Hip Arthroscopy Rehabilitation

Proper and graduated rehabilitation after hip arthroscopy is necessary to ensure a good outcome from the procedure. This rehabilitation protocol is a basic outline for patients and therapists to assist in the rehabilitation after hip arthroscopy.  This protocol is the standard however depending upon the procedure performed may be modified by the surgeon or with suggestions from the therapist.

The rehabilitation portion of hip arthroscopy requires significant dedication by the patient and therapist and it must be realized that the patient will spend much more time with the therapist than the surgeon.  The therapy protocol is presented in three phases.  The therapist determines graduation from one phase to the next, and if adjustments are to be made, these are to be discussed with Dr. Lee.

It is strongly recommended to select a therapist with an interest in hip rehabilitation prior to surgery.  A presurgical evaluation by the therapist is also recommended to establish goals, review the rehab protocol, and work on crutch mobilization with Touch Down Weight Bearing (TDWB) if needed.  Additionally a prehab exercise program focusing on core muscle strengthening and gluteus maximus and medius strengthening.

Phase One

Labral Repair – Week 1-4

Microfracture – Week 1-7

Phase one is to maintain range of motion with miniming joint inflammation.  Mucle activation focuses on rehabilitating the gluteus maximus, gluteus medius, gluteus minimus, and quadriceps.  Activation of the tensor fasciae latae (TFL), adductor longus, and iliopsoas should be avoided.  As ROM increases, one should not push through pain especially if the pain is pinching groin pain.

Goals:

1. Early protected ROM
2. Decrease soreness and swelling
3. Fluid mobilization
4. Protected weight bearing
   1. 4 weeks labral repair
   2. 7 weeks microfracture
5. Hip brace while ambulating x 3 weeks
6. Normal gait prior to graduating to phase 2

Postop Day Zero:

1. CPM 0-60 degrees
   1. 1 hour immediately postop
   2. 3 hour session one time overnight
2. Game Ready
   1. 30 minute cycles – with low compression
3. Ankle pumps, isometric

Postop Day One:

1. Dressing Change
2. Zero resistance stationary bike x 20 minutes
3. Circumduction
4. Gluteus Maximus and Quadricep Isometrics
5. Manual fluid mobilization (Massage)
6. Game Ready after therapy and at home
7. CPM at home 8 hours divided in 2-3 hour sessions

Week 1-4:

1. CPM ROM increases 10 degrees every week to end at 0-80 degrees
2. Aquatic Therapy can be initiated on POD 4 but incisions must be without drainage and covered with an impervious dressing such as an op-site or tegaderm
3. Transition to 50% weight bearing at week 3 (21 days postop) with goal to wean from crutches at week 4

Range of Motion

1. Passive Range of Motion – complete relaxation of adductor, iliopsoas, and TFL
   1. At home partner assisted range of motion is encourage twice daily for 15 minutes
      1. 5 minutes of clockwise circumduction with the hip flexed 30 degrees
      2. 5 minutes of counterclockwise circumduction with the hip flexed 30 degrees
      3. 5 minutes of internal rotation (log rolls) with the hip in full extension
   2. Therapy assisted ROM
      1. 10 minutes of clockwise and counterclockwise circumduction at 70 degrees of flexion – less flexion if pinching in groin
2. Straight leg distraction daily
3. Specific stretches
   1. Lie on nonop side, flex hip to 45 degrees – adduct knee to stretch piriformis begin week one
   2. Lie prone flex knee until stretch is felt on rectus femoris begin week zero
   3. Quadruped Rocking (Cat/Camel) start postop week 1
   4. Thomas stretch start postop week 3
4. NO flexion greater than 90 degrees x 3 weeks, No external rotation past 15 degrees x 3 weeks, Extension to neutral x 3 weeks, Abduction to 40 degrees

Strengthening

1. Isometrics
   1. Quad sets, Glute sets, Transversus Abdominus
      1. To be done with therapist week one and at home BID from week 2-4
2. Closed Chain exercises
   1. Weight Transfer to operative extremity without dropping pelvis
      1. Week one (7 days postop) 50% weight transfer
      2. Week two 75% weight transfer
      3. Week three 100% weight transfer
   2. Gluteus Maximus supine hip extensions
      1. Week one and two feet on table for extension
      2. Week three transition to single leg
3. Open Chain exercises
   1. Clam shell abduction
      1. Begin week 1
   2. Standing Abduction – do not drop the pelvis
      1. Begin week 2

Aquatic Therapy

1. Walking
   1. Begin postop day 4 with antegrade normal heel to toe gait x 15 minutes
      1. Focus on normal gait without dropping pelvis
         1. Week one and two water should be chest high
         2. Week three water should be mid abdomen
      2. Week two (postop day 14) begin walking backwards with hip extension to neutral
2. Closed chain
   1. Short squats to 30 degrees hip flexion
      1. Start at chest high water and graduate to waist high water by week 3
      2. Hands placed on the edge of the pool to help with balance
3. Open chain abduction
   1. Focus on isolating hip abductors (g. medius and g. minimus)
      1. 3 sets of 20 each leg

Phase Two

Lateral Belt Hip distraction

Knee at 90 degrees with belt around therapist and patients proximal thigh

Lateral distraction by therapist

Inline distraction daily BID

ROM

Quadratus Lumborum Stretches

Rectus Femoris Stretching

Rotation of Trunk on Single Leg Stance

Cardiovascular Rehabilitation and Core Strengthening

Lateral Lunges

Short Squats

Psoas Strengthening

Planking – op and non op side

Lying Abduction

Phase 3

Single Knee Bend

Side to Side Hip With Control

Monster Walking

Biking

Running – 1 minute interval

Ballistic Exercises

Box Jump

Diagonal Jump

Dynamic Hop with Rotation

Return to sport 8-10 months