Hip Arthroscopy Protocol

7/29/2019 Hip Arthroscopy Protocol

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Dr JN Cakic - Chuck, MD, FCS(SA)Orth, PhD

Physiotherapy Team: Barry GetzLiz BrownePaula Maclaurin

POSTOPERATIVEREHABILITATIONPROTOCOL

HIPARTHROSCOPY

FourwaysLife

Fourways

Cnr.CedarRd.andCedarAve.West

Phone:+27118751780

Fax:+27118751781

CentreforSportsMedicineand

Orthopaedics

Rosebank

9SturdeeAve.,Johannesburg

Phone:+27117885110/1

www.drcakic.co.za

[email protected]


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HIP ARTHROSCOPY

(Post-Operative Protocol)Dr. J.N. CakicMD , FCS(SA)Orth , MMed(Orth)WITS , PhD (Med) WITS

PLEASE NOTE!

This protocol is designed as a guideline only; each patient is unique and should be constantly re-assessed toascertain progression. Should you have any queries or concerns, please consult with the surgeon or attendingin-hospital physio.

Surgery procedures vary due to the type of pathology, please use the following as a guideline only.

Surgery Type Weeks Weight Bearing ROM

0-4 Partial (walking aid) Active assisted 60 - 70% of unaffected side

4- 6 Partial to Full (walking aid) > 70 % (to tolerance)

Femoro-Acatabular

Impingement(CAM / Pincer) > 6 Full Full

0-4 Partial (2x crutches) Active assisted 60 - 70% of unaffected side

4-6 Partial to Full (1x crutch) Gradually increased to toleranceLabral Repair

> 6 Full Full

0-4 Partial to Full (crutches) Full active assisted (to tolerance)Debridement

> 4 Full Full

0-8 Partial to Full (walking aid) Full active assisted (to tolerance)Microfracture / Decompression

> 8 Full Full

STAGE 1 ( 4 - 6 weeks)

AIM:Protectedweight bearing stage, protect integrity of repaired tissueRestore range of movement within restrictionsMaintain muscle function, preventing inhibition

Allow tissue healing / repair

RESTRICTIONS/PRECAUTIONS:Protect hip flexors

Limit flexion to 90 and internal rotation, specifically for labrum reconstruction

Day 1-14Patient will be D/C with basic HOME exercise program

Weight bearing and ROM (refer to table above)Continue circulatory exercisesCommence / continue isometric activity (gluteals, quadriceps, hamstrings, adductors, abductors)

Begin physiotherapy:Hip mobilization, restore normal gait pattern while still on crutchesSoft tissue mobilization, release and restore muscles around affected hipInitiate core muscle exercises

Commence stretching (within ROM guidelines) - quadriceps, calves, hamstrings, adductors, iliopsoas, piriformisStationary cycling with no resistanceCommence Closed Kinetic Chain (e.g. bridging double leg)

Address lumbar spine / sacroiliac joints from week


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2 - 6 WeeksContinue with weight bearing & ROM guidelinesContinue isometrics (as home programme)Introduce active assisted ROM (abduction, flexion, extension, adduction)Progress closed kinetic chain activity (e.g. 4 point kneeling)Continue stretchingShort lever hip flexionIncrease cycling activityContinue core stability exercises

Patient can start with stationary bike exercises with NO resistance from 7-10 days post op. Raise the seat toprevent over-flexionPatient may start with swimming exercises 4 days after sutures removed and wounds checked:

- use pool float device between the legs!- No kicking or breaststroke!

CRITERIA TO PROGRESS TO STAGE 2:- minimal or no pain with phase one exercises- ROM +/- 75% unaffected side- Proper muscle firing patterns for initial exercises


AIM:Full weight bearing (minimal discomfort) (refer to table above for possible weaning period)Restore & maintain movementIncrease muscle strength & improve proprioceptionFocus on normal arthrokinematics, normal gait patternFocus on core stability

RESTRICTIONS/PRECAUTIONS:No ballistic or forced stretchingNo axial loadingNo treadmill use

Avoid hip flexors/joint capsule inflammation

Physiotherapy:Continue hip & soft tissue mobilization

Address associated joints (e.g. lumbar / thoracic spine, sacroiliac joints etc)Advance linear strength training activity (e.g. wall slides, hip flexion / extension, 1/3 squats, flexion/extensionexercises)Introduce gentle active hip rotation (minimal resistance) Please AVOID any flare-upsIntroduce proprioceptive activityBegin gluteus medius activationFocus on muscle sequencing with core stabilizationProgress muscle passive muscle stretching after warm upPool (if possible) and land gait training


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CRITERIA TO PROGRESS TO STAGE 3:- Full ROM

- Pain free, normal gait pattern- Hip flexor strength >60% uninvolved side- Hip add, abd, IR, ER strength >70% uninvolved side


AIM:Improve & restore strength and endurance

Improve proprioceptionImprove core stability

Advance rotational hip activity (i.e. loading activity which requires internal / external hip rotation)Restoration of cardiovascular fitnessBiokinetic assessment (i.e. postural, strength assessment)

RESTRICTIONS/PRECAUTIONS:No axial loading before full biokinetic assessmentNo contact activities

Avoid hip flexors/ capsule inflammation with increase of activity level

Physiotherapy:As required soft tissue treatment, joint mobilization / correction

Monitor exercises and activity levelIntroduce lunges exercisesWater bounding and pylometricsSide to side lateral agilitiesForward and backwards running with cordStationary biking with resistanceSwimming with fins

Advanced bridgingSingle leg stance an airex matSingle leg bendsElliptical trainer or low stair climber for cardio work out

CRITERIA FOR PROGRESSION TO STAGE 4:- Full pain free ROM- Hip strength >85% of uninvolved side- Ability to perform sports specific drills

- Completion of biokinetic functional sport test


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STAGE 4 ( 10 weeks 6 months)

AIM:Biokinetics to assess return to social sportsSport specific training programme

DOCTOR FOLLOW UP: 6 weeks post op, at the same time assessment by the member ofphysio rehabilitation team

3 months post op, at the same time physio and possible isokineticassessment, depending on progress

6 months post op, with second isokinetic assessment9 months and 1 year post op

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Hip Arthroscopy Protocol