Hip Dysplasia and PAO
How long will it take to recover after a PAO?
Patients are in hospital two to four nights and can start to come off crutches after six weeks. Patients are advised to take eight weeks off work, but clearly this varies between individuals, particularly as working from home in some capacity is possible for many. However, patients may underestimate how much the surgery affects their stamina and there is no doubt that the longer patients take off work, the easier they find it on return. Patients should not do any work at all during the week of surgery and the week after so there are no distractions to recovery. Some gentle work email is reasonable from the third or fourth week, with a potential return to the office for the odd half-day from the end of week six onwards, provided the patient is driven to and from work. Return to full work is usually possible after eight weeks but be aware it will initially be tiring being back at work. In addition, physiotherapy will be continuing and setting time aside for exercise is still required. Patients with long or challenging commutes to work should adjust their hours to avoid peak-times to ensure they get a seat.
By three or four months, the hip should function almost normally in day-to-day life and patients should have resumed their usual gym activities, albeit at lower intensity, with a return to running by six months. The hip will continue to improve further for up to a year after surgery, and patients sometimes reporting further subtle improvements even in the second year.
What tablets will I need after surgery?
Patients are given slow-release oxycodone (Oxycontin, a synthetic morphine type drug), ibuprofen (Nurofen, the non-steroidal anti-inflammatory drug), and paracetamol. Patients are sent home with a reducing dose of oxycontin for seven to ten days, as well as a three-week supply of the blood-thinning capsule, Dabigatran. Patients should also have a supply of the over the counter painkillers Nurofen and paracetamol at home. Both these drugs can be taken together and with oxycontin. After two or three weeks, patients are usually only taking paracetamol tablets occasionally.
When can I drive after my PAO?
If patients are confident walking without crutches and able to enter a car unaided then a return to driving is reasonable, provided at least eight weeks have elapsed.
How much physiotherapy will I need after surgery?
Patients are advised to continue the exercises they will have learnt in hospital when they get home. It is important the hip doesn't stiffen up in whilst on crutches. Weekly land-based physiotherapy is essential for successful rehabilitation after surgery. As well as providing appropriate guidance for the hip itself, a visit to the physiotherapist provides an important focus for the week and allows the patient to see real progress at each visit. If available, hydrotherapy once or twice a week is also helpful for the first six weeks. Use of an exercise bike is strongly encouraged after coming off crutches at six weeks, initially starting with low resistance for a few minutes.
Muscles take many weeks to recover not only from the surgery but also, more importantly, the long-term effect of the dysplasia itself prior to surgery. After two or three months, physiotherapy can become more spaced out as the emphasis of rehabilitation moves from the physiotherapy practice to the patient's own gym. As the surgical discomfort subsides patients become more confident achieving goals set by their physiotherapist, with a step-wise move up from static bike, to elliptical trainer and finally treadmill.
Are there any stitches to remove?
No. The stitches are under the skin and dissolvable.
When can I fly after my PAO?
The additional risk of blood clots after a hip replacement has almost gone after six weeks. It is for this reason that patients are advised not to fly long haul within this time. Shorter flights to Europe pose little, if any, additional clot risk.
What can go wrong with a PAO?
Complications are rare with modern surgical and anaesthetic techniques. Blood clot risk (deep vein thrombosis or DVT) is kept to a minimum with use of a combination of measures. The blood-thinning tablet Dabigatran is given for four weeks after surgery and the patient is advised to wear compression (TED) stockings for six weeks after surgery. In addition, whilst in hospital, foot pumps are used to enhance blood flow in the legs whilst the patient is in hospital. Infection in a hip replacement occurs in less than 1% of cases, but, whilst the infection can usually be eradicated, it does involve lengthy treatment with antibiotics and surgery. Whilst blood loss does occur during surgery, the advent of minimally invasive PAO has abolished the risk of blood transfusion completely.
Major nerve injury to either the femoral or sciatic nerves is rare with a risk of 1%; when injured the nerves have not been cut, but have been susceptible to stretching which occurs during the operation. Failure of the bone to heal is extremely rare and loss of fixation of the fragment will only occur if the patient is involved in a severe accident. Subtle lengthening of the leg may also occur.
The most important complication is that the surgery may not succeed in its goals of relieving pain and improving activity levels. However, whilst these cases are unusual, patients do notice, as time passes, that their hip is no longer deteriorating.