ARTHROSCOPY WITH FEMORAL NECK DEBRIDEMENT
PROTOCOL
Overall Goal: Brief rehabilitation with education on signs and symptoms of overuse and
modification of activity to avoid pain.
This protocol is based on goal oriented progression. Each patient is different and should be treated
according to the tolerance in therapy.
Impact activity should not begin until at least 6 weeks postoperative (i.e. running, jumping,
stairmaster) and should be started only when the patient exhibits a nearly full passive and active
range of motion of the hip. Particular attention should be paid to the improvement of passive and
active internal rotation of the hip. In addition due to the weakened proximal femur as a result of neck
debridement, the patient should be flat foot weight bearing with crutches for 1-2 weeks following the
procedure.
I: Initial Phase:
Goals: Begin range of motion within tolerance, decrease swelling and pain, retard muscle atrophy.
Day of surgery: Begin isometric gluteal sets and ankle pumps.
A. Postoperative days 1-7:
1. Flat foot weight bearing with crutches.
2. Continue partial weight bearing for 1-2 weeks and then progress to full weight
bearing.
3. Immediate postoperative exercises: Isometric quad sets, gluteal sets, hamstring
sets, abductor sets, adductor sets.
4. Active assisted range of motion in all planes without pain. Hip immobilization is
beneficial in decreasing pain and increasing range of motion with straight
distraction.
5. Inferior glide and posterior glide exercises as tolerated.
6. Closed chain bridging, weight shift, balancing drills.
7. Open chain abduction, adduction, flexion, extension, resistance as tolerated.
8. Pool exercises; water resisted toning, swimming and walking drills.
9. Avoid straight leg raises.
10. Gentle toning exercises can begin as early as week 1 as long as patient is pain
free and remains pain free for exercises.
II: Early Phase:
Goals: Regain and improve muscular strength and normalize joint arthrokinematics.
A: Postoperative weeks 2-3
1. Continue to progress range of motion with gradual end range stretch within
tolerance.
2. Begin progressive resisted exercises as tolerated.
A: Closed chain single leg bridging.
B: Open chain above knee resisted Theraband or pulley exercise in
flexion, extension, adduction, abduction, hamstring curl as
tolerated.
C: Bike as tolerated for 5-10 minutes.
D: Pool exercises as indicated.
3. No impact or repetitive twisting activities.
III: Intermediate Phase:
Goals: Improve functional strength and endurance without high impact.
A: Postoperative weeks 4-6.
1. Progressive weight bearing as tolerated. Continue flexibility exercises.
2. Continue to progress resisted strengthening and functional strengthening
exercises.
B: Closed chain exercises as tolerated of multi-hip strengthening,
hamstring curls, knee extension.
C: Open chain activities as tolerated.
D: Continue to increase biking as tolerated.
IV: Advanced Phase:
Goals: Return to functional activity and sports specific motions.
A: Postoperative weeks 7-12.
1. Begin progression to functional activities.
2. Pivoting and rotational (high impact activities gradually introduced).
3. No pain. Predicated on normal range of motion prior to institution of activities.
V: Return to Full Activities weeks 8-12, as tolerated.
VI: Sports Activities at 12-16 weeks.
ARTHRITIC PATIENTS: DO NOT PUSH TO GAIN MOTION. LIMITED PAIN FREE
MOTION IS ACCEPTABLE.