Getting Periacetabular Osteotomy (PAO) and Other Open Hip Surgeries
Hip surgeries are performed to:
- help relieve pain,
- improve structural deformities,
- improve hip motion and strength,
- repair damage from injuries, and
- potentially prevent further joint damage due to underlying structural abnormalities that may result in a total hip replacement in the future.
Our orthopedic surgeons at University of Utah Health will give you the high-quality care and support you need to make your hip surgery a little less nerve-racking and help you get back on your feet. Our goal is to help you live a pain-free life while doing all your favorite things, whether that means playing sports, enjoying the outdoors, or spending time with your loved ones.
Scheduling Your Surgery & Insurance
When you and your doctor have decided it’s time for an open hip surgery like PAO, you will meet with the nurse and surgical coordinator to discuss time frame for surgery and follow up appointments.
Our surgical coordinator will notify your insurance company about your upcoming surgery and provide them with any information that they need to authorize it. However, it is your responsibility to talk to your insurance provider about any out-of-pocket charges.
Hip surgery often requires pre-approval from your insurance company. Our team will submit the paperwork to begin the process. Most insurance companies require at least four weeks to complete the approval process. Sometimes an appeal can be necessary. Once approved, we will proceed with the surgery.
While getting pre-approval helps streamline the insurance process, the insurance companies will state that ‘pre-approval does not guarantee payment’.
For a hip surgery cost estimate, you can reach out to one of our financial advocates at 801-581-2957.
Surgery Locations
Your surgery will take place at University of Utah Hospital. You will be treated by Dr. Christopher L. Peters or Dr. Lucas A. Anderson.
PAO Specialists
Preparing for Your Surgery
There are multiple steps you need to do to prepare for your surgery, including:
- getting equipment for surgery,
- preparing your home,
- optimizing your health,
- preparing mentally,
- monitoring your medications, and
- doing pre-surgical lab work.
Equipment
You will need a pair of reliable crutches. You will be using them for about six weeks or more. Also, it may be helpful (but not required) to get a shower chair, a sock aid, and/or a leg lifter.
Preparing Your Home
You will need to prepare your home for comfort and minimize any safety risks that may be lurking. There are a few things you can do around the house to prepare before your surgery:
- Get firm pillows for your recliner, couch, and bed.
- Remove rugs, cords, or random furniture pieces on the floor to avoid any accidental trips or falls.
- If needed, arrange for child or pet care while you recover.
- Stock up on groceries for the first few weeks. (Think frozen or simple meals and snacks.)
Optimizing Your Health
Maintaining a healthy lifestyle can help decrease any risks of complications both during and after surgery. Starting now and leading up to your surgery:
- stop all nicotine. (Smokers have more difficulty with anesthesia, higher risk of delayed bone healing and infections.) We will not perform a PAO if you are currently using any type of tobacco or nicotine products (gum, vaping, patches).
- add a daily supplement of calcium and vitamin D, in addition to a good multivitamin with iron to your diet.
- eat a well-balanced diet, high in protein; consider an anti-inflammatory diet.
- sleep at least seven to eight hours every night.
- exercise regularly, such as stationary biking, jogging or brisk walks.
Mental Preparedness
To prepare for surgery, we recommend that you try a practice called mindfulness. Mindfulness is a mental health practice that can impact your mental ability to react to what’s going on around you. Mindfulness helps you become more resilient mentally in recovering and coping as well.
We have a handout for you that will outline how to practice mindfulness and prepare yourself mentally for surgery.
Monitoring Your Medications
It is important that you tell us about any allergies or current medications you are taking, to avoid any interaction with medications given during and after surgery.
If you are currently taking any narcotic pain medications, please decrease your use of them by at least 50 percent before surgery. When your body has built up a tolerance for narcotics, it makes it more difficult to manage your pain after surgery.
You will also need to steer clear of anti-inflammatory medicines (Ibuprofen, Aleve, Motrin, and the like) for one week before your surgery to prevent excess bleeding.
Pre-Surgery Lab Work
Before surgery, we will do lab work to ensure you are healthy and have no under lying issues. This will need to be done about 60 days prior to your surgery date. Contact our office when the time gets closer and we can instruct you further.
The Day Before Surgery
The day before your surgery, the hospital will contact you between 2 and 5 pm, but if you have not heard from them by 4 pm, feel free to reach out to them at 801-585-1449 for your scheduled arrival time.
Typically, you will check in at the hospital about two hours before the surgery. Surgical times can vary, so bring something to occupy your time (book, phone, tablet, or the like) in case your operation is delayed. Whatever you bring to the hospital, be sure your name is on it or leave it with your family to ensure it does not get lost. Leave your valuables at home.
Remember, do not eat or drink anything after midnight the day before your surgery. This includes NO:
- chewing tobacco,
- candy,
- gum, or
- mints.
Drink more water and/or non-alcoholic non-caffeinated beverages the week before your surgery. If your body is hydrated, you will feel much better after surgery.
