The Journal of Hip Surgery 2018; 02(04): 189-193
DOI: 10.1055/s-0038-1676448
Special Section Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Rehabilitation for Femoroacetabular Impingement: Conservative Care and Postoperative Practice

Mia S. Hagen
1   Department of Orthopaedic Surgery - Sports Medicine, University of Washington Medical Center, Seattle, Washington
,
Robert W. Westermann
2   Department of Sports Medicine, University of Iowa, Iowa City, Iowa
,
T. Sean Lynch
3   Department of Orthopaedics, Columbia University Medical Center, New York, New York
,
James Rosneck
4   Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Garfield Heights, Ohio
› Author Affiliations
Further Information

Publication History

18 January 2018

12 October 2018

Publication Date:
10 January 2019 (online)

Abstract

The understanding of femoroacetabular impingement (FAI) has increased over the past 10 years, with advancements in diagnosis and surgical techniques. Controversy remains regarding the ideal regimen of conservative care. Additionally, there is wide variety in postoperative clinical practice after hip arthroscopy. This review is a synthesis of resources on rehabilitation as a stand-alone treatment for FAI as well rehabilitation following surgery. Best evidence regarding conservative care is presented followed by postoperative debates on weight-bearing, range of motion, and physical therapy. In most cases, such as use of bracing and continuous passive motion, there are limited experimental studies to rely on. Higher quality evidence is required to support today's rehabilitation practices which are based mostly on theory and individual experience.

