Physical Therapy Protocol After Hip Arthroscopy: Clinical Guidelines Supported by 2-Year Outcomes

Benjamin G Domb, Terrance A Sgroi, Jeremy C VanDevender, Benjamin G Domb, Terrance A Sgroi, Jeremy C VanDevender

Abstract

Context: Femoroacetabular impingement (FAI) was first described by Ganz in 2003 and is a significant cause of decreased function and mobility. Femoroacetabular impingement must be treated in an individualized, goal-oriented, stepwise fashion. This protocol was developed with biomechanical considerations of soft tissue and bony structures surrounding the hip joint.

Evidence acquisition: The PubMed database was searched for scientific and review articles from the years 2000 to 2015 utilizing the search terms: hip rehabilitation, femoroacetabular impingement, and arthroscopy.

Study design: Clinical review.

Level of evidence: Level 5.

Results: Five hundred ninety-five of 738 patients were available for follow-up showing improvement from preoperative to 2-year follow-up of 61.29 to 82.02 for modified Harris Hip Score (mHHS), 62.79 to 83.04 for Hip Outcome Score-Activities of Daily Living (HOS-ADL), 40.96 to 70.07 for Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and 57.97 to 80.41 for Non-Arthritic Hip Score (NAHS); visual analog scale (VAS) scores decreased from 5.86 preoperatively to 2.94 postoperatively.

Conclusion: Following a structured, criteria-based program, appropriate patients undergoing hip arthroscopy may achieve excellent outcomes and return to full independent activities of daily living as well as sport.

Keywords: femoroacetabular impingement (FAI); hip rehabilitation; impingement.

Conflict of interest statement

The following author(s) declared potential conflicts of interest: Benjamin G. Domb, MD, is a paid consultant for MAKO Surgical, Arthrex, and Pacira; he has grants/grants pending from Arthrex, ATI, Breg, American Hip Institute, Pacira, and MAKO Surgical; holds patents for Hip Brace, LBR technique and kit; receives royalties from Orthomerica and DJO Global; and has stock/stock options from Stryker.<?release-delay 12|0>

© 2016 The Author(s).

Figures

Figure 1.
Figure 1.
Transverse abdominis isometrics.
Figure 2.
Figure 2.
Isometric with abduction ring.
Figure 3.
Figure 3.
Circumduction.
Figure 4.
Figure 4.
Single-leg squat.
Figure 5.
Figure 5.
Outcome scores. HOS-ADL, Hip Outcome Score–Activities of Daily Living; HOS-SSS, Hip Outcome Score–Sport-Specific Subscale; mHHS, modified Harris Hip score; NAHS, Non-Arthritic Hip Score.
Figure 6.
Figure 6.
Pain visual analog scale (VAS).
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4922519/bin/10.1177_1941738116647920-img1.jpg

References

    1. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;(418):67-73.
    1. Boren K, Conrey C, Le Coquic J, Paprocki L, Voight M, Robinson TK. Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises. Int J Sports Phys Ther. 2011;6:206-223.
    1. Byrd JW. Femoroacetabular impingement in athletes: current concepts. Am J Sports Med. 2014;42:737-751.
    1. Dy CJ, Thompson MT, Crawford MJ, Alexander JW, McCarthy JC, Noble PC. Tensile strain in the anterior part of the acetabular labrum during provocative maneuvering of the normal hip. J Bone Joint Surg Am. 2008;90:1464-1472.
    1. Enseki KR, Martin RL, Draovitch P, Kelly BT, Philippon MJ, Schenker ML. The hip joint: arthroscopic procedures and postoperative rehabilitation. J Orthop Sports Phys Ther. 2006;36:516-525.
    1. Ford KR, Myer GD, Hewett TE. Valgus knee motion during landing in high school female and male basketball players. Med Sci Sports Exerc. 2003;35:1745-1750.
    1. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;(417):112-120.
    1. Gupta A, Redmond JM, Stake CE, Dunne KF, Domb BG. Does primary hip arthroscopy result in improved clinical outcomes? 2-year clinical follow-up on a mixed group of 738 consecutive primary hip arthroscopies performed at a high-volume referral center. Am J Sports Med. 2016;44:74-82.
    1. Hrysomallis C. Hip adductors’ strength, flexibility, and injury risk. J Strength Cond Res. 2009;23:1514-1517.
    1. Krause DA, Jacobs PS, Pilger KE, Sather BR, Sibunka SP, Hollman JH. Electromyographic analysis of the gluteus medius in five weight-bearing exercises. J Strength Cond Res. 2009;23:2689-2694.
    1. Leighton RD. A functional model to describe the action of the adductor muscles at the hip in the transverse plane. Physiother Theory Pract. 2006;22:251-262.
    1. Lynch TS, Terra MA, Bedi A, Kelly BT. Hip arthroscopic surgery: patient evaluation, current indications, and outcomes. Am J Sports Med. 2013;41:1174-1189.
    1. Malloy P, Malloy M, Draovitch P. Guidelines and pitfalls for the rehabilitation following hip arthroscopy. Curr Rev Musculoskelet Med. 2013;6:235-241.
    1. Martin HD, Savage A, Braly BA, Palmer IJ, Beall DP, Kelly B. The function of the hip capsular ligaments: a quantitative report. Arthroscopy. 2008;24:188-195.
    1. Spencer-Gardner L, Eischen JJ, Levy BA, Sierra RJ, Engasser WM, Krych AJ. A comprehensive five-phase rehabilitation programme after hip arthroscopy for femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2014;22:848-859.
    1. Stalzer S, Wahoff M, Scanlan M. Rehabilitation following hip arthroscopy. Clin Sports Med. 2006;25:337-357.
    1. Voight ML, Robinson K, Gill L, Griffin K. Postoperative rehabilitation guidelines for hip arthroscopy in an active population. Sports Health. 2010;2:222-230.
    1. Wahoff M, Ryan M. Rehabilitation after hip femoroacetabular impingement arthroscopy. Clin Sports Med. 2011;30:463-482.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere