Rehabilitation After Arthroscopic Decompression for Femoroacetabular Impingement

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Immediate postoperative rehabilitation

The goals of rehabilitation immediately after surgery are the same as the majority of other orthopedic procedures. Measures should be taken to control pain and postoperative inflammation and to provide an optimal healing environment for the joint. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed at the surgeon's discretion. Ice or compression should also be used at regular intervals. Various commercial pressurized ice compression systems are commercially available and may be

Weight-bearing progression

The primary goals of limiting the weight-bearing status of patient status post arthroscopic decompression to address FAI are to protect the vulnerable osseous tissue and provide optimal joint loading to encourage a proper healing environment. A partial weight-bearing status of approximately 20 pounds, or foot-flat, is typically assigned. Crutches are used to maintain this status. This limited weight-bearing status is typically assigned for 2 to 6 weeks depending on a variety of patient factors

Range of motion

ROM progression follows relatively basic guidelines. The first 2 weeks are considered a protective stage. ROM is initiated as tolerated with caution exerted to avoid excessive hip flexion, internal rotation, and abduction. Early excessive motion in these directions may cause inflammation of tissue in the vicinity of the joint. The amount of motion is typically guided by patients' report of discomfort. Excessive force to the femoral neck region should be avoided early in the rehabilitation

Strength

Gentle strength activities are initiated the day after surgery. These previously mentioned activities are primarily submaximal lower extremity isometrics and gentle AROM. Progression of strength activities usually begins 2 weeks after surgery. The gluteus medius muscle is of particular interest. Non–weight-bearing activities are initially used and exclusively continued until patients' weight-bearing status permits weight-bearing activities. Individuals undergoing concomitant procedures to

Functional progression

The majority of individuals undergoing arthroscopic decompression for FAI are active people. Postoperative rehabilitation programs must include the appropriate progression of functional activities to be comprehensive. Balance activities should be initiated as tolerated once tolerance to bearing full weight is established. Specific functional exercises should be dictated by the patient's goals and the specific demands of their normal activities.

Initiation of endurance activities is guided by the

Return to activity

Many factors play a role in determining the return to specific activities. The demands of an individual's specific activities, physical characteristics, tissues affected by surgery, and performance in previous stages of rehabilitation all moderate the time before being allowed to return to previous activities. Manual laborers may be allowed to return to work in 12 to 24 weeks. Athletes may return to the competitive environment in 12 to 32 weeks. In rare cases, earlier return is possible. The

Postoperative rehabilitation complications

Through clinical experience, the authors have noted several recurrent issues that occur during the rehabilitation process in the population of patients undergoing arthroscopic decompression to address FAI. The majority of these occurrences can be avoided with careful monitoring of patients' symptom presentation and adherence to the basic principles of postoperative rehabilitation protocols. Once present, these complications may be difficult to address. Often, a significant decrease of

Outcome: self-report instruments

Currently, there is not a universally accepted self-report outcome instrument used to define the result of treatment after hip arthroscopy for FAI. Several instruments are available to specifically assess individuals with musculoskeletal hip pathologies, including, the modified Harris Hip Score and Nonarthritic Hip Score.12, 13, 14, 15, 16, 17, 18 Each of these instruments has potential deficiencies that may have a negative impact on its ability to function as an outcome instrument for

Outcomes after arthroscopic decompression of femoroacetabular impingement

Overall, the outcome of hip arthroscopy in adults has been good. It is well documented, however, that the presence of articular cartilage lesions, in particular findings of osteoarthritis, have a negative impact on surgical outcomes.22, 23, 24, 25, 26, 27, 28 Outcome studies for FAI have been reviewed.1 Open techniques have been historically considered the gold standard for the treatment of FAI. When looking at scientific data for the surgical treatment of labral tears and FAI, however, the

Summary

The use of arthroscopic technology to address pathologic conditions of the hip joint has become a topic of growing interest in the orthopedic community. Addressing FAI through this method has generated additional attention. As surgical options evolve, rehabilitation protocols must meet the challenge of providing a safe avenue of recovery, yet meeting the goal of returning to often relatively high levels of functioning. Current rehabilitation concepts should be based on the growing body of

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      Furthermore, considering that hip and knee kinematics during a single-leg squat approximate kinematics during jogging tasks [13], this may be related to ongoing symptoms during physical activity. This situation may in part explain why less than 40% of our cohort reported having returned to their presurgery level of sporting activity, even though participants were at a postoperative time point when they are expected to have recovered and returned to their sport [24]. Findings also revealed greater pelvic obliquity on the surgical limb when participants were in the standing position, which indicates that participants were standing with the contralateral (non–weight-bearing) side of the pelvis elevated or hitched relative to the weight-bearing side.

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      LeBeau and Nho (2014) reported on a multimodal manual therapy approach to address soft tissue and joint restrictions, as well as neuromuscular training to restore hip function and reduce pain in a case report of an initially poor outcome following femoroacetabular impingement (FAI) and labral repair. Although post-operative rehabilitation following FAI and labral repair including the application of manual therapy to address joint stiffness has been reported (Cheatham and Kolber, 2012; Enseki et al., 2010; Garrison et al., 2007), the application is not well described. The patient underwent physical therapy following surgical repair with an emphasis on resistive strengthening exercises without ensuring restoration of joint mobility and addressing soft tissue restrictions.

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