Guidelines and pitfalls for the rehabilitation following hip arthroscopy

Abstract

Rehabilitation guidelines following hip arthroscopy have been presented in the literature with common themes consisting of initial protection, restoration of lumbo-pelvic stability, neuromuscular re-education, and return to sport training. The purpose of this review is to present hip arthroscopy guidelines in 4 phases and to address common pitfalls that may delay the rehabilitative process. The goal of phase 1 should be to protect healing tissues through activity modifications. Phase 2 intends to return the patient to pain-free community ambulation without compensation or irritation. A review of hip muscular actions during gait is presented to guide exercise progressions during this phase. Phase 3 should reestablish neuromuscular control through strength and endurance training to provide the foundation for return to functional activities or sports training progressions. The last phase of rehabilitation is dedicated to reestablishing power, speed, agility, and skill for advanced sports and advanced functions.

Rehabilitation after Hip Arthroscopy

“…Malloy et al, [26] recommended focusing on the tranversus abdominus and multifidus for lumbar spine stability with transfers. As the patient progresses, more emphasis is placed on gluteal muscle strengthening especially the gluteus medius and hip abductors due to their role of frontal plane stability of the pelvis in functional activities such as gait.…”

“…The primary goal of this phase was not only to return to a pain free competitive state, but also to avoid both breakdown and any type of an acute inflammatory response during the process. Malloy [26] described similar four phases of rehabilitation but emphasized the importance of initial protection and restoration of lumbo-pelvic stability before neuromuscular re-education. Milestone of this protocol was the restoration of normal gait without pain or compensation and only when achieved the patient may advance in the rehabilitation process.…”

Letter to the Editor

“…Finally, as return to rowing was assessed as early as 3 months postoperatively, what was the rehabilitation protocol? Return to sport after hip arthroscopy should be advanced slowly to prevent continued irritation or reinjury [7].…”

Pendulum Exercises After Hip Arthroscopy: A Video Technique

“…1,2 The rate of hip arthroscopic procedures has increased by 600% since 2006, 3 and this rate is expected to continue to grow. Despite this high rate of growth, there remains little consensus on the role of formal in-studio physical rehabilitation in the postoperative management of patients undergoing hip arthroscopy.…”

“…5 Current studies are underway to evaluate the efficacy of a formalized rehabilitation program regarding health-related quality of life and physical function, 4 and stronger evidence is needed to define the standard of care in postoperative management of patients undergoing arthroscopic hippreservation surgery. 2,[4][5][6][7][8] Despite variation in postoperative rehabilitation programs, most protocols reported in the literature have asserted that early mobilization is an important component of postoperative care. Passive motion helps to nourish joint surfaces, promote tissue remodeling, and increase tensile strength.…”