Rehabilitation Strategies for Patients Following Joint Preservation - - PowerPoint PPT Presentation

Rehabilitation Strategies for Patients Following Joint Preservation Procedures

Dennis A. Cardone, DO

Department of Orthopedic Surgery

Department of Orthopedic Surgery

Disclosure

• Chief Medical Officer, New York City Public High School Athletics (PSAL)

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Department of Orthopedic Surgery

Reference

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Department of Orthopedic Surgery

Hip Preservation Procedures

• Periacetabular osteotomy
• Proximal femoral osteotomy
• Cartilage restoration
• Surgical dislocation
• Adjuvant arthroscopy
• Orthobiologics

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Department of Orthopedic Surgery

Rehabilitation for Hip Preservation Procedures

Challenges and considerations

• Severity of intra-articular hip disease
• Technical strategies of the surgical reconstruction
• Muscular strength and compensation patterns

Post-operative rehabilitation:

• Functional outcomes
• Patient satisfaction

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Department of Orthopedic Surgery

Rehabilitation

Goals:

• Establishing an environment of protection and progressive motion
• Minimize atrophy
• Minimize joint stiffness
• Protect bone and cartilage healing
• Restore proper gait mechanics

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Department of Orthopedic Surgery

Rehabilitation

Progressive weightbearing Foot flat touchdown weightbearing (10-20 lbs of weight) Crutches

• Preferred assistive device
• Less likely to abduct and externally rotate femur
• More physiologic compared to a walker

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Department of Orthopedic Surgery

Rehabilitation

Non-weightbearing can be a problem…

• Decrease bone density
• Delays in bony union
• May accelerate proteoglycan degradation
• May increase demand placed on abductors / ITB
• Studies: even with NWB there is minimum 2.5x body weight on femoral head
• Risk of iliopsoas and proximal rectus tendonitis
• Prolonged functional deficits

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Department of Orthopedic Surgery

Rehabilitation

Prehab:

• Psychological benefit
• Patient satisfaction
• Lower BMI
• Screen for non-committed patients
• Improved outcomes?

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Department of Orthopedic Surgery

Rehabilitation following Joint Preservation Procedures

• Patient age
• History
• Procedure
• Psychological preparedness
• Level of sports / activity

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Department of Orthopedic Surgery 11 Division of Sports Medicine

Department of Orthopedic Surgery

Postoperative Phases

Phase I (24 hours – 4 to 6 weeks)

• Protection
• Prevent stiffness
• Pain
• ROM
• Passive
• Gluteal isometrics
• Prone lying
• Stationary bike

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Department of Orthopedic Surgery

Postoperative Phases

Phase II (4 -6 weeks) Goals

• Restore ROM
• Reeducation of normal muscle firing patterns
• Aquatic therapy
• Progressive strength and endurance exercises
• Weightbearing progression

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Department of Orthopedic Surgery

Postoperative Phases

Phase III Goals

• Normal gait
• Strength optimization
• Muscle endurance
• Driving

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Department of Orthopedic Surgery

Postoperative Phases

Phase IV Goals

• Improve muscular endurance
• Improve cardio fitness
• Improve stability

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Department of Orthopedic Surgery

Postoperative Phases

Phase V Goals Return to sports

• Type of sport: dependent on intraoperative pathology
• Encouraging data to support return to high impact sports after open procedure
• Functional rehab program with return to sports
• Team decision
• Patient, surgeon, rehab specialist
• Modified or alternative sports / activities?

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Department of Orthopedic Surgery

Postoperative Phases

Phase V Evaluate for normal pelvo-femoral mechanics

• Gait
• Single-leg hop
• Double-leg drop jump
• Straight ahead jogging

Minimum of 85% strength compared to contralateral side Sport-specific drills / tests

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Department of Orthopedic Surgery

Summary

Rehabilitation following Joint Preservation Procedures Consideration to

• Particular surgical procedure
• Patient expectations
• Sport / activity

Early rehabilitation and weightbearing Optimize functional outcome and patient satisfaction

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Department of Orthopedic Surgery

Thank you

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Department of Orthopedic Surgery

References

• Adler, KL, et al. Current Concepts in Hip Preservation Surgery: Part II-Rehabilitation. Sports Health 2015
• Givens-Heiss DL, et al. In vivo acetabular contact pressures during rehabilitation, part I: postacute phabse. Phys Ther.

1992

• Vanwanseele B, et al. The effects of immobilization on the characteristics of articular cartilage: current concepts and

future directions. Osteoarthritis Cartilage. 2002

• Kaku N, et al. Biomechanical study of load transfer of the pubic ramus due to pelvic inclination after hip joint surgery

using a three dimensional finite element model. J Orthop Sci. 2004

• Youdas JW, et al. Partial weight-bearing gait using conventional assistive devices. Arch Phys Med Rehabil. 2005
• Stalzer S, et al. Rehabilitation following hip arthroscopy. Clin Sports Med. 2006
• Tippett SR. Returning to sports after periacetabular osteotomy for developmental dysplasia of the hip. N Am J Sports

Phys Ther. 2006.

• Novais EN, et al. Open surgical treatment of femoroacetabular impingement in adolescent athletes: preliminary report
• n improvement of physical activity level. J Pediatr Orthop. 2014
• Wilk KE, et al. Recent advances in the rehabilitation of isolated and combines anterior cruciate ligament injuries.

Orthop Clin North Am. 2003

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