Protocol for PTs

Open Surgical Dislocation 
*may include the following concomitant procedures:acetabular rim trimming, labral tear repair, and osteochondroplasty of the head-neck junction

The following protocol has been designed as a guideline for rehabilitation after a hip open surgical dislocation procedure.  Please note that the precautions will differ depending on the exact procedure performed.  For example, if the labrum is repaired, the patient will be restricted to 70⁰ of hip flexion and toe-touch weight-bearing for 5-6 weeks.   Please communicate with the physician for exact procedure performed.   This protocol is a guideline and may be adjusted according to clinical presentation as well as the surgeon’s recommendations.
PHASE 1 (0-5 weeks post-op)
Strict Precautions:  toe-touch weight-bearing, no hip flexion greater than 70⁰ (if labrum repaired), no active hip abduction (due to trochanteric flip)
Goals:  Edema control, pain control, passive hip flexion ROM to 70⁰ (via CPM)
                                Day of surgery (hospital)
-          sit in chair for 20-30 minutes
-          CPM:  0⁰-25⁰/30⁰
      Day 1 (hospital)
-          ambulation with walker
-          CPM: 0⁰-35⁰/40⁰

         Day 2 (hospital)
-          gluteal sets and quad sets (2-3x/day until week 4)
-          CPM:  0⁰-45⁰/50⁰

         Day 3 (home)
-          CPM:  0⁰-50⁰/60⁰

         Day 4
-            CPM: 0⁰-60⁰/70⁰

          Day 5
              -       CPM:  0⁰-70⁰

*Continue CPM from 0⁰-70⁰ until Week 4

         Week 4
-          Heel slides
-          Bent knee fallouts
-          Prone knee flexion
-          Prone hip abduction
-          Prone foot push
-          Prone medial rotation
-          Prone lateral rotation
-          Quadruped rocking
-          Straddle weight shifts (10% weight bearing)
-          Standing hip abduction
-          Standing hip extension

        Week 5
-          Continue above exercises
-          Add seated knee extension
-          Add side-lying hip lateral rotation
-          Can begin aquatic therapy in deep water
               - bicycle
               - cross-country
               - half-jacks
               - heel kicks
                                          -        Ambulation with 2 crutches, 20-30% weight bearing

PHASE 2 (5-12 weeks post-op): 
Precautions may be lifted by surgeon.
Goals:  strengthening, increased weight bearing

        Week 6
-          Ambulation with 2 crutches, 50% weight-bearing
-          If clinic has a Hydro-Track®, may begin gait training

        Week 7
-          Continue exercises from phase 1
-          Gait training with one crutch
-          Resistance with deep water exercises

        Week 8
-          Upright bike (hip flexion < 90⁰)
-          Add seated active-assistive hip flexion
-          Add seated lateral rotation
-          Add active assistive hip flexion with towel
-          Add side-stepping (with plinth support)
-          Add supine hip abduction

         Week 9
-          Add active hip flexion
-          Add standing lateral rotation with Thera-Band®
-          Add prone hip abduction with Thera-Band®
           Week 10
-          Add resistance to standing hip extension and hip abduction

        Week 11
-          Add supine active hip flexion
-          Add single leg stance

              PHASE 3 (12 weeks-6 months post op)
              Goals:  full weight-bearing, restore functional strength and proprioception, improve endurance
        Weeks 12-6 months post op
-          Progress strengthening exercises
-          Include exercises to improve proprioception
-          Encourage utilization of pedometer to improve endurance
-          By week 16, patient should no longer use an assistive device for ambulation