Hip Arthroscopy Rehabilitation

Trochanteric Osteotomy

General Guidelines:

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

Rehabilitation Goals:

• 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

• Weight-bearing
• Manage scarring around incision
• No strengthening of abductors and Internal rotators ( 6 weeks)
• Range of motion focusing on flexion
  • No active abduction, IR, or passive ER greater than 20 degrees (6 weeks)

Guidelines:

• Weeks 0-4
  • CPM for 4 hours/day
  • Bike for 20 minutes/day (can be 2x/day)
  • Scar massage
  • Hip PROM
    • Hip flexion to 90 degrees (first 2 wks then as tolerated), abduction as tolerated
    • No active abduction, IR, passive ER greater than 20 deg, or passive adduction (6 weeks)
  • Quadruped rocking for hip flexion
  • Gait training PWB with assistive device
  • Hip isometrics
    • Extension, adduction, ER at 2 weeks
  • Hamstring/Quad isotonics
  • Pelvic tilts
  • NMES to quads with SAQ
  • Log rolling for rotation
  • Modalities
• Weeks 4-6
  • Continue with previous therex
  • Gait training PWB with assistive device
    • 20 pounds through 5 weeks then progress over week 6 to 50 % without pain
  • Progress with passive hip flexion as tolerated
  • Supine bridges
  • Isotonic adduction
  • Progress core strengthening
  • Progress ROM
    • Stool rotations for ER and IR as tolerated
  • Progress with hip strengthening
    • Start isometric sub max pain free hip flexion(4-6 wks)
    • Quadriceps strengthening
  • Scar massage
  • Aqua therapy in chest deep water
• Weeks 6-8
  • Continue with previous therex
  • Gait training: increase WBing as per MD
  • Progress with ROMs
    • Passive hip ER/IR
    • Standing on BAPS for ER and IR
  • Progress core strengthening
• Weeks 8-10
  • Continue previous therex
  • Progressive hip ROM
  • Progress strengthening LE
    • Hip isometrics » isotonics
    • Leg press (bilateral LE) limit ROM (no flexion beyond 90)
    • 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
  • Side stepping with theraband
  • Hip hiking on stairmaster (week 12)
  • Treadmill side stepping from level surface holding on progressing to inclines
• 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
• 4-8 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
  • Single leg cross-over triple hop for distance:
    • Score of less than 85% is considered abnormal for male and female
  • Step down test