Hip Resurfacing and Arthroscopy Rehabilitation

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Hip Resurfacing and Arthroscopy Rehabilitation

• Sharon Helsby MCSP Chartered Physiotherapist
• And
• Dallas Newton MCSP
• Chartered Physiotherapist

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Role of the Physiotherapist

• Pre-operative guidance and information
• Guide rehabilitation
• Motivation
• Support
• Facilitate Discharge

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Stages of Rehabilitation

• Stage 1
• Day 1 Day 5/7 Post op
• Initial contact and explanation of rehabilitation
• Safe transfers from bed-chair-walking
• Increasing mobility and exercise tolerance
• Stairs
• Gait re-education (walking aids)
• Teaching of home exercise programme

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Home Exercises

• Circulation exercises
• Range of motion exercises in supine and standing
• Extension Gluteus Maximus
• Flexion Iliopsoas
• Hip Abduction Gluteus Medius
• Teach basic core stability HEP TA and Psoas

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Stages of Rehabilitation

• Stage 2
• 2 weeks 4 weeks
• Re-evaluation of ROM exercises
• Improve ROM
• Muscle strength testing
• Improve muscle strength and control and
  personalise the exercise programme to the patient
• Gait Education/Walking Aids
• Exercise tolerance

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Stages of Rehabilitation

• Stage 3
• 4 weeks 6 weeks
• Fine tune dynamic stability specific muscle
  improvement.
• Proprioception
• Core Stability
• Exercise Tolerance

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Aims of the Rehabilitation Programme

• Restore normal range of active and passive
  movement
• Restore dynamic stability of the muscles in the
  lumbar/pelvic/hip region
• Restore balance and proprioception
• To regain normal functional ability for the
  individual patient

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1. Restore Normal ROM

• Mobilising exercises
• Manual Mobilisations
• Muscle lengthening techniques (sustained stretch)
• Muscle energy techniques

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2. Restore Dynamic Stability

• Facilitate muscles that act as local stabilisers
  and those that act as global stabilisers of the
  pelvis on the weight bearing leg
• Failure causes gait abnormalities
• -Antalgic
• -Trendellenburg (glut medius)
• -Glut maximus gait

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3. Balance and Proprioception

• Impulses originating from joints, muscles,
  tendons and deep tissue
• Processed by the CNS to provide information
  about joint position, motion, vibration and
  pressure
• This is the process by which the body can vary
  muscle contraction in immediate response to
  incoming information regarding external forces.

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3.Balance and Proprioception

• Wobble-boards
• PNF stretches and exercises
• Swiss Balls Core stability

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Strength and ROM Exercises

• Hip Abduction
• Aim to increase strength and dynamic stability of
  the hip through increased strength of Gluteus
  Medius.
• Proximal stability and control
• Pelvis control

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Strength and ROM Exercises

• Hip Abduction
• Aim to increase strength and dynamic stability of
  the hip through increased strength of Gluteus
  Medius.
• Proximal stability and control
• Pelvis control

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Strength and ROM Exercises

• Hip Abduction
• Aim to increase strength and dynamic stability of
  the hip through increased strength of Gluteus
  Medius.
• Proximal stability and control
• Pelvis control

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Strength and ROM Exercises

• Hip Flexion
• Improve functional range of motion and strengthen
  Ilio Psoas
• Control of Trunk on Pelvis movement

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Strength and ROM Exercises

• Hip Flexion
• Improve functional range of motion and strengthen
  Ilio Psoas
• Control of Trunk on Pelvis movement

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Strength and ROM Exercises

• Hip Extension
• Strengthen the gluteus maximus muscles and
  improve gait
• Dynamic stability

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Strength and ROM Exercises

• Hip Extension
• Strengthen the gluteus maximus muscles and
  improve gait
• Dynamic stability

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Strength and ROM Exercises

• Hip Extension
• Strengthen the gluteus maximus muscles and
  improve gait
• Dynamic stability

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Strength and ROM Exercises

• Hip Extension
• Strengthen the gluteus maximus muscles and
  improve gait
• Dynamic stability

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Discharge Criteria

• Full weight-bearing gait without walking aids
• Good hip stability/control absence of Gait
  disturbances.
• Good proximal stability and muscle strength
• Full/Functional Pain free ROM
• Advise patient to continue with exercise
  programme for up to 6 months.
• 6 weeks of physiotherapy prior to discharge,
• may require more if returning to a specific
  sport

