Postsurgical Rehabilitation: FAI

Abstract

Rehabilitation following hip arthroscopy has long been recognized as an integral component of the clinical outcome of the procedures. In recent years there are several works in literature that propose different protocols of rehabilitation after hip arthroscopy. At this point, works that carry out a systematic review concluded that “the current literature of hip arthroscopy rehabilitation lacks high-quality evidence of support to specific protocol.” For a proper setting of the rehabilitation protocol, we first need to know specifically which type of surgery was performed. The type of operation together with the type of patient will allow us to set the proper protocol for that patient. We can also find several techniques together in one operation. This makes us understand that the information and protocols described are to be used as a guide that permits us to tailor it to suit each patient. The majority of the authors propose weight bearing as tolerated in cases of labral debridement, loose body removal, and osteoarthritis debridement. In cases of labral repair, femoral osteochondroplasty, and pincer acetabuloplasty, we recommend a partial weight bearing or slight weight bearing for 3–4 weeks. In case of microfractures, the literature proposes protected bearing time for up to 6 weeks. All guidelines suggest initiating early, protected ROM. The utilization of gentle ROM circumduction for the hip joint has been suggested early in the rehabilitation process. We consider four phases in the rehabilitation protocol. The phase I, t, is a protection period. The goal is to reduce lower limb edema, gently progress hip range of motion, and regain normal neuromuscular firing patterns of the pelvis and hip. The goal of the second phase is for the patients to achieve independence in daily activities with little or no discomfort. The focus of this phase is to continue progressing ROM (pain-free) and soft tissue flexibility while beginning to transition the emphasis to strengthening. The goal of the phase III is to become asymptomatic recreationally. Strengthening exercises should now incorporate multi-planar movement involving multiple muscle groups. The primary objective of the phase IV is a safe and effective competition or return to previous activity level. Phase IV generally requires pain-free full-motion, strength, without any subjective or objective deficit during training. The rehabilitation protocol efficacy should be assessed using patient-reported outcome. The instruments that are appropriate for use in this patient population and have been recommended to guide therapy progression are Hip Outcome Score (HOS), the International Hip Outcome Tool (iHOT-33/iHOT-12), and the Copenhagen Hip and Groin Outcome Score (HAGOS). In conclusion, rehabilitation following hip arthroscopy should be individualized and evaluation based rather than time based. Weight bearing and motion progression is based upon the specific surgical techniques performed. The protocol proposed here is a summary of the current literature together with our experience and the protocols applied in our daily work.