Rehabilitation Following Hip Arthroscopy

Stalzer, Steve; Wahoff, Michael; Scanlan, Molly

doi:10.1016/j.csm.2005.12.008

Cited by 93 publications

(84 citation statements)

References 14 publications

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“…Gluteus medius strength is consistently emphasized across the guidelines. Singleton and Stalzer et al describe specific exercises on a time-line [14,15]. Though variable depending on specific procedure and individual patient characteristics, guidelines most often suggest a minimum period of approximately 12 weeks before initiating a return to athletic or other strenuous activities (exceptions may apply in rare cases) [13][14][15].…”

Section: Rehabilitation Guidelinesmentioning

confidence: 99%

Post-operative guidelines following hip arthroscopy

Edelstein

Ranawat

Enseki

et al. 2012

Curr Rev Musculoskelet Med

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Rehabilitation following hip arthroscopy can vary significantly. Existing programs have been developed as a collaborative effort between physicians and rehabilitation specialists. The evolution of protocol advancement has relied upon feedback from patients, therapists and observable outcomes. Although reports of the first femoroacetabular impingement (FAI) surgeries were reported in the 1930's, it was not until recently that more structured, physiologically based guidelines have been developed and executed. Four phases have been developed in this guideline based on functional and healing milestones achieved which allow the patient to progress to the next level of activity. The goal of Phase I, the protective phase, is to progressively regain 75% of full range of motion (ROM) and normalize gait while respecting the healing process. The primary goal of Phase II is for the patient to gain function and independence in daily activities without discomfort. Rehabilitation goals include uncompensated step up/down on an 8 inch box, as well as, adequate pelvic control during low demand exercises. Phase III goals strive to accomplish pain free, non-compensated recreational activities and higher demand work functions. Manual muscle testing (MMT) grading of 5/5 should be achieved for all hip girdle musculature and an ability to dynamically control body weight in space. Phase IV requires the patient be independent with home and gym programs and be asymptomatic and pain free following workouts. Return to running may be commenced at the 12 week mark, but the proceeding requirements must be achieved. Athletes undergoing the procedure may have an accelerated timetable, based on the underlying pathology. Recognizing the patient's pre-operative health status and post-operative physical demands will direct both the program design and the program timetable.

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Section: Rehabilitation Guidelinesmentioning

confidence: 99%

Post-operative guidelines following hip arthroscopy

Edelstein

Ranawat

Enseki

et al. 2012

Curr Rev Musculoskelet Med

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“…Hastalara iki ay boyunca antiinflamatuar ilaç verilmiş ve fizik tedavi uygulanmış, ancak bu yaklaşımın başarısız olması nedeniyle cerrahi tedaviye karar verilmişti. [7][8][9] Hastalarda, ameliyattan sonraki dönemde aynı radyolojik tetkikler aracılığıyla baş-boyun bileşkesindeki rezeksiyon alanları ile avasküler nekroz gelişme riski değerlendirildi. Ameliyattan sonra aynı gün sürekli pasif hareket [continuous passive motion (CPM)] ile pasif olarak 70 dereceye kadar kalça hareketleri ve aktif kuadriseps egzersizleri başlandı.…”

Section: Gereç Ve Yöntemlerunclassified

“…Ameliyattan sonra aynı gün sürekli pasif hareket [continuous passive motion (CPM)] ile pasif olarak 70 dereceye kadar kalça hareketleri ve aktif kuadriseps egzersizleri başlandı. [7][8][9] Bir çift koltuk değneği ile tolere edebildiği kadar yük verildi. Literatürde belirtildiği gibi, beş fazlı rehabilitasyon programına, ameliyattan sonraki birinci günden itibaren başlandı.…”

