • Microfracture
  • Capsulorraphy

Complications & Prognosis

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Possible complications can occur as a result of hip arthroscopy.  In general, life-threatening or limb-threatening complications are extremely rare.  The most common complication from a hip arthroscopy is a temporary nerve injury (transient neuropraxia).  Nerve injuries are typically the result of long surgical procedure time or excessive traction (force) used to pull the hip joint open.  Other possible complications include infection, healing problems, joint cartilage damage, and persistent pain.  Complication rates are generally reported in the range of 5-10%. 

The prognosis from a hip arthroscopy is very good.  Most authors agree that the most important factor in determining success is the proper selection of patients.  When patients who have problems that are not well served with arthroscopic treatment (such as patients with hip arthritis), their results are generally less successful.

Individual rehabilitation protocols will vary by patient and procedure, this information is simply a guide to the rehabilitation following hip arthroscopy in some patients. Always defer to your doctor when making decisions about your rehabilitation!

Sources:

McCarthy, JC "Hip Arthroscopy: Applications and Technique" J. Am. Acad. Ortho. Surg., May 1995; 3: 115 - 122.

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