Orthopaedic Surgeon
Hip Arthroscopy Surgical Rehabilitation
Phase I (Surgery to 2-6 weeks postoperative)
Appointments
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Home exercise program will begin after surgery – 2 weeks
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1-2 visits per week with HEP instruction
Rehabilitation Goals
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Protection of the post-surgical hip through limited weight bearing and education on avoiding pain with range of motion exercises
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Restore normal hip range of motion
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Normalize gait
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Restore leg control
Precautions
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Use crutches for normal gait with straight leg—may allow full WB early, otherwise, follow:
Week 0-2: 30% weight bearing
Week 2- 50% with progression to 75%
Week 3- progress to full weight bearing as tolerated Week 4- discontinue crutches -
Avoid active hip flexion past 90 degrees and avoid passive range of motion that causes pinching pain
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Avoid exercises that engage the iliopsoas
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Avoid passive unilateral extension until 3 weeks postoperative
Suggested Therapeutic Exercise
Weeks 0-2:
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Stationary bicycle without resistance- no pain
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Gluteal sets, quad sets, heel slides, calf pumps
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Passive range of motion of hip avoiding ER and emphasize IR
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Isometric strengthening- transverse abdominus, hip abduction
and adduction
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Uninvolved knee to chest, piriformis stretching without ER
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Supine hip roll IR, standing hip IR, quadruped rocking
Weeks 2-6:
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Continue all exercises above
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Add light resistance to stationary bike
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SLR 4 directions
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Side-lying clams, bent knee fall outs, short lever hip flexion
(seated)
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Weight shifts with progression to single leg proprioception
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Double leg bridging
Cardiovascular exercise
• Upper body circuit training or upper body ergometer (UBE)
Progression Criteria
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Normal gait with assistive device with FWB (pain free)
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Good leg control at low velocity
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Functional range of motion (pain free)
Phase II (weeks 6 – 3 months)
Appointments
• Rehabilitation appointments are 1-3 times per week
Rehabilitation Goals
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Improve muscular strength and endurance
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Good control and no pain with sport and work specific
movements
Precautions
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Post activity soreness should resolve within 24 hours
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No ballistic or forced stretching
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Avoid post-activity swelling or muscle weakness
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Be cautious with repetitive hip flexion activities
Suggested Therapeutic Exercise
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Continue above exercises
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Kneeling hip flexor stretch, manual long axis distraction,
manual A/P mobs, double 1/3 knee bends, cord resisted
standing double leg IR and ER
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Swimming with fins, bounding, plyometric
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Mini-squats and wall slides
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Toe raises with weights, step ups
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Trunk strength- transverse abdominus, side supports, trunk
and low back stabilizers
Cardiovascular exercise
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Seated rowing, elliptical, stair climber
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Swimming as stated above
Progression Criteria
• Normal gait, dynamic neuromuscular control without pain or swelling
Phase III (3-4 months)
Appointments
• Rehabilitation appointments are once every 1-2 weeks
Rehabilitation Goals
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Improve muscular strength and endurance
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Good control and no pain with sport and work specific
movements
Precautions
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Post activity soreness should resolve within 24 hours
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No ballistic or forced stretching
• Avoid post-activity swelling or muscle weakness
Suggested Therapeutic exercises
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Continue all above exercises
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Dynadisc, advanced bridging, side supports, cord resisted
single leg standing IR/ER, skaters/side stepping, Pilates or slideboard, single knee bends, single leg windmills, lunges, side to side lateral agility, forward/backward running with cord
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Closed chain exercises including leg press, step ups, mini- squats, and hamstring curls
Cardiovascular exercise
• Jump rope exercises, jogging on even ground (no treadmill)
Criteria for Progression
• Normal gait, dynamic neuromuscular control without pain or swelling
Phase IV (4-6 months)
Appointments
• Rehabilitation appointments are once every week
Rehabilitation Goals
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Development of strength, power, and endurance
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Begin gradual return to functional activities
Precautions
• No active reactive swelling or joint pain that lasts more than 12 hours
Suggested Therapeutic exercises
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All previous exercises as appropriate
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Begin advanced strengthening with weights including leg
press, squats, leg curls and lunges
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Initiate plyometric program
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Functional training exercises including fast straight running,
backward running, cutting, cross overs, carioca
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Gradual return to previous sport and activities under
controlled conditions
Cardiovascular exercise
• Continue as above
Progression/ return to sport
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Normal muscle strength in the involved lower extremity
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Jog and full speed run without a limp
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Full range of motion
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Satisfactory clinical examination