PL3.9 The 2024 International Society for Hip Preservation (ISHA) physiotherapy agreement on post-operative rehabilitation following hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS)

Abstract Introduction Hip arthroscopy (HA) is a well-accepted, effective treatment intervention for symptomatic femoroacetabular impingement syndrome (FAIS). Post-operative physiotherapy (PT) is crucial for achievement of optimal outcomes; however, no well-accepted post-operative protocol exists for use following HA for symptomatic FAIS. Methods Members of the International Society for Hip Preservation (ISHA) with an expertise in rehabilitation following HA participated in this modified-Delphi study. In the first round of the Delphi process, two senior authors presented proposed post-operative phases and goals based upon the guidelines set forth in the 2019 ISHA PT agreement on assessment and treatment of FAIS. The panelists agreed on the proposed post-operative phases and were given the opportunity to present a comprehensive list of interventions for each phase and rehabilitation domain for potential consideration, which were compiled by two senior authors. Utilizing the Grading of Recommendations, Assessment, Development, and evaluation (GRADE) scale, the panelist graded each proposed treatment intervention. Consensus was achieved for 100% of the items included in the guidelines by the second survey round. Following physiotherapist consensus, the identified group of surgeons reviewed and approved the guidelines. Results The panel consisted of 10 physiotherapists and 8 surgeons representing 5 countries. All 10 (100%) physiotherapists who were deemed experts in the rehabilitation of HA for symptomatic FAIS participated in each survey round and provided feedback on each item utilizing the GRADE scale. All 8 (100%) of surgeons specializing in hip preservation approved the guidelines. Discussion Restoration of pain-free range of motion (ROM), increased strength of the lumbopelvic musculature, and normalization of lower extremity (LE) neuromuscular (NM) control are common rehabilitation goals following HA. The panelists recommend a six-phase rehabilitation progression with time and milestone-based progression to ensure ensure appropriate lumbopelvic and lower extremity neuromuscular control during all recreational and sport specific tasks. Conclusion This consensus statement presents a six-phase rehabilitation progression for use in individuals following HA for symptomatic FAIS. These expert-driven guidelines will help reduce practice variation and standardize post-operative timelines.