Table 1. Summary of rehabilitation guidelines for use following a periacetabular osteotomy (PAO).

PAO Rehabilitation Guidelines
Phase I: Immediate Post-Operative Phase Weeks 1-4
Goals: Protect healing tissues and osteotomy sites Reduce post-operative pain and inflammation Normalize gait pattern with appropriate assistive device	Precautions: Weightbearing: Foot flat weight bearing 25% body weight Range of Motion: Hip flexion limited to 90° Hip external rotation limited to 20° Active long lever hip flexion contraindicated until 8-12
Therapeutic Interventions: Ankle pumps and submaximal hip isometric exercises Cryotherapy and compression for inflammation and edema control
Phase II: Early Post-Operative Phase Weeks 4-6
Goals: Gentle progression of ROM Continue protecting healing osteotomy sites Limit irritation of surrounding soft tissues with increasing activity	Precautions: Weightbearing: Foot flat weight bearing 25% body weight Range of Motion: Hip flexion limited to 90° Hip external rotation limited to 20° Active long lever hip flexion contraindicated until week 8-12
Physical Therapy: Submaximal isometrics in all directions Gradual loading of iliopsoas tendon is critical to avoid tendonitis Short lever A/AAROM Lumbopelvic neuromuscular control exercises in supine
Phase III: Initial Strengthening Phase Weeks 6-12
Goals: Near full, symmetrical ROM Improve hip and core strength and neuromuscular control Gradual WB progression (normalized gait pattern and physician clearance required for discharging assistive device)	Precautions: Monitor for symptoms of intra- and extra-articular irritation with exercise and WB progression Avoid premature weaning from assistive device Active long lever hip flexion contraindicated until week 8-12
Physical Therapy: Gradual progression of functional ROM Introduce upright stationary bike between 6-8 weeks Introduce elliptical between 10-12 weeks as tolerated Introduce stretching progression between 8-12 weeks Initiate closed chain strengthening progression Progress lumbopelvic stabilization and postural control exercises
Phase IV: Advanced Strengthening Phase Weeks 12-20
Goals: Increase muscular and cardiovascular endurance Begin to re-establish neuromuscular control for sport-specific activity	Precautions: Avoid provocation of symptoms with progression of exercise No running, jumping, hopping, or cutting/pivoting
Physical Therapy: Progress multi-directional hip and LE strengthening Progress to end range strengthening with emphasis on dynamic control of lower extremity and pelvis Core stability progression to meet demands of sport
Phase V: Return to Low Level Impact (Weeks 20-26)
Goals: Tolerance of running and straight plane agility drills with appropriate lumbopelvic and lower extremity control		Precautions: Avoid provocation of symptoms with progression of exercise No jumping, hopping, cutting/pivoting
Physical Therapy: Initiate running and agility progressions with emphasis on dynamic control of pelvis and lower extremity Continue high level strength and control exercises with emphasis on pelvis and lower extremity musculature
Phase V: Return to Full Participation in Sports (Weeks 26+)
Goals: Tolerance of jumping, hopping, cutting/pivoting drills with appropriate lumbopelvic and lower extremity control Return to full participation in sports		Precautions: Avoid provocation of symptoms with progression of exercise
Physical Therapy: Initiate jumping and hopping progression with emphasis on dynamic control of lower extremity and pelvis Sport specific cutting and pivoting drills with emphasis on dynamic control of lower extremity and pelvis