Weight Bearing Strategies for Post-Hip Arthroscopy Recovery

Overseen By David J Spaeder

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of Pittsburgh

Disqualifiers: Msk tumor, Hypermobility, Revision, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 12

Duration: 6 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how different weight-bearing strategies after hip surgery might speed up recovery. Participants will either begin putting weight on their hip as they feel comfortable immediately after surgery (Weight Bearing as Tolerated, WBAT) or follow a more restricted approach for two weeks (Flat Foot Weight Bearing, FFWB). The trial focuses on individuals who have undergone hip arthroscopy (a minimally invasive surgery) for conditions such as femoroacetabular impingement and labral tears. Those who have had this surgery at specific hospitals and do not have other complicating conditions might be suitable candidates. As an unphased trial, this study provides a unique opportunity to enhance understanding of recovery strategies following hip surgery.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that these weight bearing strategies are safe for post-hip arthroscopy recovery?

Research shows that both flat foot weight bearing (FFWB) and weight bearing as tolerated (WBAT) are generally safe after hip surgery using a small camera. Earlier studies found that FFWB, when combined with the right support device, prevents overuse of certain muscles, aiding recovery. Most surgeons believe it is safe for patients to bear weight on their hip as much as they can tolerate immediately after surgery.

For WBAT, studies indicate that athletes can safely return to sports about six months post-surgery, suggesting that WBAT is well-tolerated and does not cause major issues.

Both methods aim to aid recovery without stressing the healing hip. No major safety concerns have been reported with either approach, indicating these strategies are likely safe for recovery. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores different weight-bearing strategies to aid recovery after hip arthroscopy. The two techniques under study, Weight Bearing as Tolerated (WBAT) and Flat Foot Weight Bearing (FFWB), offer unique approaches. WBAT allows individuals to gauge their weight-bearing based on personal pain and confidence, potentially speeding up recovery by promoting natural movement sooner. On the other hand, FFWB restricts weight to about 20 pounds on the surgical hip, possibly minimizing stress and promoting healing. This trial seeks to determine which method provides the best balance of safety and efficiency in post-surgery recovery.

What evidence suggests that these weight bearing strategies are effective for post-hip arthroscopy recovery?

Research shows that weight-bearing methods after hip surgery can influence recovery. In this trial, participants will follow different weight-bearing strategies. One group will use the weight bearing as tolerated (WBAT) approach, allowing patients to put weight on their leg as soon as they feel comfortable. Studies suggest that WBAT often leads to positive outcomes, such as earlier discharge and similar recovery results compared to stricter weight limits. Another group will follow the flat foot weight bearing (FFWB) strategy, which is more restrictive and involves placing approximately 20 lbs of weight through the surgical hip. Some studies indicate that strict weight limits might not be necessary for better recovery in the medium term. Overall, allowing some weight when ready might speed up recovery without affecting surgical repair. ^{1 2 6 7 8}

Are You a Good Fit for This Trial?

This trial is for individuals aged 12 or older with hip impingement syndrome or a hip labral tear, who will undergo or have undergone hip arthroscopy with femoroplasty and labral repair at UPMC Children's or St. Margaret's Hospital. Both unilateral and bilateral cases are accepted. Those with musculoskeletal tumors, generalized hypermobility, or needing revision surgeries cannot participate.

Inclusion Criteria

I have had hip surgery to reshape the femur and repair the labrum.

Unilateral and bilateral hip patients

I am 12 years old or older.

Exclusion Criteria

I have had surgery to correct or improve a previous procedure.

I am extremely flexible or have very loose joints.

I have a hip joint condition related to my cancer.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo hip arthroscopic labral repair and femoroplasty with randomized weight-bearing protocols

6 weeks

Post-operative follow-ups at 6 weeks, 3 months, and 6 months

Follow-up

Participants are monitored for safety and effectiveness after treatment, including ultrasound evaluations and strength measures

6 months

Regular follow-ups up to 6 months post-operative

What Are the Treatments Tested in This Trial?

Interventions

• Flat foot weight bearing (FFWB)
• Hip Arthroscopy
• Weight Bearing as tolerated (WBAT)

Trial Overview

The study compares two post-surgery approaches to weight bearing: 'Weight Bearing as Tolerated' (WBAT) allows patients to put as much weight on the foot as comfortable immediately after surgery; 'Flat Foot Weight Bearing' (FFWB) means only the sole of the foot may bear weight right away.

How Is the Trial Designed?

