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Variability in United States online rehabilitation protocols after open and endoscopic hip abductor repair
Chukwudubem Anwunah1, Samuel Rosenberg1, Matthew Hartwell2
1University of Michigan-Ann Arbor, Ann Arbor, USA.
Purpose:
The purpose of this study was to evaluate readily accessible U.S. based online physical therapy protocols for open and endoscopic hip abductor repairs and to assess the variability in post-operative rehabilitation protocols.
Methods:
Online physical therapy protocols from U.S. based orthopaedic institutions for gluteus medius/minimus repair were collected using a web-based query utilizing search terms "hip abductor repair rehabilitation protocol" and "gluteus repair rehabilitation protocol." Published protocols from both Electronic Residency Application Service (ERAS) academic orthopaedic surgery programs and private groups were collected. All publicly available protocols were included. Protocols were analyzed using a standardized spreadsheet to assess rehabilitation components and timelines. Descriptive statistics (median values, percentages, ranges) were calculated.
Results:
54 rehabilitation protocols were assessed, including 22 (41%) from ERAS-affiliated academic programs or associated physicians. Postoperative weight-bearing was addressed in 53/54 (98%) protocols, with 41 (77%) recommending toe-touch/touchdown/flat-foot/20-lb weightbearing. Median duration of restricted weight-bearing was 6 weeks (range, 2-8 weeks). Regarding range of motion restrictions, 37 (69%) protocols limited hip flexion to 90°, 42 (78%) advised against passive adduction past neutral, and 49 (91%) against active abduction. Bracing was recommended in 30 (56%) protocols, with 25 (83%) lacking brace specification and only 5 (17%) recommending an abduction brace. Return-to-sport timelines were included in 19 (35%) protocols, with a median 16 weeks (range 12-24). Functional testing was mentioned in 22 (41%) protocols, though tests and criteria varied.
Conclusion:
Substantial variability exists in the composition and timing of rehabilitation protocols following hip abductor tendon repair. A majority of protocols advised limited weight bearing for the first 6 weeks after surgery and avoidance of active hip abduction and passive hip adduction, however there was wide variation in the recommendations regarding brace use, strengthening progressions, the role of functional testing, and the timeline for return to activity and sport.