Variability in Physical Therapy Protocols After Hip Arthroscopy

Background: Hip arthroscopy remains one of the fastest-growing procedures in orthopaedic surgery, with an 85% increase in procedure frequency from 2011 to 2018. There is agreement on the need for physical therapy after hip arthroscopy and a strong literature base on various modalities that can be implemented to aid recovery. Yet, little continuity exists among institutions on rehabilitation prescriptions. Purpose: To identify common trends and the vast variability in publicly available physical therapy protocols after hip arthroscopy. Study Design: Cross-sectional study. Methods: Inclusion in protocol collection was based on the 175 Accreditation Council for Graduate Medical Education–accredited orthopaedic surgery programs and their affiliated surgeons. Rehabilitation protocols were collected utilizing a web-based search engine (Google.com) using the input “[Insert Program Name] hip arthroscopy rehabilitation protocol.” Each protocol was analyzed for variability in brace utilization, weightbearing restrictions, range of motion (ROM) restrictions, exercise implementation, and duration for each phase and modality of rehabilitation. Results: Of the 175 programs, only 36 unique rehabilitation protocols were publicly available from 41 (23.4%) programs. Thirteen (36.1%) protocols required brace usage with a mean duration of 3.2 weeks. Weightbearing restrictions had the largest variability, ranging from full body weight to just 20 pounds of pressure. ROM restrictions were inconsistent among the 36 protocols with varying views on duration and degree of ROM restriction for various hip rotations. Exercise implementation varied from phase to phase of recovery with little agreement between protocols. Variability in time to return to various levels of activity also existed among the protocols analyzed. Conclusion: There is a significant amount of variability that exists within the publicly available hip arthroscopy rehabilitation protocols concerning brace wear, weightbearing restrictions, ROM restrictions, and exercise prescriptions. More work must be done to standardize rehabilitation protocols based on defined criteria and identify which factors have the greatest effect on patient recovery to maximize patient outcomes.