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A periacetabular osteotomy (PAO) is a type of surgery used to treat developmental dysplasia of the hip (DDH), also known as hip or acetabular dysplasia. During a PAO, the surgeon makes a series of cuts around the hip socket and repositions the joint into a more mechanically appropriate position. Some muscles around the hip are temporarily moved during the procedure in order to safely make the cuts, and they are reattached at the end of the surgery. The hip joint may be opened in order to treat torn or damaged tissue and improve the roundness of the upper femur. The bone is held together with screws. A PAO is sometimes called a Ganz osteotomy, named after the professor who developed the procedure.

If your child’s hip dysplasia isn’t treated, it can lead to issues and pain when the labrum and cartilage, which protect the hip joints, start to wear down. When these tissues wear down, the bones rub together and can cause pain and issues with movement. Hip dysplasia is one of the most common causes of hip pain and arthritis in patients younger than 50 years old.

While the idea of your child going into the hospital for surgery can be scary, sometimes it can be beneficial to treat your child’s hip dysplasia and avoid more significant complications as she grows up.

This surgery:

  • Helps reduce joint stress and improve hip function.
  • Is for children or teens with developmental dysplasia of the hip who are near or have reached the end of skeletal growth.
  • May help delay or eliminate the need for total hip replacement later in life. Your child’s doctor will perform tests and imaging studies to help you determine if this procedure is right for your child.

If your child’s doctor has recommended your child undergo PAO surgery to help his hip dysplasia, it’s helpful to know what to expect before, during and after the procedure, as well as what recovery in the hospital, recovery at home and physical therapy may entail.

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, your child will:

  • Continue to wear the TED hose for four weeks.
  • Use an incentive spirometer to help expand her lungs. You will receive instructions on how to do this.
  • Take one baby aspirin a day for four weeks.
  • Prop her leg on the foam ramp while in bed. Your child can bend and straighten the hip as much as is comfortable. Your child can stop using the ramp when she can comfortably straighten her hip all the way.
  • Take pain medication as needed. You are typically given prescriptions for a narcotic pain medicine (Norco or Percocet) and an NSAID (naproxen). Your child should begin weaning off the narcotic and substituting Tylenol as her pain improves.
  • Change 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. Your child will be encouraged to walk with crutches, putting about 20-30% of her body weight on the operated leg. Your child should perform the home exercises that she was taught while in the hospital recovering after surgery.

Your child will need physical therapy before and after the surgery. Physical therapy will:

  • Teach your child weight-bearing restrictions.
  • Strengthen your child’s hip muscles.
  • Help your child in the recovery process.

Your child’s doctor will determine how much physical therapy she needs. PAO patients typically require four to five months of physical therapy following surgery.

Four weeks post-op

Four weeks after surgery, your child may stop:

  • Using the TED hose.
  • Taking baby aspirin.

Six weeks post-op

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

Three months post-op

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

Improving movement, strength, coordination and balance after surgery

Physical therapy is important to the recovery process and helps patients regain movement before or after surgery. It also helps teach weight-bearing restrictions, strengthens hip muscles and aids in the recovery process after surgery.

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