Functional Outcomes of Hip Arthroscopy in an Active Duty Military Population Utilizing a Criterion-Based Early Weight Bearing Progression

Abstract

Introduction: Hip arthroscopy allows surgeons to address intra-articular pathology of the hip while avoiding more invasive open surgical dislocation. However the post-operative rehabilitation protocols have varied greatly in the literature, with many having prolonged periods of limited motion and weight bearing. Purpose: The purpose of this study was to describe a criterion-based early weight bearing protocol following hip arthroscopy and investigate functional outcomes in the subjects who were active duty military. Methods: Active duty personnel undergoing hip arthroscopy for symptomatic femoroacetabular impingement were prospectively assessed in a controlled environment for the ability to incorporate early postoperative weight-bearing with the following criteria: no increased pain complaint with weight bearing and normalized gait pattern. Modified Harris Hip (HHS) and Hip Outcome score (HOS) were performed preoperatively and at six months post-op. Participants were progressed with a standard hip arthroscopy protocol. Hip flexion was limited to not exceed 90 degrees for the first three weeks post-op, with progression back to running beginning at three months. Final discharge was dependent upon the ability to run two miles at military specified pace and do a single leg broad jump within six inches of the contralateral leg without an increase in pain. Results: Eleven participants met inclusion criteria over the study period. Crutch use was discontinued at an average of five days following surgery based on established weight bearing criteria. Only one participant required continued crutch use at 15 days. Participants' functional outcome was improved postoperatively, as demonstrated by significant increases in HOS and HHS. At the six month follow up, eight of 11 participants were able to take and complete a full Army Physical Fitness Test. Conclusions: Following completion of the early weight bearing rehabilitation protocol, 81% of participants were able to progress to full weight bearing by four days post-operative, with normalized pain-free gait patterns. Active duty personnel utilizing an early weight bearing protocol following hip arthroscopy demonstrated significant functional improvement at six months.

Structured physical therapy protocols following hip arthroscopy and their effect on patient-reported outcomes—a systematic review of the literature

“…Furthermore, Tijssen et al [ 20 ] had a mean follow-up of 26.8 months (range 7.5–45.3) for their patients. Shaw et al [ 21 ] had followed their patients for a 6-month post-operative period, while Bennell et al reported 24-week follow-up and Mansell et al [ 23 ] reported 24-month follow-up.…”

“…The following phases of rehabilitation were set to establish healthy healing of the tissue, reduce pain, restore gait, strength and endurance, regain cardiovascular fitness and proprioception (Saavedra et al [ 19 ] and Mansell et al [ 23 ]) and regain range of motion (ROM) and ability to RTS without pain among the phase-based studies [ 1 , 19–21 , 23 ]. Saavedra et al [ 19 ] and Shaw et al [ 21 ] did not include pre-operative phases. Finally, Shaw et al [ 21 ] designed their protocol to control pain, increase active ROM, normalize gait, restore strength and ability to perform daily living activities, increase agility movements and help patients to return to and pass the Army Physical Fitness Test (APFT).…”

Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review

“…Across all pooled data, four studies demonstrated extreme positive effects. Three of these studies [54, 101,120] involved participants undertaking high-level physical activity with elevated post-arthroscopy scores. Conversely, Michal et al [102] reported very low pre-arthroscopy scores in a cohort who underwent surgery for subspinal decompression.…”

Rehabilitation for Femoroacetabular Impingement: Conservative Care and Postoperative Practice

“…Shaw et al recently reported on a series of 11 active-duty military patients who were allowed to fully weight bear as tolerated following hip arthroscopy for FAI. 24 Most of the patients in their cohort underwent osteoplasty and labral repair. They used specific criteria to allow crutch-wean, including a near-normal pain-free gait pattern.…”