 
  • References

  • 1 Truntzer JN, Shapiro LM, Hoppe DJ, Abrams GD, Safran MR. Hip arthroscopy in the United States: an update following coding changes in 2011. J Hip Preserv Surg 2017; 4 (03) 250-257
  • 2 Montgomery SR, Ngo SS, Hobson T. , et al. Trends and demographics in hip arthroscopy in the United States. Arthroscopy 2013; 29 (04) 661-665
  • 3 Maradit Kremers H, Schilz SR, Van Houten HK. , et al. Trends in utilization and outcomes of hip arthroscopy in the United States between 2005 and 2013. J Arthroplasty 2017; 32 (03) 750-755
  • 4 Palmer AJR, Malak TT, Broomfield J. , et al. Past and projected temporal trends in arthroscopic hip surgery in England between 2002 and 2013. BMJ Open Sport Exerc Med 2016; 2 (01) e000082
  • 5 Griffin DR, Dickenson EJ, O'Donnell J. , et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 2016; 50 (19) 1169-1176
  • 6 Cvetanovich GL, Lizzio V, Meta F. , et al. Variability and comprehensiveness of North American online available physical therapy protocols following hip arthroscopy for femoroacetabular impingement and labral repair. Arthroscopy 2017; 33 (11) 1998-2005
  • 7 Draovitch P, Edelstein J, Kelly BT. The layer concept: utilization in determining the pain generators, pathology and how structure determines treatment. Curr Rev Musculoskelet Med 2012; 5 (01) 1-8
  • 8 Emara K, Samir W, Motasem H, Ghafar KA. Conservative treatment for mild femoroacetabular impingement. J Orthop Surg (Hong Kong) 2011; 19 (01) 41-45
  • 9 Wall PD, Fernandez M, Griffin DR, Foster NE. Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature. PM R 2013; 5 (05) 418-426
  • 10 Wall PD, Dickenson EJ, Robinson D. , et al. Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial. Br J Sports Med 2016; 50 (19) 1217-1223
  • 11 Griffin DR, Dickenson EJ, Wall PDH. , et al; FASHIoN Study Group. Protocol for a multicentre, parallel-arm, 12-month, randomised, controlled trial of arthroscopic surgery versus conservative care for femoroacetabular impingement syndrome (FASHIoN). BMJ Open 2016; 6 (08) e012453
  • 12 Griffin DR, Dickenson EJ, Wall PDH. , et al; FASHIoN Study Group. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet 2018; 391 (10136): 2225-2235
  • 13 Murphy NJ, Eyles J, Bennell KL. , et al. Protocol for a multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapy-led care for femoroacetabular impingement (FAI): the Australian FASHIoN trial. BMC Musculoskelet Disord 2017; 18 (01) 406
  • 14 Palmer AJ, Ayyar-Gupta V, Dutton SJ. , et al. Protocol for the Femoroacetabular Impingement Trial (FAIT): a multi-centre randomised controlled trial comparing surgical and non-surgical management of femoroacetabular impingement. Bone Joint Res 2014; 3 (11) 321-327
  • 15 Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. Am J Sports Med 2018; 46 (06) 1306-1314
  • 16 Domb BG, Sgroi TA, VanDevender JC. Physical therapy protocol after hip arthroscopy: clinical guidelines supported by 2-year outcomes. Sports Health 2016; 8 (04) 347-354
  • 17 Enseki KR, Martin RL, Draovitch P, Kelly BT, Philippon MJ, Schenker ML. The hip joint: arthroscopic procedures and postoperative rehabilitation. J Orthop Sports Phys Ther 2006; 36 (07) 516-525
  • 18 Inman VT. Functional aspects of the abductor muscles of the hip. J Bone Joint Surg Am 1947; 29 (03) 607-619
  • 19 Schwachmeyer V, Damm P, Bender A, Dymke J, Graichen F, Bergmann G. In vivo hip joint loading during post-operative physiotherapeutic exercises. PLoS One 2013; 8 (10) e77807
  • 20 Erickson BJ, Gupta AK, Harris JD. , et al. Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers. Am J Sports Med 2014; 42 (03) 536-543
  • 21 Rath E, Sharfman ZT, Paret M, Amar E, Drexler M, Bonin N. Hip arthroscopy protocol: expert opinions on post-operative weight bearing and return to sports guidelines. J Hip Preserv Surg 2017; 4 (01) 60-66
  • 22 Grzybowski JS, Malloy P, Stegemann C, Bush-Joseph C, Harris JD, Nho SJ. Rehabilitation following hip arthroscopy - a systematic review. Front Surg 2015; 2 (May): 21
  • 23 Jayasekera N, Aprato A, Villar RN. Are crutches required after hip arthroscopy? A case-control study. Hip Int 2013; 23 (03) 269-273
  • 24 Shaw KA, Jacobs JM, Evanson JR. , et al. Functional outcomes of hip arthroscopy in an active duty military population bearing progression. Int J Sports Phys Ther 2017; 12 (05) 840-847
  • 25 Willimon SC, Briggs KK, Philippon MJ. Intra-articular adhesions following hip arthroscopy: a risk factor analysis. Knee Surg Sports Traumatol Arthrosc 2014; 22 (04) 822-825
  • 26 Lewis CL, Sahrmann SA, Moran DW. Anterior hip joint force increases with hip extension, decreased gluteal force, or decreased iliopsoas force. J Biomech 2007; 40 (16) 3725-3731
  • 27 Freeman S, Mascia A, McGill S. Arthrogenic neuromusculature inhibition: a foundational investigation of existence in the hip joint. Clin Biomech (Bristol, Avon) 2013; 28 (02) 171-177
  • 28 Pierce CM, Laprade RF, Wahoff M, O'Brien L, Philippon MJ. Ice hockey goaltender rehabilitation, including on-ice progression, after arthroscopic hip surgery for femoroacetabular impingement. J Orthop Sports Phys Ther 2013; 43 (03) 129-141
