Rehabilitation Guidelines for Use Following a Periacetabular Osteotomy (PAO): A North American Based Delphi Consensus

Abstract

Background Treatment of acetabular dysplasia with a periacetabular osteotomy (PAO) has been shown to improve long term outcomes and is considered the gold standard in the setting of symptomatic hip dysplasia in patients younger than 35 years of age. Post-operative rehabilitation following a PAO plays an important role in helping patients return to their prior level of function and reduce the impact of strength deficits that may persist. Currently, there is a paucity of research supporting post-operative rehabilitation guidelines. The purpose of this study is to present expert-driven rehabilitation guidelines to reduce practice variation following a PAO. Methods A panel of 16 physiotherapists from across the United States and Canada who were identified as experts in PAO rehabilitation by high-volume hip preservation surgeons participated in this Delphi study. Panelists were presented with 11 questions pertaining to rehabilitation guidelines following a PAO. Three iterative survey rounds were presented to the panelists based on responses to these questions. This three-step Delphi method was utilized to establish consensus on post-operative rehabilitation guidelines following a PAO. Results Total (100%) participation was achieved for all three survey rounds. Consensus (>75%) was reached for 11/11 questions pertaining to the following areas: 1) weight-bearing and range of motion (ROM) precautions, 2) therapeutic exercise prescription including neuromuscular control, cardiovascular exercise, and flexibility, and 3) objective measures for return to straight line running and return to full participation in sports. Conclusion This Delphi study established expert-driven rehabilitation guidelines for use following a PAO. The standardization of rehabilitative care following PAO is essential for achieving optimal outcomes despite other factors such as geographical location and socioeconomic status. Further research on patient-reported outcomes is necessary to confirm successful rehabilitation following the guidelines outlined in this study.

Periacetabular Osteotomy: An Analysis of Social Media to Determine the Most Common Questions Asked by the Periacetabular Osteotomy Population

“…Questions ranged from speci c physical therapists to work with postoperatively, rehabilitation supplies such as walkers and other durable medical equipment, to different stretches and exercises that helped other patients' recovery and symptoms. Prior studies have shown the standardization of rehabilitative care following PAO is essential for achieving optimal outcomes despite other factors such as geographical location and socioeconomic status 5 . Connecting with physical therapists that specialize in PAO or developmental dysplasia of the hip (DDH) rehabilitation through use of social media or virtually could be a great opportunity for improving outcomes and marketing physical therapy services.…”

Evaluating Functional Performance Tests in those with Non-arthritic Intra-articular Hip Pain: An International Consensus Statement

“…This study utilized a modified Delphi technique to establish group consensus on use of functional performance tests for individuals with non-arthritic intra-articular hip pain. 25,26 Methods for the current study are similar to those described in Disantis et al 27 Briefly, a list of relevant questions regarding the use of functional performance tests was determined and consensus was reached over three survey rounds. During round one, panelists were presented with list of potential topics via email.…”

Team Approach: Hip Preservation Surgery

“…Physical therapy plays an important role in postoperative care and recovery of hip preservation surgery 67 . Although a PAO is often combined with hip arthroscopy, the addition of hip arthroscopy does not dramatically change the rehabilitation.…”