Section: Gereç Ve Yöntemlerunclassified

“…Literatürde belirtildiği gibi, beş fazlı rehabilitasyon programına, ameliyattan sonraki birinci günden itibaren başlandı. [7][8][9][10] C Ce er rr ra ah hi i T Te ek kn ni ik k: : Hasta lateral pozisyonda yatı-rılarak, Gibson insizyonu ile kalçaya yaklaşım yapıldı. Trokanterik osteotomi, femur başının beslenmesini sağlayan mediyal femoral sirkumfleks arteri korumak için, eksternal obturatuar kas korunacak şekilde yapıldı.…”

Section: Gereç Ve Yöntemlerunclassified

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Analysis of Surgical Treatment Outcomes in Femoroacetabular Impingement Syndrome

Bülbül¹,

Uzun²,

Ayanoğlu³

et al. 2012

Turkiye Klinikleri J Med Sci

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Ö ÖZ ZE ET T AAm ma aç ç: : Femoroasetabular sıkışma sendromu (FASS) olan hastalarda kalça dislokasyonu ile güvenli rekonstrüksiyon uyguladığımız olguların klinik sonuçlarını değerlendirmeyi amaçladık. G Ge er re eç ç v ve e Y Yö ön n--t te em ml le er r: : 2006-2009 yılları arasında, kalça displazisi saptanmayan, FASS tanısı alan, ön sıkışma testi (anterior impingement sign) pozitif olan 13 erkek hasta çalışmaya dâhil edildi. Beş olguda arka sıkışma testi de pozitif olarak değerlendirildi. Ortalama yaş 39,3 (aralık 32-47) idi. Tüm olguların ameliyattan önce ve sonra kalça antero-posterior ve false profil grafileri çekildi. Ameliyattan önceki dönemde, olguların tümünde femur tipi, birinde ise eşlik eden asetabulum tipi sıkışma mevcuttu. Tüm olguların radyolojik incelemesinde asetabulum arka duvarı yetmezliği ve "cross-over" bulgusu mevcuttu. Olgular, Harris kalça skorlaması ile fonksiyonel açı-dan değerlendirildi. Cerrahi dislokasyon, Ganz ve ark.nın tarif ettiği şekilde uygulandı. Trokanterik osteotomi hattı iki adet kanüllü vida ile tespit edildi. B Bu ul lg gu ul la ar r: : Ameliyat sırasında tüm olgularda femoral sıkışma nedeni ortadan kaldırıldı. Hastaların yalnızca birinde asetabulum tipi lezyonu, labrumda tam dejenerasyonu ve ayrışması mevcuttu; bu hastada labrum rezeksiyonu gerekli oldu. Hiçbir olguda trokanterik osteotomiden sonra kaynamama gözlenmedi. Ameliyattan önce Harris kalça skoru ortalaması 63,24 (aralık 55-70) olan 13 olgunun, ameliyattan iki yıl sonra skor ortalamasının 89,75 (aralık 72-98) düzeyine yükselmiş olduğu saptandı. Wilcoxon Signed Ranks testi ile yapılan istatistiki değerlendirme, hastaların Harris skorlamalarının ameliyattan önceki ve sonraki değerleri arasındaki farkın son derece anlamlı (p<0,001) olduğu tespit edildi. Tüm olgularda, ameliyattan sonraki dönemde sıkışma testleri negatif olarak tespit edildi. S So on nu uç ç: : Güvenli kalça luksasyonu ile FASS olgularının cerrahi tedavisinin sonuçlarının ümit verici olduğu kanısına vardık. FASS olgularında komplikasyon/klinik düzelme oranının, klinik düzelme lehine olması nedeniyle, güvenli cerrahi dislokasyonun, tedavi için uygun bir yöntem olduğunu düşünüyoruz.A An na ah ht ta ar r K Ke el li im me el le er r: : Kalça; kalça eklemi; osteoartrit,kalça; femoracetabular sıkışma A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : We aimed to investigate the clinical outcomes of femoroacetabular impingement syndrome (FAIS) cases who underwent reconstruction with safe hip dislocation. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Between 2006 and 2009, 13 male cases diagnosed with FAIS, whose anterior impingement sign was positive without hip dysplasia were included in the study. Posterior impingement test was positive in five cases. Mean age was 39.3 years (range 32-47). Pre-and post-surgical radiological investigation included hip antero-posterior and false profile x-rays in all cases. In the preoperative period, all cases had femur type impingement except one case with acetabulum type impingement. Radiological inve...

