Postoperative weight-bearing restrictions and rehabilitation after periacetabular osteotomy: a systematic review

Abstract

Abstract Aims This systematic review aimed to synthesize current evidence on postoperative rehabilitation strategies, particularly weight-bearing restrictions after periacetabular osteotomy (PAO). Methods A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Web of Science, and Embase were searched until January 12, 2025. After duplicate removal, studies were screened by title, abstract, and full text using predefined criteria. Studies were included if they reported postoperative weight-bearing protocols after isolated PAO; studies with additional procedures, non-human data, or lacking mobilization details were excluded. Primary endpoints included postoperative weight-bearing instructions, duration of partial weight-bearing, and brace use. Secondary endpoints included hip function, return to sports, and complications. Data extraction was performed independently by two reviewers. Bias was assessed using the MINORS tool. Results The majority of studies recommended partial weight-bearing immediately postoperatively, commonly initiated on postoperative day one (18% of studies), typically lasting six (21%) to eight (18%) weeks. Variations included toe-touch, tip-touch, touch-down, flat-foot, protected, or restricted weight-bearing. Crutches were frequently recommended (48%). Bracing was infrequently reported (5%), with limited details provided. Return to sporting activities varied widely, typically recommended between six and twelve months postoperatively. Complication rates were diverse, with delayed weight-bearing showing a lower incidence of pelvic fractures compared to immediate full weight-bearing. Conclusion This review highlights substantial variability and imprecise terminology in existing PAO mobilization protocols and a lack of standardization. Future research should prioritize prospective comparative studies to clarify safe, effective postoperative mobilization strategies. Establishing standardized, evidence-based rehabilitation guidelines could enhance patient outcomes, reduce complications, and decrease practice variability following PAO.