Arthroscopic Hip Surgery for Femoroacetabular Impingement
Copyright © 2020 The Brigham and Women's Hospital, Inc., Department of Rehabilitation Services. All rights reserved
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Departments of Rehabilitation Services and Orthopaedic Surgery
Post-operative Rehabilitation Protocol following Arthroscopic
Hip Surgery for Femoroacetabular Impingement
Hip preservation surgery has become an increasingly common procedure to address a number of intra-
articular hip disorders including labral tears and femoroacetabular impingement. The number of hip
arthroscopies has increased greatly in the past decade. With this increase in number of surgeries have
come advancements and refinements in surgical techniques and increasingly complex considerations for
rehabilitation needs. Hip arthroscopies with labral repair and FAI correction are typically a successful
procedure with improvements in function (mHHS) and pain (VAS) typically seen in patients at 3, 6, and
12 months.
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This rehabilitation protocol has been written with consideration of current surgical techniques and
avoidance of post-operative complications. Proper rehabilitation to avoid post-operative adhesions, and
appropriate weight bearing, along with manual therapy to manage post-operative impairments are all
important factors to consider in order to minimize the risk of adverse outcomes. The rationale for aspects
of this protocol is provided in the following paragraphs to increase clinician knowledge and
understanding. Since surgical techniques and procedures can vary for each patient, the clinician should
obtain and read the detailed operative report in order to gain a full understanding of what must be
considered in the post-operative period.
Consideration for tissue quality, bone quality, success of repair, and surgical technique should be assessed
and considered by the clinician. Avoidance of irritation and inflammation in the post-operative phase is
imperative. In the first phase of rehabilitation the focus is to protect the repair and avoid irritation. Gluteal
isometrics have been shown to be helpful in decreasing iliopsoas spasm and preventing anterior hip pain
and are therefore initiated in Phase I of the protocol.
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One surgical technique that merits special consideration in post-operative rehabilitation is capsular
closure. Capsular closure is performed to restore the normal anatomy and minimize the risk of post-
operative issues with instability. With the capsular repair closure technique, it is necessary to protect and
limit hip external rotation and extension in the early healing phase to protect the integrity of the repair.
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Capsular integrity has been correlated to improved outcomes after hip arthroscopy with FAI correction.
Additionally, the clinician should consider whether the labrum was repaired or reconstructed. If the labral
tissue is inadequate the surgeon may reconstruct the labrum using an autograft or allograft. This
information can be accessed in the operative note and will impact rehabilitation.
The evidence for manual therapy after hip arthroscopy is developing. It is thought that manual therapy to
the musculature and joints around the hip joint helps to decrease nociceptive input and address
impairments that develop in the pre and post-operative period, thereby decreasing abnormal forces to the
hip joint and improving patient outcome.
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In order to protect the integrity of the labral repair or
reconstruction, capsular repair, and protect the fluid seal, long axis hip distraction should not be
performed until 8 weeks after labral repair and 12 weeks after labral reconstruction. Joint mobilizations of
grade III-IV should not be performed until 8 weeks postoperatively for the aforementioned reasons.