Rehabilitation after PAO

If it says something different from this page, follow the discharge letter – it is tailored to your operation, for example if the femoral neck was also reshaped or the thigh bone was rotated.

Day of surgery

15 kg with crutches: get up and take your first steps.

Days 3–5

15 kg with crutches: discharge home.

Weeks 1–6

15 kg: walk with crutches, no hip flexion beyond 90°, no active leg lifting.

From week 3

15 kg: exercise bike without resistance, with the operated leg moving passively.

Week 6

X-ray check.

Weeks 7–8

Increase to full weight-bearing and gradually stop using crutches.

Weeks 1–8

No active hip flexion or active leg lifting (clearance after 6–8 weeks).

Weeks 8–10

Driving.

From month 3

Gradual return to sport.

During PAO, we released your hip socket from the pelvis, turned it into a better position and fixed it with screws. The screws hold the socket securely – but the bone itself has to heal. This takes about six weeks.

During this time we want to avoid too much load on the bone before it has healed and too much pull from the hip flexor muscles on the freshly fixed socket. Hence partial weight-bearing, the flexion limit and no active leg lifting.

Your hip joint itself is not at risk: it cannot ‘pop out’ as with some hip replacements. All precautions protect the healing bone.

On the day of surgery you get up for the first time with our physiotherapists. That sounds early, but it is intended: getting up early lowers the risk of thrombosis, pneumonia and circulation problems, and you feel independent again sooner.

Over the following days you will learn:

• Walking with forearm crutches using a three-point gait with 15 kg partial weight-bearing
• Climbing stairs with crutches
• Getting up, sitting down and lying down without bending the hip too much
• Exercises for home that you can safely do on your own

We treat pain consistently. Good pain management is what allows you to move well. After 3 to 5 days you go home, once you can walk safely with crutches and manage stairs.

You may put about 15 kg of weight on the operated leg. That is roughly the weight of the leg itself – so you place your foot down and roll through, but shift your body weight onto the crutches.

Tip: Stand with your operated leg on a bathroom scale and press down until it shows 15 kg. This gives you a feel for how little that is.

Holding the foot completely in the air is not better. Light contact is intended: it protects your back, improves your gait and stimulates bone healing.

When sitting, your thigh should be no higher than horizontal – your knee no higher than your hip. In everyday life:

• Use a high chair or wedge cushion; avoid low sofas and bean bags
• Use a raised toilet seat if your toilet is low
• A slightly higher bed helps; get up over the edge of the bed with the leg straight
• Use a sock aid, a long shoehorn and slip-on shoes or elastic laces
• Do not pick things up from the floor – a reacher helps

Weeks 1–8: no active hip flexion or active leg lifting (clearance after 6–8 weeks). Do not lift your straight leg by your own strength while lying down. The hip flexor muscles pull exactly at the osteotomy. Passive movement – when someone else moves the leg or you support it with your hands or your other leg – is fine.

Getting in and out of bed: hook the foot of your healthy leg under the heel of your operated leg and lift both together.

You may sleep on your back and on your healthy side. A pillow between your knees makes side-lying more comfortable. Lying on the operated side is fine once it no longer hurts.

Remember: ‘Good leg goes up, bad leg goes down.’ Going up, step with the healthy leg first, then the operated leg with the crutches. Going down, place the crutches and operated leg first, then the healthy leg.

Keep the dressing dry until the wound is closed. Showering with a waterproof dressing is possible. Baths, sauna and swimming pools only once the wound has fully healed. Stitches or staples – if needed – are removed after about 12 to 14 days; this is stated in your discharge letter.

While you are only partially weight-bearing, the risk of thrombosis is increased. Take your thrombosis prevention exactly as long as stated in your discharge letter – even if you feel well long before.

Once the wound has healed, you may use an exercise bike:

• without resistance
• with the seat set high, so the hip does not bend beyond 90°
• the healthy leg pedals; the operated leg only moves along passively

This keeps the joint mobile, promotes circulation and lifts your mood.

The goal is not building strength, but keeping mobility and walking correctly:

• Gait training with crutches
• Passive hip movement within the allowed limits
• Isometric tensing exercises for buttocks and thigh
• Strengthening of trunk, arms and healthy leg
• Calf pump: move your feet up and down regularly
• Avoid straight-leg raises, strength training for the operated leg and stretches beyond 90° of flexion

Feel free to show this page to your physiotherapist.

After about six weeks we take an X-ray. We check that the bone is healing and the socket has stayed in the correct position. If everything is fine – which is the rule – we clear you for the next step.

• Increase weight-bearing: within about one to two weeks you move to full weight-bearing. First drop one crutch on the healthy side, then both – depending on how steady your gait is.
• Active hip flexion and leg lifting require clearance after 6–8 weeks; until then, the restriction for weeks 1–8 applies.
• Physiotherapy becomes active: now muscle building begins – above all the lateral gluteal muscles (gluteus medius and minimus), which are key to walking without a limp, and the hip flexors (iliopsoas).
• Use the exercise bike with light resistance; the operated leg pedals actively.
• Swimming front crawl or backstroke is possible once the wound has healed and weight-bearing is cleared. Breaststroke with frog kick a little later.
• Driving is usually possible from weeks 8 to 10 – once you can move your leg safely and quickly again, for example for an emergency stop. With an automatic car and an operated left leg, often earlier; please ask us.

Limping is normal in this phase. The muscles have had little work for six weeks and need time. The limp usually disappears with targeted training over the following weeks.

• Office work: often possible from about weeks 6 to 8, ideally starting from home or with reduced hours
• Standing or light physical work: usually after about 3 months
• Heavy physical work: usually after 3 to 6 months

We will discuss the exact timing with you at your check-ups – it depends on your job.

Our own data from Greifswald show: about 43% of our patients are back to sport after three months, 77% after six months and 95% after one year.

The usual order is cycling, swimming and cross-trainer from about month 3; jogging from about months 4 to 6, increased slowly; and jumping, contact and ball sports such as football, handball, tennis and skiing from about month 6.

What matters is not the calendar but your hip: pain-free walking, no limp, enough strength. Increase slowly – better two weeks later than risk a setback.

• The wound is leaking, red or swollen
• Fever or clearly increasing pain
• Pain, swelling or tightness in the calf
• Persistent burning pain or numbness on the outer thigh – this can be irritation of the lateral femoral cutaneous nerve. It is rare, but treats well if treated early. Please do not wait.
• Shortness of breath or chest pain: call 112 immediately

Online and in forums you will find many personal stories – often from other hospitals, with other techniques and other rules. Comparing tends to unsettle rather than help. If you have questions or problems, contact us directly. We know your operation and coordinate everything else.

For questions about rehabilitation, write directly to Prof. Wassilew. For appointments, contact the outpatient clinic or use the appointment email shown below.

Nonnenmacher L, Fischer M, Kaderali L, Wassilew GI. Predicting early return to sport after periacetabular osteotomy: a machine-learning approach. Bone Jt Open 2025;6(6 Suppl B):33–42. https://pmc.ncbi.nlm.nih.gov/articles/PMC12184721/