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Resurfacing vs THR

• Ease of movement - ROM
• Confidence in the prosthesis
• Less pain
• Mobility progress
• No precautions
• Dynamic Stability
• Return to activity quicker

• Limited ROM slower progress
• Initially apprehensive
• More painful
• Mobility takes longer
• Combined movement limitations
• Less Stability
• Slow return

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• Hip Arthroscopy Rehabilitation

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Aims of Physiotherapy

• Address pattern of recruitment of muscles
  involved in hip movement
• Restore normal range of movement and gait pattern
• Increase core stability and proprioception
  (balance reactions)
• Return patient to previous lifestyle/sport

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Stage 1 (immediate Rehabilitation)

• This should be followed whilst the patient is
  using walking aids, and may last 2 days -gt 6
  weeks dependent on the level of surgical
  intervention.

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Exercises during Stage 1 aim to

• Restore range of movement
• Maintain muscle function
• Allow tissue healing and pain to settle

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Exercises (Stage 1)

• Range of movement (flex, ext abd)
• Begin core stability HEP
• TA setting
• Pelvis tilting with TA control
• Gentle stretches ( quads, hams, piriformis)
• Bent knee fallout with theraband
• Static Quads, Hams, Gluts etc.

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Precautions

• Do not push through hip flexor pain
• May need to keep to specific range of movement
  restrictions
• May need to keep to specific weight bearing
  restrictions

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Criteria for progression to stage 2

• Minimal pain with stage 1 exercises
• ROM (85 of uninvolved side)
• Correct muscle recruitment patterns for initial
  exercises
• Do not progress until patient is fully weight
  bearing

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Stage 2 (Intermediate Rehabilitation)

• Exercises taught at this stage are aimed at
• restoring and maintaining movement
• promoting normal walking patterns
• strengthening muscles
• improving balance reactions
• There is a strong focus on core stability work
  at this stage.

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Exercises (stage 2)

• Cycling (stationary bike) low resistance
• Swimming (no breast stroke)
• -front crawl
• -kicking with float
• Progression of core stability HEP
• -Bridging
• -Heel slides
• Proprioception Work

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Exercises (Stage 2)

• Strengthening with theraband
• -Flex, ext, abd, add, int/ext rot, PNF patterns
• Side stepping
• Stretches (Piriformis, ITB, Quads, Hams etc)
• Passive Stretches/ Joint mobilisations
• Gait Reeducation

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Precautions

• No forced stretching
• No treadmill use
• Avoid inflammation of anterior structures of hip

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Criteria for progression to stage 3

• Full ROM
• Pain free / normal gait pattern
• Hip strength 70 of uninvolved side

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Stage 3 (Advanced Exercises)

• The goals at this stage are the restoration of
  muscular and cardiovascular endurance, and the
  improvement of balance reactions.
• Return to social sport should be possible at
  this stage.

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Exercises (stage 3)

• Gradually build up gym routine to pre-injury
  level
• -Cross trainer
• -Stepper
• -Cycling
• Introduce gentle jog and gradually build up time
  and intensity

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Exercises (Stage 3)

• Introduce Ball work, Starting with a light ball
  and gradually introduce full size ball with
  drills
• Lunges

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Criteria for progression to stage 4

• Cardiovascular fitness equal to pre-injury level
• Demonstrates no faulty muscle recruitment
  patterns during stage 3 exercises
• Hip strength 80 of uninvolved side

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Stage 4 (sport specific training)

• Not all patients require rehabilitation to this
  level.
• Those who take part in competetive sport will
  certainly benefit from further strengthening and
  more sport specific exercises.
• Training regimens should be developed in
  conjunction with sports club physio /personal
  trainer.

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Stage 4 (Sports specific Training)

• Speed
• Endurance
• Plyometrics
• Advanced proprioception exercises
• Multidirectional
• Full sport specific training can begin

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Criteria for return to full competition

• Full, painfree range of movement
• Hip strength gt90 of the uninvolved side
• Ability to perform sport specific drills at full
  speed without pain

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Conclusion

• Physiotherapy is an integral part of the process
  of recovery for patients undergoing any hip
  surgery in order to restore
• -Movement
• -Strength
• -Core stability
• -Proprioception
• -Function

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THANK YOU

• Sharon Helsby MCSP
• Chartered Physiotherapist
• One Health Physiotherapy,Windsor