Hip Arthroscopy

Weight-Bearing Status:

• Non-weight bearing (NWB) for 6 weeks (core decompression or subchondroplasty).

Instructions:

• Provide guidance on ambulation and stair climbing using crutches.

Suggested Therapeutic Exercises:

• Stationary Bike: 20 minutes daily, no resistance.
• Continuous Passive Motion (CPM): 4 hours/day, can reduce to 3 hours if stationary bike is used.
• Brace: Wear at all times during ambulation. Use brace or abduction pillow for sleep (x 2 weeks).
• Range of Motion (ROM) Exercises: Begin passive ROM (PROM) – including circumduction, abduction, and log rolls.
  • 20 minutes, twice daily.
  • Instruct a family member or caregiver for assistance.
  • Maintain PROM restrictions for 3 weeks.
• Prone Lying: 2-3 hours per day.
• Isometric Exercises: Quadriceps sets, glute sets, and transversus abdominis (TA) activation.
  • Hold each for 5 seconds, 20 repetitions, twice daily.

Goal: Protect the joint and avoid irritation.

Physical Therapy Pointers:

• Aim for symmetric ROM by 6-8 weeks.
• Avoid active open-chain hip flexor activation.
• Focus on proximal control (core, pelvis, and hip muscles).

Weight-Bearing Status:

• NWB for 6-8 weeks.

Brace Settings:

• Locked in 0-90° for ambulation or sleep.
• Continue using the brace or abduction pillow for sleep as needed.

Initial ROM Restrictions (Weeks 0-3):

• Flexion: Limit to 90° for 2 weeks (CPM may allow for slightly greater flexion).
• Extension: Limit to 0° for 3 weeks.
• External Rotation: Limit to 30° at 90° flexion for 3 weeks.
• Internal Rotation: Limit to 20° in prone for 3 weeks.
• Abduction: Limit to 20° at 90° flexion for 3 weeks.
• No restrictions in prone position.

Suggested Therapeutic Exercises:

• Stationary Bike: 20 minutes daily; increase time as tolerated starting week 3.
• Soft Tissue Mobilization: 20-30 minutes each session, focusing on adductors, TFL, QL, and inguinal ligament.
• Isometric Exercises: Continue quad sets, glute sets, and TA activation (week 1-2).
• Diaphragmatic Breathing: Week 1-2.
• Quadruped Exercises: Rocking, pelvic tilts, arm lifts.
• Anterior Capsule Stretches: Surgical leg off the table in figure 4 position.
• Clamshells/Reverse Clamshells: Week 1-3.
• TA Activation with Bent Knee Fall Outs: Week 1-3.
• Bridging Progression: 5x/week (week 2-6).
• Prone Hip ER/IR and Hamstring Curls: 5x/week (week 2-6).

Weight-Bearing Status:

• WBAT progression starts at 6 weeks post-op.

Goal: Achieve a non-compensatory gait and continue rehabilitation progression.

Physical Therapy Pointers:

• Gradually increase ambulation without crutches or a brace as tolerated, ensuring proper gait mechanics.
• Provide tactile and verbal cues to prevent compensatory patterns.
• Progress exercises as patient demonstrates control both proximally and distally.

Weight-Bearing Status:

• Begin WBAT progression starting at 6-8 weeks.
  • Start with Toe-Touch Weight Bearing (TTWB), progressing to Partial Weight Bearing (PWB) (25%, then 50%) under physical therapy guidance.
  • Transition off crutches by 7-8 weeks.
  • Discontinue brace once crutches are no longer needed.

Suggested Therapeutic Exercises:

• Stationary Bike: 20 minutes daily; increase time as tolerated starting week 3.
• Soft Tissue Mobilization: 20-30 minutes per session, with a focus on specific restrictions.
• Anterior Capsule Stretches: Continue surgical leg off the table in figure 4 position.
• Prone Hip ER/IR and Hamstring Curls: Continue until 6 weeks post-op.
• Prone Hip Extension: Begin 5x/week (week 3-5).
• Core and Shoulder Girdle Strengthening: Tall kneeling and ½ kneeling exercises (week 3-6).
• Standing Weight Shifts: Side-to-side and anterior-posterior, 5x/week (week 6).
• Backward and Lateral Walking (no resistance): 5x/week (week 6-8).
• Standing Double Leg 1/3 Knee Bends: 5x/week (week 8-10).
• Double Leg Squats: 5x/week (week 8-10).
• Forward Step-ups: 5x/week (week 8-10).
• Modified Planks and Side Planks: 5x/week (week 8-10).
• Elliptical: Begin with 3 minutes at 8 weeks, increase as tolerated.
• Joint Mobilizations:
  • Posterior/inferior glides: 2x/week (week 6-10).
  • Anterior glides: 2x/week (week 7-10).

Goal: Progress toward returning to pre-injury activity levels.

Physical Therapy Pointers:

• Focus on more functional exercises in all planes of motion.
• Progress exercises only if the patient demonstrates proper control with previous exercises.
• Individualized progression depending on patient’s goals and recovery pace.

Suggested Therapeutic Exercises:

• Soft Tissue and Joint Mobilizations: As needed.
• Lunges: Forward, lateral, and split squats, 3x/week.
• Side Steps and Retro Walking: With resistance, starting more proximally, 3x/week.
• Single-Leg Balance Activities: Balance, squats, trunk rotation, 3x/week.
• Planks and Side Planks: Progress as tolerated.
• Single-Leg Bridges: Progress duration as tolerated.
• Slide Board Exercises: 3x/week.
• Agility Drills: 3x/week (if pain-free).
• Hip Rotational Activities: 3x/week (if pain-free).

Goal: Full return to sport and activity.

Physical Therapy Pointers:

• Full recovery may take 4-6 months, or up to 1 year for maximal improvement.
• Perform a running analysis before returning to running, cutting, or agility.
• Assess functional strength and proximal control before progressing to more advanced activities.

Suggested Therapeutic Exercises:

• Running Progression: Begin on Alter-G treadmill at week 16, progress as tolerated.
• Agility Exercises: Start at week 20.
• Multidirectional and Cutting Activities: Begin at week 24.
• Plyometrics: Begin at week 24.
• Sport-Specific Exercises: Begin at week 24.