Post-op Protocol - Hip Arthroscopy

Precautions:

• No forceful stretching or ROM
• Modify sitting position to avoid hip flexion past 90 deg
• No flexion, adduction, or extension SLR’s

Weight-bearing:

• Crutches and Foot Flat WB with up to 10% Body Weight x 3 weeks, then gradual progression to Full WB when able to ambulate without pain or a limp

Range of Motion (ROM):

• Flexion: 90 deg
• Extension: 0 deg
• Abduction: 25 deg
• External rotation: 25 deg at 0 deg flexion
• Internal rotation: 10 deg at 0 deg flexion
• At week 3, gradual progression to full and painfree ROM

Therapeutic Exercises/Neuromuscular Re-education: 

• Glute, quad, and hamstring isometrics
• Foot and ankle stretching and strengthening
• OKC knee flexion in prone
• Transversus abdominis activation
• Prone lying x 1-2 hours per day
• Initiate Week 3:
  • Hip IR/ER isometrics, pelvic tilts, double leg bridges, clamshells, double leg press/shuttle 0-60 deg hip flexion, standing hip abduction, quadruped rocking

Stationary Bike:

• Upright stationary bike with no to light resistance

Manual Therapy and Modalities:

• Soft tissue massage
• Beginning week 3: Grade 1 posterior capsule and long axis distraction; No Anterior mobilizations until week 6
• Passive hip circumduction (2 times per day) for 5 minutes
• Small circles, clockwise and counterclockwise, in 30 degrees of hip flexion
• Cryotherapy (ice)

Progression Criteria:

• Near full ROM
• Minimal Pain
• Full weight-bearing

Precautions:

• No forceful stretching or ROM
• No flexion, adduction, or extension SLR’s

Weight-bearing:

• Progress to Full weight-bearing when able to ambulate without a limp

Range of Motion (ROM):

• Gradual progression to full and painfree ROM
• Hip flexibility as needed based on patient tolerance (hip flexor, piriformis, quad, hamstring, Iliotibial band)

Therapeutic Exercises/Neuromuscular Re-education:

• Initiate CKC strengthening
• Mini squats, step ups, step downs, etc.
• Progress core, glute, and hip strength
• Tall and half kneeling core strengthening, planks (modified progressing to full prone and side planks), lateral and backward walking (without resistance, progressing to banded resistance), quadruped rocking
• Cardio: Upright stationary bike, aquatic PT

Manual Therapy and Modalities:

• Scar massage, soft tissue mobilization, and low grade hip joint mobilizations
• Cryotherapy (ice)

Progression Criteria:

• Full and painfree ROM
• Painfree, non-antalgic gait
• Hip Strength >80% of the uninvolved side

Precautions:

• No forceful stretching or ROM
• No running/jogging/plyometrics

Therapeutic Exercises/Neuromuscular re-education:

• Progress previous core and hip strength and endurance exercises in all planes
  • Progression of lunges, squats, single leg squats, dead lifts 
• Single leg proprioception
• Flexibility as needed
• Cardio
  • Upright stationary bike, treadmill walking

Manual Therapy and Modalities: 

• Scar massage, soft tissue mobilization, and low grade hip joint mobilizations as needed
• Cryotherapy (ice) as needed

Progression Criteria:

• Full and pain free ROM
• Pain free, non-antalgic gait
• Hip Strength >80% of the uninvolved side
• Lower quarter y balance test (<4 cm difference compared to uninvolved side) 
• Demonstration of exercises with proper body mechanics

Precautions:

• Gradual progression of impact and dynamic exercises

Therapeutic Exercises/Neuro re-education: 

• Continue core and hip strengthening
• Dynamic balance and proprioception drills
• Core strengthening strength and endurance
• Work on proper form and body mechanics during dynamic activities
• Initiate sport specific skills and drills
• Cardio:
  • Progressive return to run, starting at week 12 and when criteria are met
  • Bike, elliptical, stair climber
• Plyometric/sport specific progressions
  • Agility drills, dynamic warm ups
  • Sport specific exercises
  • Double leg plyometrics with progressing to single leg/multiplane as tolerated

Criteria to Return to Sport: 

• Surgeon clearance  
• Full and pain-free ROM
• Hip strength testing >90% of the uninvolved side
• Functional hop test battery > 90% of the uninvolved test 
• Lateral hop test > 90% of the uninvolved test 
• Lower quarter anterior y balance <4 cm difference compared to the uninvolved side
• Drop vertical jump LESS <2 errors
• Patient Reported Outcome Measures: HOS, The Copenhagen HAGOS