EP8.1 Recovery after structured milestone-based rehabilitation following hip arthroscopy for mixed femoroacetabular impingement and labral repair: a case report

Abstract

Abstract Background Hip arthroscopy is widely used to treat femoroacetabular impingement syndrome (FAIS) and labral pathology, yet high-quality evidence on postoperative rehabilitation remains limited. Patients may demonstrate persistent deficits in strength and function after surgery, highlighting the need for targeted rehabilitation. However, existing literature lacks standardized protocols and clearly defined progression criteria, limiting clinical applicability. This case report describes recovery following arthroscopic treatment of mixed FAIS with labral repair using a structured rehabilitation approach with defined progression criteria. Case Presentation A 36-year-old man underwent left hip arthroscopy for symptomatic mixed cam/pincer FAIS with labral repair. Supervised outpatient physiotherapy began approximately 2 weeks post-operatively. Initial assessment demonstrated pain-limited hip flexion to 80°, restricted abduction and extension, gait compensation, and weakness of the gluteal, quadriceps, and lumbopelvic musculature. A milestone-based rehabilitation program was delivered across 24 sessions and combined symptom-guided manual therapy, capsular and soft-tissue mobility, progressive range-of-motion restoration, gluteal and core strengthening, neuromuscular retraining, gait re-education, and staged functional loading. HOS activities of daily living (HOS-ADL) and sport items were collected serially alongside clinical reassessment. Results Hip Outcome Score–Activities of Daily Living (HOS-ADL) improved from 58% at baseline to 88% by session 6, reaching 96% by session 12 and 100% by session 24. In contrast, Hip Outcome Score–Sport (HOS-Sport) demonstrated a more gradual progression, increasing from 25% at baseline to 45% at session 6, 68% at session 12, and 82% at session 24. Clinically, early improvements were observed in pain, gait quality, and hip flexion (80° to 90°). Functional recovery of daily activities preceded higher-level sport function, with normalization of ADL performance occurring by mid-rehabilitation, while sport-related capacity remained partially limited at the final assessment. No recurrence of mechanical symptoms such as locking was reported throughout the rehabilitation period. Conclusion This case demonstrates that milestone-based rehabilitation can facilitate rapid restoration of daily function following hip arthroscopy, with a delayed trajectory for sport recovery. The dissociation between ADL and sport outcomes highlights distinct phases of recovery and supports the need for criteria-driven progression. Serial PROM monitoring was feasible and clinically informative. Future studies should evaluate whether early HOS-ADL normalization predicts return to sport and work.