March 1, 2011

Rehabilitation for arthroscopic treatment of FAI

Recently, several individuals have inquired about the nature of rehabilitation following an arthroscopic procedure for treatment of femoroacetabular impingement (FAI).  I reviewed the literature and found that the following article provided a nice overview of rehabilitation guidelines:

Enseki KR, Martin R, Kelly BT.  Rehabilitation After Arthroscopic Decompression for Femoroacetabular Impingement.   Clin Sports Med 2010; 29:  247-255.

This article provides general guidelines regarding the following:  immediate postoperative rehabilitation, weight-bearing progression, range of motion, strength, functional progression, and return to activity.  I have included a synopsis of the guidelines provided in the article.

Immediate postoperative rehabilitation
  • walking postoperative brace maybe utilized to limit abduction and hip flexion greater than 80 degrees (used for 1-2 weeks post-op)
  • sleeping immobilizer maybe utilized to limited external rotation
  • therapeutic exercises:  active ankle plantarflexion, isometric quadriceps setting, isometric gluteal setting, and posterior pelvic tilt
  • stationary bike can be utilized when tolerated by patient (elevate seat to avoid excessive hip flexion)
Weight-bearing progression
  • partial weight-bearing (20 pounds)  for 2-6 weeks (depends on surgical specifics)
  • gradual weening of crutches over 1-2 week period
  • aquatic therapy
Range of motion
  • 0-2 weeks:  protective stage (avoid excessive hip flexion, internal rotation, and abduction)
  • 2-4 weeks:  full passive ROM
  • 4 weeks:  gentle stretching of all hip joint musculature
  • For patients who continue to have a pinching sensation with hip flexion, the PT can apply a gentle manual caudal joint distraction during flexion or place patient in quadruped to encourage hip flexion
  • post-op day 1:  begin exercises mentioned above
  • week 2:  progression of strength activities with focus on gluteus medius (performed in non-weight bearing);  be cognizant of concomitant procedures and modify program to avoid tissue irritation
  • week 4-6:  begin weight bearing exercises:  quadriceps, hamstrings, gluteal, and lumbopelvic muscle groups
Functional Progression
  • begin balance activities once tolerance to bearing full weight is established
  • week 6-8:  weight-bearing endurance activities (elliptical or stepper machine) 
  • week 12:  jogging progression
Return to Activity
  •  week 12-24:  manual laborers may be allowed to return to work
  •  week 12-32: athletes may return to the competitive environment