Recovery

Rehabilitation after hip surgery involves distinct phases of recovery. The goal is to allow the best environment for tissue healing while maximizing long-term function for return to as many of the activities you love as possible.

Your rehabilitation should be done under the guidance of a physical therapist, who can refer to our Post‐Operative Arthroscopic Hip Protocol for specific suggestions regarding rehabilitation progression.

Typical Recovery Process

This is merely an example of a typical recovery process, and should not be used to direct your rehabilitation after surgery. Each procedure and patient presents a unique set of circumstances, which is why the guidance of a physical therapist is essential to an effective recovery.

Phase I – Maximal Protection Typically the period from 0-2 weeks after surgery

During Phase I, the goal is to provide maximal protection to the surgically repaired tissue while restoring basic range of motion (ROM) and strength. This phase includes passive ROM (using a rope or a helper to move your leg for you) and basic isometrics (tightening muscles in specific positions without moving the leg). The most important thing to focus on during this phase is getting the joint to simply calm down after surgery. You will be on crutches during this phase but the specific weight bearing restrictions depend on your exact procedure and will be determined at the time of your surgery.

Phase II – Moderate Protection Typically the period from 2-6 weeks after surgery

During Phase II, the tissue fixation has become a little stronger but still requires protection. Active ROM (moving the leg on its own power) is recommended as tolerated. Hip flexor activation will often cause increased and unnecessary irritation so try to avoid lifting your leg straight up under its own power. Specific exercises to activate and strengthen the external rotators and abductors of the hip along with progressive weight bearing activities are also initiated during this phase. You will also be weaned off crutches as tolerated, although some procedures need extra time.

Phase III – Minimal Protection Typically the period from 6-12 weeks after surgery

By Phase III the tissue should be well along in the healing process. This does not mean that it is completely secure, but it should require some sort of impact load to the tissue to cause damage. This includes running, jumping, and quick pivoting – these activities should continue to be avoided through Phase III. During this phase you will be off of your crutches and focused on regaining any remaining ROM deficits and trying to increase the overall strength of your entire leg. A systematic progression through increasingly challenging exercises while minimizing discomfort to your hip is ideal and should be performed under the guidance of a physical therapist.

Phase IV – Return to Activities Typically the period from 3-6 months after surgery

By Phase IV, most repaired tissue should be very well affixed. During this phase your physical therapist will systematically test your tolerance of increasingly intense impact loads. Any discomfort will require modification of the activity. If tolerated, a progressive running program can be initiated also under the supervision of your physical therapist. Activities that you will be resuming after rehab is complete will be simulated in the clinic to test tolerance and to modify your program to address any remaining deficits you may have.

It is important to understand that this phase can be a three-month process in and of itself. Plan for six months of recovery before fully returning to high-level activities such as sports. You will often need to continue a consistent home program to maintain the highest level of function for years after surgery. Before undergoing surgery, it is also important to understand that the goal of the surgery is to maximize your function. It is not a guarantee that your hip will be perfect or "good as new". Occasional discomfort that is tolerable and manageable during activities is not uncommon long-term after surgery. Also, sometimes the irreparable damage that was already done to your joint prior to surgery may make certain activities very difficult to resume, if ever. Your surgeon and physical therapist can advise on this as you return to activities.

Hey Dr. Wagner, here is a photo of a recent skin/ski of Mt. St Helens.

I have had complicated hip dysplasia on both hips, requiring extensive surgery on one. I chose not to repeat this in favor of arthroscopic repair, and have been more than pleased with the results. I required fairly extensive micro-fracture surgery and labral resection. More extensive damage than expected, though am glad I went through the surgery and recovery.

At baseline, I am a very active backcountry skier, bike rider (road and mountain) and tend to push myself fairly hard physically. I did the appropriate physical therapy and within 4 months I was back to full activity. My celebratory return to activity was to skin up and ski down Mt. St Helens. I had no pain while doing so and feel I am now back to full activity with no restrictions.

I have been more than pleased that with a minimally invasive procedure, my dysplasia can be mitigated and I can return to my desired activities with no pain. In retrospect, I would have had this procedure much sooner should I have known how successful this was to be. Thank you Dr. Wagner.

Chris Burke, MD

Emergency Physician

Dear Dr. Wagner and Team:

I would like to write a testimony on behalf of Dr. Mark Wagner for his excellent job on my hip arthroscopy on March 25th, 2014.

After years of hip pain due to ski racing and hockey goaltending, I ended my freshman season as a D1 goaltender at Rochester Institute of Technology with a devastating hip injury. After being diagnosed by team doctors, I decided to conduct my own research. I searched for a highly qualified hip surgeon that made me comfortable with the procedure and ability to return to the rink. Dr. Wagner fit the description perfectly with his extensive experience and research in the field of young adult hip issues and athletes with hip injuries.

