Periacetabular Osteotomy (PAO) Surgery

Testing

• Your child will have a physical exam.
• Your child’s complete health history will be reviewed by your child’s doctor.
• Your child will need to have all imaging studies performed several weeks before surgery. These include X-rays, an MRI and possibly a CT scan.

Pre-operative appointment

• Your child’s doctor and physical therapist will see you in the office for a pre-op visit. During this appointment, the therapist will instruct you and your child on:
• How to properly use crutches.
• Exercises to do before and after surgery.
• Post-surgical restrictions.

Medications

• If your child is taking birth control pills, she should stop taking them one month before surgery.
• If your child is taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, your child should stop taking them five days before surgery, as they can increase bleeding. Tylenol is fine to take before surgery.

To help you prepare for your child’s surgery:

• Your child’s doctor will give you specific instructions for preparing for surgery, including when your child should stop eating and drinking the night before. It’s important that your child follow these instructions.
• The night before surgery, your child should take a bath and clean the hip area with antibacterial soap.
• Your child should not shave the area before surgery, as this may increase the risk of infection.

Visit choa.org/patients to learn about our hospital amenities and what to expect during your child’s stay.

Your child’s PAO surgery should take about two to three hours. After the procedure, she will wake up in the recovery room, where she will stay until she is ready to go to her hospital room. Your child’s doctor will talk with your family while your child wakes up in the recovery room.

After surgery, your child will have:

• A bandage on her hip with a drain under the bandage.
• Compression stockings (TED hose) on her legs to help prevent blood clots.
• Have a PlexiPlus put on her feet, which will intermittently squeeze to help circulate blood and help minimize the risk of deep vein thrombosis (DVT).
• A catheter in her bladder.
• Pain medications given by the recovery room nurse and a patient-controlled analgesia (PCA) machine.
• A foam ramp elevating the leg. There is a tendency for the operated leg to roll outward at the hip following surgery, so the nurse will make sure your child’s knee and toes are pointed straight up and not to the side. Your nurse will also instruct you and your child on how to use the PCA machine.

Your child will stay overnight in a hospital room. Once you and your child are in your hospital room, ice will be applied to your child’s hip intermittently, and she will spend the day resting. Your child may be allowed to drink liquids and eat, although most patients do not eat until the next morning.

Day 1

On the first day after surgery, your child will:

• Have blood drawn to check for anemia.
• Have the drain removed, depending on how much fluid is draining. Sometimes the drain will need to stay in for longer.
• Be assisted by a physical therapist in getting out of bed, sitting in a chair and getting to the bathroom. The therapist will reinforce the hip precautions and proper use of crutches. Your child will have physical therapy twice a day.
• Have the bladder catheter removed.
• Be able to eat and drink. Once your child is drinking well, the intravenous fluids will be stopped.
• Switch from PCA-delivered pain medicine to oral pain medication.
• Take a baby aspirin, a multivitamin with iron and a stool softener (Colace). This is a regimen that your child will be on for several weeks. Your child’s doctor will advise how often to take these.

Day 2

On the second day after surgery:

• The drain will be removed if it hasn’t been removed already. Your child will continue with physical therapy.
• The case manager will begin making arrangements for your home needs.

Day 3

On the third day after surgery:

• Your child will continue physical therapy.
• Your child will, most likely, be ready to go home. The nurse will give you your child’s prescriptions and discharge instructions.

Once you are home, you will:

• Continue to wear the TED hose for four weeks.
• Have plexipulses put on your feet, which will intermittently squeeze to help circulate blood and minimize risk of deep vein thrombosis (DVT).
• Use an incentive spirometer to help expand your lungs. You will receive instruction on how to do this.
• Take one baby aspirin a day for four weeks.
• Prop your leg on the foam ramp while in bed. You can bend and straighten the hip as much as is comfortable. You can stop using the ramp when you can comfortably straighten the hip all the way.
• Take pain medicine as needed. You are typically given prescriptions for a narcotic pain medicine (Norco or Percocet) and an NSAID (Naproxen). You should begin weaning off the narcotic and substitute Tylenol as the pain improves.
• Change your bandages daily and leave the white Steri-Strips in place. They will begin to fall off in about two weeks.
• Begin showering one week after surgery.
• Walk with crutches and exercise. You are encouraged to walk with crutches, putting about 20 to 30 percent of your body weight on the operated leg. You should perform the home exercises that you were taught.

Four weeks post-op 
Four weeks after surgery, you may stop: 

• Using the TED hose. 
• Taking baby aspirin.

Six weeks post-op 
At six weeks post-op, you will have an office visit with X-rays. If the osteotomy is healing well, you will be allowed to put more weight on the leg and use one crutch or a cane for the next one to two weeks. You may also begin more strengthening and stretching exercises. You will be allowed to resume driving once you are able to put full weight on the operated leg and are off prescription pain medication. 

Three months post-op
At three months post-op, you may begin returning to normal activities. Physical therapy may continue intermittently for four to six months. Home exercises should be done daily.

You will need physical therapy both before and after your surgery. Physical therapy will:

• Teach weight-bearing restrictions.
• Strengthen the hip muscles.
• Help in the recovery process.

Your doctor will determine how much physical therapy you will need. PAO patients typically require four to five months of physical therapy following the surgery. The physical therapy exercises prescribed after surgery will help protect and stabilize the hip as it heals. 

Review the physical therapy exercises recommended after surgery >