  • 29 Edelstein J, Ranawat A, Enseki KR, Yun RJ, Draovitch P. Post-operative guidelines following hip arthroscopy. Curr Rev Musculoskelet Med 2012; 5 (01) 15-23
  • 30 Philippon MJ, Decker MJ, Giphart JE, Torry MR, Wahoff MS, LaPrade RF. Rehabilitation exercise progression for the gluteus medius muscle with consideration for iliopsoas tendinitis: an in vivo electromyography study. Am J Sports Med 2011; 39 (08) 1777-1785
  • 31 Austin AB, Souza RB, Meyer JL, Powers CM. Identification of abnormal hip motion associated with acetabular labral pathology. J Orthop Sports Phys Ther 2008; 38 (09) 558-565
  • 32 Safran MR, Rylander J, Shu B, Andriacchi TP. Can bracing affect altered gait patterns in femoroacetabular impingement?. Orthop J Sports Med 2013 1. (4 Suppl). Doi: 10.1177/2325967113S00050
  • 33 Newcomb NRA, Wrigley TV, Hinman RS. , et al. Effects of a hip brace on biomechanics and pain in people with femoroacetabular impingement. J Sci Med Sport 2018; 21 (02) 111-116
  • 34 Truntzer JN, Hoppe DJ, Shapiro LM, Abrams GD, Safran M. Complication rates for hip arthroscopy are underestimated: a population-based study. Arthroscopy 2017; 33 (06) 1194-1201
  • 35 Gupta A, Suarez-Ahedo C, Redmond JM. , et al. Best practices during hip arthroscopy: aggregate recommendations of high-volume surgeons. Arthroscopy 2015; 31 (09) 1722-1727
  • 36 Nugent-Derfus GE, Takara T, O'neill JK. , et al. Continuous passive motion applied to whole joints stimulates chondrocyte biosynthesis of PRG4. Osteoarthritis Cartilage 2007; 15 (05) 566-574
  • 37 Cunningham DJ, Lewis BD, Hutyra CA, Mather RC, Olson SA. Early recovery after hip arthroscopy for femoroacetabular impingement syndrome: a prospective, observational study. J Hip Preserv Surg 2017; 4 (04) 299-307
  • 38 Spencer-Gardner L, Eischen JJ, Levy BA, Sierra RJ, Engasser WM, Krych AJ. A comprehensive five-phase rehabilitation programme after hip arthroscopy for femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc 2014; 22 (04) 848-859
  • 39 Malloy P, Gray K, Wolff AB. Rehabilitation after hip arthroscopy: a movement control-based perspective. Clin Sports Med 2016; 35 (03) 503-521
  • 40 Grant LF, Cooper DJ, Conroy JL. The HAPI 'Hip Arthroscopy Pre-habilitation Intervention' study: does pre-habilitation affect outcomes in patients undergoing hip arthroscopy for femoro-acetabular impingement?. J Hip Pres Surg 2017; 4 (01) 85-92
  • 41 Diamond LE, Wrigley TV, Hinman RS. , et al. Isometric and isokinetic hip strength and agonist/antagonist ratios in symptomatic femoroacetabular impingement. J Sci Med Sport 2016; 19 (09) 696-701
  • 42 Charlton PC, Bryant AL, Kemp JL, Clark RA, Crossley KM, Collins NJ. Single-leg squat performance is impaired 1 to 2 years after hip arthroscopy. PM R 2016; 8 (04) 321-330
  • 43 Aoyama M, Ohnishi Y, Utsunomiya H. , et al. A prospective, randomized, controlled trial comparing conservative treatment with trunk stabilization exercise to standard hip muscle exercise for treating femoroacetabular impingement: a pilot study. Clin J Sport Med 2017 Doi: 10.1097/JSM.0000000000000516
  • 44 Bennell KL, Spiers L, Takla A, O'Donnell J, Kasza J, Hunter DJ, Hinman RS. Efficacy of adding a physiotherapy rehabilitation programme to arthroscopic management of femoroacetabular impingement syndrome: a randomised controlled trial (FAIR). MJ Open 2017; 7: e014658
  • 45 Kemp J, Moore K, Fransen M, Russell T, Freke M, Crossley KM. A pilot randomised clinical trial of physiotherapy (manual therapy, exercise, and education) for early-onset hip osteoarthritis post-hip arthroscopy. Pilot Feasibility Stud 2017; 4 (01) 16
  • 46 Tijssen M, van Cingel RE, Staal JB, Teerenstra S, de Visser E, Nijhuis-van der Sanden MW. Physical therapy aimed at self-management versus usual care physical therapy after hip arthroscopy for femoroacetabular impingement: study protocol for a randomized controlled trial. Trials 2016; 17 (01) 91
  • 47 Domb BG, Stake CE, Finch NA, Cramer TL. Return to sport after hip arthroscopy: aggregate recommendations from high-volume hip arthroscopy centers. Orthopedics 2014; 37 (10) e902-e905
  • 48 Wörner T, Thorborg K, Moksnes H, Eek F. Similar views on rehabilitation following hip arthroscopy among physiotherapists and surgeons in Scandinavia: a specialized care survey. Knee Surg Sports Traumatol Arthrosc 2018; 26 (08) 2519-2526
  • 49 Levy DM, Kuhns BD, Frank RM. , et al. High rate of return to running for athletes after hip arthroscopy for the treatment of femoroacetabular impingement and capsular plication. Am J Sports Med 2017; 45 (01) 127-134
  • 50 Casartelli NC, Leunig M, Maffiuletti NA, Bizzini M. Return to sport after hip surgery for femoroacetabular impingement: a systematic review. Br J Sports Med 2015; 49 (12) 819-824
  • 51 Cheatham SW, Enseki KR, Kolber MJ. Postoperative rehabilitation after hip arthroscopy: a search for the evidence. J Sport Rehabil 2015; 24 (04) 413-418