Dr. Wagner and his whole staff scheduled me in as soon as they could. They completely accommodated my schedule so I could fly in from New York and have the procedure performed. Every detail was taken care of, from the insurance to the flight home protocol. Dr. Wagner and his team helped me put together the entire process. It doesn't stop there. Not only did Dr. Wagner ensure my career and livelihood as an athlete with his spectacular surgical ability, but the follow up care was simply wonderful. From answering my questions over the phone to my follow up visits. I felt they were with me every step of the way.

Day one of being injured, I did not know if I could ever be the same. As a hockey player and as an athlete. I'm writing this testimony because on the achy days, the difficult rehabilitation moments and the rough weeks, I never thought I could be here, six months later, stronger than ever. I praise the magnificent work of Dr. Wagner and his team to help me reach my highest athletic potential. I have not felt this great since I was 16. I am so ecstatic I chose have the surgery performed. Thank you for all you have done Dr. Wagner and team!

Sincerely,

Jetta Rackleff

RIT D1 Women's Ice Hockey Goaltender
USA Women's Inline Hockey Goaltender

I had labrum/hip surgery a few years ago after getting injured in an international basketball tournament. Dr. Wagner did a fantastic job assessing the injury, performing the surgery and helping with the rehabilitation program so that I was able to get back to playing basketball within only a few weeks.

One of Dr. Wagner's greatest strengths is his understanding of the athlete's mindset due to the fact that he has worked with so many high level athletes. This enables him to speak to athletes in a way that is encouraging and thorough - yet progressive and optimistic with a clear action plan for recovery.

I highly recommend Dr. Wagner and still count on him for occasional advice even 5 years after the surgery!

Lawrence Norman

Managing Director of Adidas South East Europe
Professional Basketball Player - Israel
Gold Medal, Maccbiah Carnival, Open Division, Sydney, 1989
Gold Medal, Pan Am Maccabiah Games, Open Division, Montevideo, 1991
Gold Medal, Pan Am Maccabiah Games, Masters Divison, Buenos Aires, 2007
Silver Medal, Maccabiah Games, Masters Division, Tel Aviv, 2009
Gold Medal, Pan Am Maccabiah Games, Masters Division, Sao Paolo, 2011

Dr. Wagner,

I thought I’d share my most recent post hip-replacement endeavors.

Over the last two years my activity level has increased exponentially. I’ve lost 20+ pounds, I’m able to wade my favorite fishing waters, climb in and out of my boat painlessly, and hike the backwoods like a teen-ager (sort of); all things that were impossible before surgery.

As a current active duty firefighter the job can at times be quite arduous, and the older I get the more I have to focus on maintaining myself “Fit for Duty”. Recently a great friend was diagnosed with AML Leukemia. His son is a firefighter and I learned he was going to participate in the Seattle Firefighter Stairclimb in his dad’s honor. The event is a benefit for the Leukemia and Lymphoma Society. Having participated in this event more than 15 years ago, I knew what I was up against, and immediately pledged to climb (yes, I’m crazy)… showing my support while giving me the motivation to train for the event.

The firefighter stairclimb occurs on March 6th, at the Columbia Center in downtown Seattle. It requires firefighters to wear full combat gear complete with breathing apparatus and climb 69 flights of stairs. That’s 1,311 steps with a vertical elevation gain of 788 feet. I have set my goal at sub 20 minutes, which will be a huge accomplishment for my age group.

To prepare for the climb I started training in December. My regime includes countless hours on the stairmaster while climbing local high-rise stairwells, including Portland’s “Big Pink” tower. I also add in a healthy dose of CrossFit and interval training, with lots of focused leg exercises including squats, lunges, box jumps, burpees, mountain climbers, and even dead lifts.

I am happy to share that my hip is holding up perfectly, and just like you predicted, the only time I’m reminded of my hip replacement is seeing the scar. I guess next time I’ll ask for a plastic surgeon.

Sincerely,

Troy Buzalsky

Battalion Chief, Longview Fire Department

Doctor Wagner,

I wanted to let you know how incredibly well the surgery worked for me. As you know, I'd been dealing with chronic groin pain for about ten years and never found anything that alleviated the discomfort. Over the years I had two different courses of physical therapy, a stretching program, a series of cold laser treatments and also some ultrasound therapy none of which had any lasting effect. I'd finally given up and resigned myself to just having to live with the problem. That is until I heard about the procedure you do which releases the damaged tendon from the bone. I was skeptical at first, but after speaking to you and another orthopaedic surgeon (Dr. Rod Wigle in Bend, Oregon) I was convinced to go ahead and have the surgery and the results have been nothing short of spectacular. A few easy hours in the hospital for the outpatient procedure and that evening I was on crutches for a total of about 2 hours and realized I didn't need them and never used them or any other type of walking aid again. I never needed pain medication stronger than Tylenol and that was only for a day or two. And within a couple of days I was easily able to climb stairs and resume virtually all my normal activities. The best part was 10 days after the surgery I was able to ski again and 2 weeks after that I was back riding my 900 pound motorcycle. You've truly given me my life back. I'm 72 years old, but feel like I'm 20 years younger. It's amazing!

Thank you.