Preparing for PAO Surgery
If you or your child has recently been diagnosed with dysplasia, and a PAO surgery has been recommended, read below for some helpful information to prepare you for surgery.
You will need to have all imaging studies performed well in advance of the surgery. This includes X-rays, an MRI and possibly a CT scan. You will have your blood type checked at a local Red Cross center and you may have people donate blood to possibly use during or after surgery. If you are taking birth control pills, you should stop taking them one month before surgery. If you are taking NSAIDs (such as Advil, Ibuprofen, Alleve, or Motrin), you should stop taking them 5 days prior to surgery. Tylenol is fine to take before surgery.
The night before surgery you should take a bath and clean the hip area with antibacterial soap. Do not shave the area before surgery as this may increase the risk of infection.
You will be seen in the office for a preop visit with your COA surgeon, and will be seen by a physical therapist. The therapist will show you how to properly use crutches, will show you exercises to do before and after surgery, and will go over some of the precautions for after surgery.
Your surgery should take about three to four hours. You will wake up in the recovery room where you will stay until you are ready to go to your room. You will have a bandage on the hip, you will have TED hose on your legs, your operated leg will be elevated on three pillows. There is a tendency for the operated leg to roll outwards at the hip following surgery so the nurse will make sure your knee and toes are pointed upwards and not outwards. You will have a drain under the bandage and a catheter in your bladder. You will be given pain medications by the nurse in the recovery room and will be instructed on how to use a patient controlled analgesia (PCA) machine.
Once you are in your hospital room, you will have ice applied to the hip intermittently and the rest of the day will be spent resting. You may be allowed to drink liquids although most patients don't eat or drink until the next morning. Plexipulses will be put on your feet and they will intermittently squeeze to help circulate blood and minimize risk of deep venous thrombosis (DVT). You will be instructed on how to use an incentive spirometer to help expand your lungs.
On the day following your surgery, your blood will be drawn to check for anemia. The drain may or may not be removed depending on how much is draining. A physical therapist will assist you getting out of bed, sitting in a chair and getting to the bathroom. They will reinforce the hip precautions and proper use of crutches. The Foley (bladder) catheter will be removed. You will be allowed to eat and drink and once you are drinking well the iv fluids will be stopped. You will start taking oral pain medicine and the PCA will be stopped. You will have PT twice a day. You will be started on a baby aspirin, multivitamin with iron and a stool softener (Colace).
On the second day after surgery, the drain will be removed if it hasn't already been done. You will continue with PT. The case manager will begin making arrangements for your home needs.
On the third day after surgery you will continue PT and very likely be ready to go home. The nurse will give you discharge instructions and your prescriptions.
You will continue to use the TED hose, take one baby aspirin a day and prop your leg on three pillows for four weeks. You can take pain medicine as needed. You should change the bandages daily and leave the white steri-strips in place. They will begin to fall off in about two weeks. You can begin showering one week after surgery. You are encouraged to walk with crutches putting about 20-30% of your body weight on the operated leg. You should perform the home exercises that were demonstrated before and after surgery. You should not fully flex or fully extend the operated hip for four weeks.
Your postop appointment will be around two weeks after surgery. Your doctor will check the incision, check the strength and motion of the hip and take X-rays. A prescription for PT will be provided and you should begin scheduling that appointment.
At four weeks postop, you can stop using the TED hose and the pillows under the leg. You can begin to sleep on your stomach. You will stop taking the baby aspirin.
At six weeks postop you will have another office visit and X-rays. If the osteotomy is healing well then you will be allowed to put more weight on the leg and use one crutch or a cane for the next 1-2 weeks. You are also allowed to resume driving once you are able to put full weight on the operated leg and are off prescription pain medication.
At three months postop you may begin returning to normal activities.
PT may continue intermittently for 4-6 months. Home exercises should be done daily.
PAO surgeries can be life changing in the long term. The better prepared you are, the more successful your surgery. Read the success story of one COA patient here. Please do not hesitate to contact us with any additional questions you have. The best contact person is the surgeon you spoke to and/or your surgeon's patient care coordinator.