Arthroscopic Hip surgery for Femoroacetabular Impingement

Orthopedic Hip Surgery

Authors
Affiliations

Nate Yomogida, PT, DPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, PT, DPT

Doctor of Physical Therapy

B.A. in Neuroscience

Specific Procedures

  • Acetabuloplasty
  • Labral repair
  • Labral Debridement
  • Labral reconstruction
  • Chrondroplasty
  • Microfracture
  • Fibrin glue repair
  • Femoroplasty
  • Capsular repair
  • Iliopsoas release
  • Endoscopic Trochanteric Bursa Excision
  • Endoscopic Abductor Repair

Weight bearing

General Weight Bearing time frame1
Timeframe Weightbearing
0-21 days PWB 20lb
Step-to pattern
foot-flat gait
3-6 wk Gradual increase weightbearing to pain-free WBAT
6-8 weeks Gradually wean from crutches
Decrease to single crutch
Without device as tolerated

Range of Motion

Bracing: None
Range of motion timeframe1
Timeframe Flexion Extension Abduction ER IR
0-21 Days 0-90° 0° 0-30° 0-30° 0-30°
3-6 Weeks Pain free ROM 0-10° 0-45° 0-45° 0-45°
6-12 Weeks Increase to full ROM as tolerated Increase to full ROM as tolerated Increase to full ROM as tolerated Increase to full ROM as tolerated
12+ Weeks Increase to full ROM as tolerated Increase to full ROM as tolerated Increase to full ROM as tolerated Increase to full ROM as tolerated

Phase 1

  • Day 1-28
  • Initial physical therapy is generally scheduled ~2 weeks after surgery1.

Stage goals:

  • Minimize pain and inflammation1
  • Protect integrity of repair1
  • Avoid post-op adhesions1
  • Improve pain-free AROM and PROM1
  • Improve gait mechanics1
  • Reduce muscle inhibition1
  • Independence with HEP1

Precautions and guidelines:

  • No active straight leg raise (SLR) throughout rehab period1
  • Avoid ambulation to fatigue or pain1
  • No active hip flexion from day 0-21 (self-assisted hip flexion only)1
  • No grade III-IV hip mobilization for first 8 weeks1
  • No long axis hip distraction for first 8 weeks for labral repair1
  • No long acis hip distraction for first 12 weeks for labral reconstruction1
  • At all times, pain and pinching in the hip should be avoided1

Throughout rehabilitation the preventative action should be taken to avoid:

  • Hip flexor tendinitis1
  • Synovitis of operative joint1
  • Trochanteric bursitis1
  • Lower back syndrome1
  • Sacroiliac pain1

Criteria for progression to next phase:

  • Minimal pain with ambulation1
  • Non-antalgic gait with use of crutches1
  • Minimal pain at rest1
  • Patient able to perform exercise program without increase in baseline pain1

Treatment strategies

Patient education:
  • No crossing of legs1
  • Avoid sitting >30 min for the 1st 2 weeks, but progressively increase sitting tolerance1.
  • Lie in prone for 15min 2-3 per day to prevent hip flexor contractures1.
  • Consider a raised toilet seat to avoid excessive hip flexion1.

Manual therapy:

  • STM to quadriceps, hamstrings, TFL, glute med, ilacis, psoas major and minor, quadratus lumborum, and lumbar paraspinals1.

References

1.
Rogers-Hyde D, Safran-Norton C. Surgical protocol: Arthroscopic Hip Surgery for Femoroacetabular Impingement. Published online 2020. https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/hip-fai-post-op-rehab-protocol.pdf

Citation

For attribution, please cite this work as:
Yomogida N, Kerstein C. Arthroscopic Hip surgery for Femoroacetabular Impingement. https://yomokerst.com/The Archive/Surgery/Hip Surgery/arthroscopic_hip_surgery_fai.html