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“…7,12,13,17,47,50 Manual therapy for the treatment of joint stiffness is often mentioned but not well described in these publications. While Hoeksma et al, 21 MacDonald et al, 33 and Howard and Levitsky 23 have all demonstrated significant improvements in hip range of motion (ROM), pain ratings, and Harris hip scores 22 when using a manual physical therapy approach to treat hip osteoarthritis, to the authors' knowledge, there are no published case reports or clinical trials demonstrating the effectiveness of manual therapy in patients following labral/FAI repair.…”

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confidence: 99%

The Use of Manual Therapy Post–Hip Arthroscopy When an Exercise-Based Therapy Approach Has Failed: A Case Report

LeBeau

Nho²

2014

J Orthop Sports Phys Ther

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A number of publications describe postoperative rehabilitation following hip arthroscopic procedures. 7,12,13,17,47,50 Manual therapy for the treatment of joint stiffness is often mentioned but not well described in these publications. While Hoeksma et al, 21 MacDonald et al, 33 and Howard and Levitsky 23 have all demonstrated significant improvements in hip range of motion (ROM), pain ratings, and Harris hip scores 22 when using a manual physical therapy approach to treat hip osteoarthritis, to the authors' knowledge, there are no published case reports or clinical trials demonstrating the effectiveness of manual therapy in patients following labral/FAI repair.The purpose of this case report was to describe a multimodal manual therapy approach used with a patient who had undergone labral repair with FAI decompression and initially responded poorly to an exercise-based treatment approach postsurgery. The approach described consisted of a combination of soft tissue and joint mobilization, trigger point dry needling, and specific neuromuscular rehabilitation to restore hip function, reduce pain, and improve functional outcomes. CASE DESCRIPTIONT he patient was a 30-year-old female surgical resident specializing in the ear, nose, and throat. She reported a 2-year history of anterior lateral hip pain with insidious onset. The patient denied having a history of low back pain or lumbar radiculopathy prior to onset of her hip pain. The diagnosis of labral tear was made by the third orthopaedic surgeon she had consulted. Magnetic resonance arthrography and fluoroscopy indicated a labral tear in the anterior superior aspect of the hip, with a focal cam lesion and reactive pincer lesion. After a lack of improvement with conservative care that consisted of activity modification and steroid injections, the patient underwent arthroscopic surgery for labral repair, acetabular trimming, and femoral osteochondroplasty.Postsurgical management for the first 3 weeks consisted of reduced weight bearing, bracing, and hip ROM exercises. Twenty days postsurgery, the patient returned to her highly demanding occupation, which required prolonged standing and walking with limited rest. At that time, she discontinued the use of her brace and progressed to a cane for ambulation.Upon her return to work, the patient reported an exacerbation of hip pain with the increased activity level. The physical therapy interventions she received at that time appeared to deviate from published protocols by progressing resistance exercise too quickly and not sufficiently addressing soft tissue and joint mobility deficits. She reported increased pain during and after physical therapy treatment. At her 6-week follow-up postsurgery, the surgeon noted being concerned about her elevated pain levels and limited recovery. Additional therapy was prescribed to address soft tissue tightness as a potential cause of her symptoms. The patient continued to perform her demanding duties as a surgical resident and to experience elevated pain levels, gait abnormalities, and...

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Rehabilitation Following Hip Arthroscopy

Cited by 93 publications

References 14 publications

Post-operative guidelines following hip arthroscopy

Post-operative guidelines following hip arthroscopy

Analysis of Surgical Treatment Outcomes in Femoroacetabular Impingement Syndrome

The Use of Manual Therapy Post–Hip Arthroscopy When an Exercise-Based Therapy Approach Has Failed: A Case Report

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