Rehabilitation after hip arthroscopy for impingement: staged recovery

Royal Berkshire describes hip arthroscopy as a less invasive form of hip surgery that allows rehabilitation to start sooner, with the aim of reducing pain, instability and stiffness. Royal Bournemouth explains that surgeons may trim or repair damaged areas, and that where bone has been reshaped, for example a bump removed from the thigh bone, crutches after surgery can reduce the risk of a later fracture of that area.

For that reason your ward physiotherapist explains how much weight you may put through the leg, and for how long. Royal Berkshire says stage 1 is based on your weight-bearing status, using both crutches, heel touching the ground first and some weight through the foot before pushing off through the big toe.

Royal Berkshire lists the goals of stage 1: controlling inflammation and pain, re-establishing range of movement, normalising the walking pattern as you go from aids to walking independently, maintaining muscle strength and protecting the healing structures. Crutches are used until the limp has gone, and the leaflet suggests going from two crutches to one, held in the hand opposite the operated leg.

The exercises are gentle and low in load: pelvic tilts, standing hip movements while holding support, bending the knee lying on the front, static quadriceps and hamstring contractions, squeezing a ball between the knees, a supported single-leg balance and a pelvic hitch. Each has a stated number of repetitions, and the leaflet warns not to push into pain.

Stage 2 starts when you have pain-free hip flexion to 90 degrees, can squat to 70 degrees of knee flexion with good control, and can contract individual muscles around the hip. Its goals are full range of movement with minimal pain, good control through a double-leg squat and bridge, even weight-bearing in walking and core stability.

Stage 3 builds muscle strength through the full range and starts jumping and explosive movements, and stage 4 maintains strength while adding changes of direction, acceleration and deceleration and sport-specific training. The leaflet is written to guide exercise choice by what you can do, so a person may spend longer in one stage than the example timetable of another patient.

Wrightington says you need a responsible adult with you for 48 hours after the operation, that stitches are usually removed by the practice nurse or district nurse about 14 days after surgery, and that wounds must be kept clean and dry until then. It says it is likely you will be advised not to drive for 4 to 6 weeks and to wear elasticated stockings for 6 weeks, and that most patients are advised to take blood-thinning medication following a clot-risk assessment based on NICE recommendations.

Royal Bournemouth says smoking delays wound healing, that scars from hip arthroscopy are small and should fade to a thin white line over 2 years, and that having someone to help in the first two weeks makes recovery easier.

On driving, Royal Bournemouth says that if you must not put full weight on the joint you should not drive until that period has passed, and that if full weight is allowed you must wait at least 48 hours before deciding when you feel able, being comfortable and able to perform an emergency stop, and checking your insurance. Wrightington advises waiting until you can walk normally without crutches, or until the 6-week check.

Wrightington says you can return to work when you can function safely and with reasonable comfort, most people at about 6 weeks, although a job that involves standing for long periods or is manual may need up to 12 weeks. Royal Bournemouth says work depends on your surgery and your job and should be discussed with your surgeon.

Wrightington says most patients can begin light activities such as cycling and swimming within a few weeks, that sports training can resume at 3 months and that competitive sport should be delayed for 6 months. It adds that if symptoms before surgery stretched back over many years, full recovery may take up to 12 months. Royal Bournemouth says you should be able to return to sports and hobbies, guided by your consultant at your review, and that if you have no specific restrictions you should return to usual activities when you feel ready and comfortable, building up gradually.

Royal Bournemouth gives no single date, because the answer depends on what was done inside the hip and the demands of the sport. The stage 3 and 4 criteria in the Royal Berkshire staged approach are a useful way to think about readiness alongside Wrightington's dates.

Contact your hospital or NHS 111 for a wound that becomes red, hot or discharges, a high temperature, increasing groin or thigh pain that does not ease with rest and painkillers, or new numbness in the leg. Use 999 or A&E for chest pain, sudden breathlessness, or a swollen painful calf, which can signal a blood clot.