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1st Jan

2017

Weakness and Functional Impairments Seen 1-2 Years After Hip Arthroscopy

Hip arthroscopy is a rapidly growing surgical procedure, performed for patients with femoroacetabular (hip) impingement, and labral tears.The labrum is a stabilizing cartilage ring in the hip socket. Hip impingement is believed to predispose a person to labral tears and joint osteoarthritis, i.e. wear and tear of the joint cartilage.

In the past decade, hip arthroscopy rates reportedly have increased by 18 times in the US. However, a relatively small number of orthopedic surgeons specialize in hip arthroscopy. Following surgery, physical therapy rehabilitation is typically recommended. There are, however, indications that such rehabilitation on a large scale has been less than optimal.

A group of Australian researchers recently presented a study on patients who had undergone hip arthroscopy due to labral tears and/or cartilage pathology in the hip. They found significant functional deficits in these people, 1-2 years following the surgery, as compared to people without hip pain or signs of injury.

Specifically, they scored much lower on a repeated single leg squat test, a one legged hop test, and a side plank test primarily for trunk strength testing. Of interest is, that this was also found on the non-operated side. Hip muscle weakness was also found with testing, and abductor weakness (muscles on the outside of the buttock) correlated with the functional impairments.

I have in the past written about similar weakness and functional impairments long-term following total hip replacement surgery. However, hip arthroscopy is a much less drastic procedure, and retains much of your normal anatomy, and therefore, better functional outcomes could be expected. Furthermore, hip arthroscopy is in general performed on younger people, than those who have hip replacement surgery. Consequently, these results are disappointing.

One reason for such poor functional progress long-term, may be that rehabilitation programs have been too brief or have not been progressed sufficiently. Another possible cause could be use of ineffective exercise tools, e.g. use of elastic bands or body weight only, versus use of an adjustable pulley apparatus which could allow for incremental resistance progressions over many months. Certainly, preexisting joint arthritis could contribute to long term functional deficits, but significant progress with rehabilitation should still be expected, with the exception of people with advanced arthritis (loss of joint cartilage), who ultimately would require hip replacement surgery.

Younger people, and those with essentially no arthritis seen during hip arthroscopy, should also be progressed in their rehabilitation, to include functional exercise such as one legged squats, step exercise, modified lunges, and for some athletes jumping, while ensuring optimal coordination with all movements. For those who will return to sports, failure to include such functional and sports specific training would make them more likely to sustain a re-injury or other compensatory injuries. Elite and professional athletes typically understand this, whereas recreational athletes often neglect this vital final step in rehabilitation, and are often released from physical therapy prematurely, most commonly due to insurance limitations.

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