What Is a Periacetabular Osteotomy?
Pain in the hip can be caused by a deformity in the bones of the hip joint. This may have stemmed from a childhood disease, such as Legg-Calve Perthes disease or slipped capital femoral epiphysis (SCFE), or from a developmental condition, such as hip dysplasia or femeroacetabular impingement (FAI).
An osteotomy is a surgery that cuts and repositions your bone to restore more normal alignment in your hip joint and improve your gait, as well as reduce pain. You may also want to consider an osteotomy when a hip replacement is not a good option due to young age.
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What a Hip Osteotomy Treats
Specialists recommend a periacetabular osteotomy for patients who have symptoms that don’t improve with non-surgical treatments, like rest, medication, or physical therapy. These symptoms could include:
- Pain, swelling, or stiffness in the hip;
- Torn cartilage or ligaments; or
- Torn labrum (lining of the hip socket).
If these symptoms are being caused by a problem in the alignment of your hip joint, a periacetabular osteotomy can be performed to correct the alignment and prevent further damage to your joint.
What to Expect: Day of Procedure
Hip osteotomy surgery involves cutting out or carving around the hip socket to move it to a new and better location. To do this, the surgeon makes an incision over the front of the hip, about six to eight inches long, separating muscles to get to the pelvis. Then with X-ray guidance (fluoroscopy), he carefully cuts through the three pelvic bones (ischium, pubis, ilium) around the hip socket to free it from its original position.
Next the acetabulum is fixed in its new location with screws (usually three to six); a bone graft is used if needed.
Sometimes if the angle made by the femur and head is too low (varus) or too high (valgus), then an osteotomy of the femur may be needed. This helps the femoral head to be in a more normal position to preserve it from wearing out. This surgery is called a proximal femoral osteotomy.
Hip Osteotomy Recovery
You will be walking within a couple days of surgery, but on one or two crutches for three months. It usually takes 9-12 months to feel fully recovered.
The hospital stay for an osteotomy is usually two to three days after surgery. When you leave the hospital, you will need 24-hour help for a week. Or if you don't have adequate help at home, you could consider a rehabilitation center. The final plans will be made while you are recovering in the hospital.
Starting the day after surgery you will have physical therapy twice a day that includes gentle exercises, learning to sit, stand, and walk with partial weight-bearing and crutches. You may take a few steps the first day around your room, and the second day out into the hallway and so on.
After you leave the hospital, you need to walk, rest, and let your surgery heal. We do not want formal physical therapy for the first six weeks; after that we evaluate your needs on an individual basis.
Timeline After Leaving the Hospital
Here is a basic recovery timeline:
First six weeks: Finish taking blood thinners (aspirin for six weeks), wear TED hose, walk with crutches (partial weight bearing), keep wound clean.
You will probably only need to take narcotics for about seven to 21 days from surgery. Be aware that sometimes anti-inflammatories (NSAIDS) can slow down bone healing, but Tylenol is not a problem.
Next six weeks: Transition to one cane or crutch as instructed by your physician until three months after surgery; may start gentle stretching or strengthening exercises; walk.
After three months: Return to work part time or full time as tolerated (two to three months from surgery); continue to walk and return to gentle exercise.
After six months: You may return to full activity (when the bone cuts are completely healed) except for running/jumping activities.
You will probably have staples and should see your doctor in two weeks, then again six weeks after surgery for X-rays, then three months, six months, one year, and every year or two so we can see how the hip progresses.
After this, we advise patients to resume what they can tolerate, especially walking, swimming, and bicycle riding. We discourage repetitive jumping, running, and heavy manual labor and lifting. These activities tend to wear out your hip faster.
When Can I Drive After an Osteotomy?
Usually three to four weeks after surgery (when you're safe enough to not be at fault if you get in an accident and off narcotics).
How Long Will the Corrective Osteotomy Last?
We hope to extend the time between now and when you need a hip replacement (total hip arthroplasty). But the exact time in years is unknown and based on the amount of arthritis in your hip already.
See Our Providers for Hip Pain
You do not need a referral to see one of our specialists for hip pain.* Before you come to see us, please follow these steps:
- Get an X-ray at your local health center.
- Send us your X-ray.
- Make an appointment with our hip pain specialists by calling 801-587-7109.*
Based on your X-ray, we'll make every attempt to get you in with the right provider for the most appropriate evaluation and individualized treatment of your hip pain.
*Be sure to check with your insurance beforehand to see if they require you to have a referral to see one of our hip pain specialists.