Hip Arthroscopy Rehabilitation

Gluteus Medius Repair with or without Labral Debridement

General Guidelines:

• Normalize gait pattern with brace and crutches
• Weight-bearing: 20 lbs for 6 weeks
• Continuous Passive Motion Machine
  • 4 hours/day or 2 hours if on stationary bike for 2 bouts of 20-30 minutes if tolerated

Frequency of Physical Therapy:

• Seen post-op Day 1
• Seen 1x/week for 6 weeks
• Seen 2x/week for 6 weeks
• Seen 2-3x/week for 6 weeks

Precautions following Hip Arthroscopy:

• Weight-bearing will be determined by procedure (protecting the repair)
• Hip flexors tendonitis
• Trochanteric bursitis
• Synovitis
• Manage scarring around portal sites
• Increase range of motion focusing on flexion
  • No active abduction, IR, or passive ER, adduction (6 weeks)

Guidelines:

• Weeks 0-4
  • CPM for 4 hours/day
  • Bike for 20 minutes/day (can be 2x/day) as tolerated
  • Scar massage
  • Hip PROM 
    • Hip flexion as tolerated, abduction as tolerated
    • Log roll
    • No active abduction and IR
    • No passive ER (4 weeks) or adduction (6 weeks)
    • Stool stretch for hip flexors and adductors
  • Quadruped rocking for hip flexion
  • Gait training PWB with assistive device
  • Hip isometrics - 
    • Extension, adduction, ER at 2 weeks
  • Hamstring isotonics
  • Pelvic tilts
  • NMES to quads with SAQ with pelvic tilt
  • Modalities
• Weeks 4-6
  • Continue with previous therex
  • Gait training PWB with assistive device and no trendelenberg gait
  • 20 pounds through 6 weeks
  • Stool rotations IR/ER (20 degrees)
  • Supine bridges
  • Isotonic adduction
  • Progress core strengthening (avoid hip flexor tendonitis)
  • Progress with hip strengthening
  • Start isometric sub max pain free hip flexion(4 weeks)
  • Quadriceps strengthening
  • Scar massage
  • Aqua therapy in low end of water
• Weeks 6-8
  • Continue with previous therex
  • Gait training: increase Weight bearing to 100% by 8 weeks with crutches
  • Progress with ROM
  • Passive hip ER/IR
    • Stool rotation ER/IR as tolerated » Standing on BAPS » prone hip ER/IR
  • Hip Joint mobs with mobilization belt (if needed)
    • Lateral and inferior with rotation
    • Prone posterior-anterior glides with rotation
  • Progress core strengthening (avoid hip flexor tendonitis)
• Weeks 8-10
  • Continue previous therex
  • Wean off crutches (2 » 1» 0) without trendelenberg gait / normal gait
  • Progressive hip ROM
  • Progress strengthening LE
  • Hip isometrics for abduction and progress to isotonics
  • Leg press (bilateral LE)
  • Isokinetics: knee flexion/extension
  • Progress core strengthening
  • Begin proprioception/balance
  • Balance board and single leg stance
  • Bilateral cable column rotations
  • Elliptical
• Weeks 10-12
  • Continue with previous therex
  • Progressive hip ROM
  • Progressive LE and core strengthening
    • Hip PREs and hip machine
    • Unilateral Leg press
    • Unilateral cable column rotations
    • Hip Hiking
    • Step downs
  • Hip flexor, glute/piriformis, and It-band Stretching – manual and self
  • Progress balance and proprioception
    • Bilateral » Unilateral » foam » dynadisc
  • Treadmill side stepping from level surface holding on progressing to inclines when gluteus medius is with good strength
  • Side stepping with theraband
  • Hip hiking on stairmaster (week 12)
• Weeks 12 +
  • Progressive hip ROM and stretching
  • Progressive LE and core strengthening
  • Endurance activities around the hip
  • Dynamic balance activities
  • Treadmill running program
  • Sport specific agility drills and plyometrics
• 3-6 months Re-Evaluate (Criteria for discharge)
  • Hip Outcome Score
  • Pain free or at least a manageable level of discomfort
  • MMT within 10 percent of uninvolved LE
  • Biodex test of Quadriceps and Hamstrings peak torque within 15 percent of uninvolved
  • Step down test