Return to running after arthroscopic hip surgery: literature review and proposal of a physical therapy protocol

Kraeutler, Matthew J.; Anderson, Joy; Chahla, Jorge; Mitchell, Justin J.; Thompson-Etzel, Robyn; Mei-Dan, Omer; Pascual‐Garrido, Cecilia

doi:10.1093/jhps/hnx012

Cited by 14 publications

(12 citation statements)

References 18 publications

(23 reference statements)

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“…The physical examination tests we used included passive hip range of motion (supine, lateral, and prone), the flexion-adduction–internal rotation test, the flexion-abduction–external rotation test, the ligamentum teres test, the posterior impingement test, use of the Beighton hypermobility score, and subjective reports of hip instability. 15 …”

Section: Methodsmentioning

confidence: 99%

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Ramos

Kraeutler

Marty

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Despite the rapid growth in the use of hip arthroscopy, standardized data on postoperative pain scores and activity level are lacking. Purpose: To quantify narcotic consumption and use of the stationary bicycle in the early postoperative period after hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: In this prospective case series, patients undergoing a primary hip arthroscopy procedure by a single surgeon were asked to fill out a daily survey for 9 days postoperatively. Patients were asked to report their pain level each day on a visual analog scale from 1 to 10, along with the amount of narcotic pain pills they used during those postoperative days (PODs). Narcotic usage was converted to a morphine-equivalent dosage (MED) for each patient. Patients were also instructed to cycle daily starting on the night of surgery for a minimum of 3 minutes twice per day and were asked to rate their pain as a percentage of their preoperative pain level and the number of minutes spent cycling on a stationary bicycle per day. Results: A total of 212 patients were enrolled in this study. Pain levels (POD1, 5.5; POD4, 3.8; POD9, 2.9; P < .0001) and the percentage of preoperative pain (POD1, 51.6%; POD4, 31.8%; POD9, 29.5%; P < .01) significantly decreased over the study period. The amount of narcotics used per day (reported in MED) also significantly decreased (POD1, 27.3; POD4, 22.3; POD9, 8.5; P < .0001). By POD4, 41% of patients had discontinued all narcotics, and by POD9, 65% of patients were completely off narcotic medication. Patients were able to significantly increase the number of minutes spent cycling each day (POD1, 7.6 minutes; POD4, 13.8 minutes; POD9, 19.0 minutes; P < .0001). Patients who received a preoperative narcotic prescription for the affected hip were significantly more likely to require an additional postoperative narcotic prescription ( P < .001). Conclusion: Patients can expect a rapid decrease in narcotic consumption along with a high degree of activity tolerance in the early postoperative period after hip arthroscopy.

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Section: Methodsmentioning

confidence: 99%

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Ramos

Kraeutler

Marty

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…From 2015 to December 2017, only MF was carried out as treatment of chondral defects. Patients were treated a rehabilitated using the Steadman recommended post-operative protocol [ 18 , 19 ]. From January 2018 onwards, BR was adopted as the treatment method for all chondral lesions and this allowed for a facilitated bilateral sequential surgery, enhanced recovery protocol.…”

Section: Methodsmentioning

confidence: 99%

Autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate compared with microfracture for arthroscopic treatment of femoroacetabular impingement and chondral lesions of the hip: bridging the osteoarthritis gap and facilitating enhanced recovery

Sobti

Baryeh

Woolf

et al. 2020

Journal of Hip Preservation Surgery

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In an attempt to bridge the osteoarthritis (OA) gap, this study compared biological reconstruction with traditional microfracture (MF) techniques in patients with femoroacetabular impingement and focal cartilage defects. Cohorts of two groups were investigated; age, gender and Tonnis grade matched comparison for outcomes between MF and newer biological reconstruction techniques hip arthroscopy surgery using autologous matrix-induced chondrogenesis and bone marrow aspirate combination. Outcomes investigated were pre-op and post-op mean iHOT-12 scores up to 18 months after surgery with a Kaplan–Meier survivorship analysis. Of 111 patients, 46 patients underwent MF and 65 biological reconstruction hip arthroscopy including cam/pincer osteoplasty and labral repair surgery. Age range was 20–69, mean age 45 years for both groups, Tonnis grading was as follows: Grade 0: 26% versus 30%, Grade 1: 52% versus 47% and Grade 2: 22% versus 23% in MF and biological reconstruction groups, respectively. The mean post-operative iHOT-12 score differences between MF and biological reconstruction were significant at 1-year minimum follow-up (P = 0.01, SD 2.8). Biological reconstruction allowed for an enhanced recovery protocol. The MF group had a 67.4% survivorship for conversion to hip replacement at 18 months (32.6% failure rate for any reason) and biological reconstruction had 100% survivorship at 18 months post-operatively with no failures for any reason. This study provides further support to the evidence base for biological reconstructive techniques as superior to MF in combination with joint preservation arthroscopic surgery, even in the face of focal cartilage defects and offers both surgeons and patients a potential bridging of the OA gap.

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“…Advancing to the next phase usually depends on the achievement of certain goals and timelines are better used as a guideline. Kraeutler et al 59 provide an excellent review and discussion of published protocols along with specific recommendations for patients who want to return to running or high-impact activities. They mention that return to sport is usually between 12 and 20 weeks post-operatively; however, it depends on the procedure performed and the sport.…”

Section: Hip Arthroscopymentioning

confidence: 99%

Hip arthroscopy for femoroacetabular impingement

Nasser

Domb

2018

EFORT Open Reviews

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The purpose of this article is to give a general overview of femoroacetabular impingement (FAI) and how it could be treated arthroscopically, with some details about indications, the procedure itself and some of the complications associated with the surgery.FAI is a dynamic condition of the hip that can be a source of pain and disability and could potentially lead to arthritis.When symptomatic, and if conservative treatment fails, FAI can be addressed surgically.The goal of surgical treatment for FAI is to recreate the spherical contour of the femoral head, improve femoral offset, normalize coverage of the acetabulum, repair/reconstruct chondral damage and repair/reconstruct the labrum to restore normal mechanics and joint sealing.Advances in equipment and technique have contributed to an increase in the number of hip arthroscopy procedures performed worldwide and have made it one of the more common treatment options for symptomatic FAI.Hip arthroscopy is a procedure with an extremely steep and long learning curve.Cite this article: EFORT Open Rev 2018;3:121-129. DOI: 10.1302/2058-5241.3.170041

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Return to running after arthroscopic hip surgery: literature review and proposal of a physical therapy protocol

Cited by 14 publications

References 18 publications

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate compared with microfracture for arthroscopic treatment of femoroacetabular impingement and chondral lesions of the hip: bridging the osteoarthritis gap and facilitating enhanced recovery

Hip arthroscopy for femoroacetabular impingement

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