Group I: Weight bearing as tolerated (WBAT) immediately following surgery. Experimental Treatment 1 Intervention

Subjects will be able to self-select weight bearing based on pain and confidence in surgical hip.

Group II: Flat foot weight bearing (FFWB) for 2 weeks after surgery. Active Control 1 Intervention

Subjects will be limited to FFWB, approx 20lbs through the surgical hip.

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

Published Research Related to This Trial

A survey of 75 Dutch orthopedic surgeons revealed significant variability in postoperative weight-bearing instructions for patients with periprosthetic femoral fractures (PPFF), indicating a lack of consensus on best practices.

The study highlights the need for further research to establish effective guidelines for permissive weight bearing (PWB) after surgical treatment of PPFF, as current practices differ widely among surgeons.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Postoperative Load Bearing in Periprosthetic Femoral Fractures Around Hip Arthroplasty: A Survey Among Orthopedic Surgeons in the Netherlands. Vesseur, MAM., Jelsma, J., Most, J., et al.[2023]

A multicenter study involving 441 patients with subtrochanteric femur fractures found that allowing weight bearing as tolerated (WBAT) post-surgery significantly reduced the length of hospital stay from 9.7 days to 7.4 days without increasing re-operation rates.

The study suggests that immediate WBAT is safe and effective for patients treated with intramedullary fixation, particularly benefiting those aged 41-80 and with specific fracture characteristics, making it a recommended practice if no contraindications exist.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immediate weight bearing as tolerated (WBAT) correlates with a decreased length of stay post intramedullary fixation for subtrochanteric fractures: a multicenter retrospective cohort study. Cunningham, BP., Ali, A., Parikh, HR., et al.[2021]

Immediate unrestricted weight bearing (UWB) after uncemented total hip arthroplasty (THA) is safe, showing no adverse effects on femoral stem micromotion or increased risks of surgical revision compared to partial weight bearing (PWB).

While UWB did not demonstrate superior outcomes compared to PWB, patients showed a better Harris hip score at one year post-surgery, suggesting that UWB may enhance patient compliance and rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early unrestricted vs. partial weight bearing after uncemented total hip arthroplasty: a systematic review and meta-analysis. Huang, L., Han, W., Qi, W., et al.[2023]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10757416/

Postoperative weight-bearing restrictions and rehabilitation ...

The primary objective of this study was to determine if sufficient evidence exists to recommend specific weight-bearing restrictions postoperatively.

2.

sciencedirect.com

sciencedirect.com/science/article/pii/S2666061X25001567

Protected Weight-Bearing and Early Passive Mobilization ...

Postoperative weight-bearing ... Midterm outcomes and satisfaction after hip arthroscopy are associated with postoperative rehabilitation factors.

3.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC4443726/

Rehabilitation Following Hip Arthroscopy – A Systematic Review

Three studies described partial weight bearing as “foot-flat,” while two described it as “toe-touch” or “touchdown.” Performance of microfracture warranted ...

4.

arthroscopysportsmedicineandrehabilitation.org

arthroscopysportsmedicineandrehabilitation.org/article/S2666-061X(21)00225-X/fulltext

Rehabilitation and Return to Sport After Arthroscopic ...

Together with two physical therapists, Domb described two-year outcomes and associated clinical guidelines for physical therapy following hip arthroscopy.

5.

researchgate.net

researchgate.net/publication/338303668_Postoperative_Weightbearing_Protocols_After_Arthroscopic_Surgery_for_Femoroacetabular_Impingement_Does_Not_Affect_Patient_Outcome_A_Comparative_Study_With_Minimum_2-Year_Follow-up

Postoperative Weightbearing Protocols After Arthroscopic ...

This study highlights that weightbearing restrictions after hip arthroscopy may not be necessary for improved mid-term outcomes and instead may have the ...

6.

sciencedirect.com

sciencedirect.com/science/article/pii/S2059775425005541

Factors associated with treatment failure after hip ...

The study included 15 hips in 14 patients. Nine hips achieved successful outcomes, while six hips were considered failures. The failure group was statistically ...

7.

academic.oup.com

academic.oup.com/jhps/advance-article/doi/10.1093/jhps/hnaf055/8303980

2024 international society for hip preservation physiotherapy ...

Flat foot weight bearing with the appropriate assistive device (AD) is recommended to minimize overactivity of the iliopsoas. Additionally ...

8.

mdpi.com

mdpi.com/2673-4095/4/3/39

Return to Work Following Hip Arthroscopy for ...

There is a high rate of return to full work duties at an average of 9.3 weeks following hip arthroscopy for FAIS.