Reevaluating Postoperative Protocols for Periacetabular Osteotomy: Navigating Rehabilitation Variability

A recent systematic review documents wide variability in postoperative weight-bearing protocols after periacetabular osteotomy (PAO), complicating recovery planning, risk stratification, and rehabilitation for patients undergoing reconstruction.

In pooled analyses the review found marked heterogeneity in recommended protected weight-bearing intervals. Most studies advised initiating partial weight-bearing immediately after surgery—commonly for six to eight weeks—but progression to full weight-bearing and timelines for return to sport varied widely across centers and study designs. The review included multiple centers and study types and called for standardization to improve comparability.

That heterogeneity leaves clinicians with inconsistent guidance when balancing fixation protection against functional recovery. Likely drivers include differing fixation techniques, surgeon preference, use of grafts or concomitant procedures, institutional rehabilitation resources, and patient factors such as bone quality, BMI, and comorbidity burden.

Clinically, delayed weight-bearing may protect fixation but prolong deconditioning and limit early gains; earlier advancement can accelerate recovery but risks complications if bony healing is incomplete. Typical milestones reported were immediate partial weight-bearing for the initial postoperative period (commonly six to eight weeks), progressive loading thereafter, and earlier return to low-impact activities than to high-impact sports. An example pathway: partial weight-bearing for six weeks, progressive loading over the next four to six weeks with sport-specific rehabilitation, and clinical plus radiographic confirmation before resuming high-impact activities at roughly four to six months—individualized by patient and surgical factors.

Looking ahead, the review highlights the need for consensus-driven, evidence-based postoperative protocols and prioritizes prospective comparative studies of weight-bearing strategies with standardized outcome measures (time to radiographic union, validated functional scores, and return-to-sport metrics). Reducing variability through standardized protocols has the potential to improve safety and functional recovery after PAO.