Shower the night before or morning of surgery with surgical soap (chlorhexidine gluconate soap). We may have given you a bottle when you were in our offices for your initial consultation and surgery scheduling. If not, this soap is available for purchase over-the-counter at your local pharmacy or store.
If you feel ill within 24-48 hours before your surgery, please notify your surgeon’s office immediately.
Day of Your Hip Surgery
When you arrive at the hospital, the surgery check-in desk is at the main entrance. It is the first desk on the right-hand side inside the lobby. We recommend that that you bring these items:
Your identification, insurance cards, and any applicable co-pay or deductible payment with you to check in.
- A list of your medications, including herbal and over-the-counter drugs.
- Remove your contact lenses or bring your lens case.
- Make sure you have a responsible adult to drive you home.
- Wear loose fitting clothing.
For any questions, please call your surgeon’s office or the U of U Hospital at 801-585-1449.
Before You Go into the Operating Room
A nurse will assess your health, which includes:
- taking your vitals,
- starting an IV, and
- prepping the skin around the surgical area.
Your surgeon will also visit with you to discuss your surgery, mark the site of operation, have you sign the surgical consent, and answer any questions you may have.
Hip surgery typically takes about two hours, although could last longer if your hip is more complicated.
Anesthesiology
You will get the opportunity to speak to the anesthesiologist about your:
- health,
- medical history, and
- anesthesia options, including the risks.
A spinal anesthetic can be helpful for pain right after surgery but often a general anesthetic is needed to keep you from moving at all during your surgery.
After Surgery
You will be staying at U of U Hospital in a single patient room. This allows you to have a guest stay with you while you are with us. There is a couch or sometimes a recliner that your guest can use to sleep on if desired. Visiting hours are flexible depending on what you would like.
Hospital Staffing
Hospital staff are a nurse, aide, and your physical therapist. Normally, they work shifts from 7 am-7 pm. They rotate shifts and you may have the same nurse/aide throughout your stay, but more than likely they will change.
Your physical therapist will usually visit you twice a day. This generally is the same therapist but can change as well. Nurses are crucial in your recovery and pain control. Ensure good communication with them, tell them how you are feeling, how well (or not) your pain is controlled, medication questions, discharge questions, and the like. Your aides will help you get up to the bathroom, change your sheets, and assist you in your daily activities.
Residents, fellows, and physician assistants help with your care before and after surgery as well. They are all coordinating with Dr. Peters and Dr. Anderson about your care.
Pain Control
Before surgery, we will give you medication to start blunting the pain before it starts. After surgery, your pain will be controlled using a local medication injected into your hip. You will also have regular doses of acetaminophen and celecoxib to keep your pain more manageable.
Additionally, as you need it, we will give you oral and IV pain relievers to help with pain control. Generally, we give each patient a standard dose of pain medication to help control pain.
Discuss how you are feeling with your care team in the hospital and how well your pain is controlled. Sometimes what works for one patient, may not work for another.
Ice packs can help relieve swelling and soothe painful areas. Ask your care team for ice packs frequently through each day and night when you need them. You can take them home and use them for pain control when you are home as well. They are one of the easiest, yet most effective methods of pain control.
Do not apply an ice pack directly to your skin. Make sure there is some light cloth between the ice pack and your skin so you do not burn your skin. Use ice AT LEAST three to four times a day for 20 minutes each time.
Blood Transfusions
There is a five to 10 percent chance that you may need a transfusion. We recycle the blood you lose at surgery and give it back to you if there is enough. We have screened your blood type and will match it very carefully in our lab at the university if we determine that you need an additional transfusion.
Hip Surgery Complications
It is uncommon, but all surgical patients are at risk for the following complications.
Infection - It is rare, but an infection may occur in the wound or around the incision sites. Check your incisions for signs of:
- increasing redness,
- tenderness,
- swelling or warmth, and/or
- excessive drainage from the wound.
You may also experience a fever, shaking, chills, or night sweats. If you have concerns about an infection, please call your physician's office.
Blood clots - Blood clots in the leg are also called a deep vein thrombosis (DVT). Blood clots can move to the lungs and cause a pulmonary embolism (PE). While extremely uncommon, pulmonary embolism can be life threatening. Signs of DVT/PE include:
- large amounts of swelling in a leg or arm,
- cramps in your calf or lower leg,
- sharp/sudden chest pain, and
- difficulty breathing or shortness of breath.
If there are signs of swelling or cramping (possible DVT), call your physician's office. If you are experiencing sudden chest pain or difficulty breathing (possible PE), call 911 and immediately report to an emergency room for further help.
Nerve palsy and numbness - Anytime a surgery is performed, the small nerves around the skin can be injured or cut. It is common to have patchy numbness around the surgical area or below it. Minor numbness on the outside of your thigh is common. This improves with time.
There is a sensory nerve called the lateral femoral cutaneous nerve, right where the incision from surgery is. We do our best to identify it and protect it, but there is a chance you will have some numbness over the side of your thigh. Over time sensation usually returns.
There are also bigger nerves, femoral and sciatic nerves, which are deeper and can get stretched with a big correction/surgery, but this is very rare (happens to fewer than one percent of patients).