Hip dysplasia in adults: exercise, surgery and what to expect

What is hip dysplasia in adults?

Hip dysplasia in adults means the socket does not cover enough of the ball at the top of the thighbone. The joint is not out of place, and nothing is broken. The socket is simply shallower than it should be, so the load that a whole dome of bone is meant to share lands on a smaller area at the rim, along with the ring of tough cartilage that lines that rim (the labrum).

That explains most of what people with a dysplastic hip describe: groin pain that builds through a long day on your feet, clicking or catching, and a hip that feels unreliable rather than simply sore. Quite a few people describe a hip that feels about to give way under them. The NHS page on developmental dysplasia of the hip lists hip pain, groin pain and a clicking, snapping or popping feeling in the joint for adults, and says that in older children and adults the diagnosis is made with X-rays.

Two facts have to sit next to each other here, and both are true. Exercise will not change the shape of your socket. It still matters, because the muscles have to supply steadiness the bone is not supplying. Everything below comes from holding both of those at once instead of picking the comfortable one.

Being told it was a groin strain for years

Plenty of people reach a diagnosis of dysplasia after a long run of other explanations: a groin strain that never settled, a tight hip flexor, clicky hips you were told to ignore. That is not carelessness by any one clinician. The Zurich consensus on hip-related pain says in as many words that clinical examination and imaging have limited diagnostic value on their own, and that competing causes such as the lumbar spine have to be excluded first (Reiman and colleagues, 2020). A shallow socket also hurts long after it forms, so the pain arrives in your twenties or thirties with no injury to point at.

If that was your experience, there is one practical thing to take from it. Ask what your X-ray measurements were, and ask whether anyone has looked at the shape of the socket as well as the soft tissue. The answer changes which treatments belong on the table.

How is hip dysplasia in adults diagnosed?

Plain X-rays, read alongside an examination, are the starting point. The Zurich consensus recommends an anteroposterior view of the pelvis and a lateral view of the head and neck of the thighbone first, keeping MRI and CT for when more detail would change the plan, such as confirming a diagnosis or planning an operation (Reiman and colleagues, 2020). It also places acetabular dysplasia and hip instability as one of the three main causes of hip-related pain in young and middle-aged active adults, alongside hip impingement and the labral and cartilage problems that come without a distinct bone shape.

Cover is usually described with a measurement called the lateral center edge angle. The dysplasia consensus takes an angle below 20 degrees as dysplastic and 20 to 25 degrees as borderline, and in the same breath calls that single number an oversimplification of the diagnosis, useful mainly for deciding when a physical therapist (physiotherapist) should refer on (Disantis and colleagues, 2023). So the angle is a signpost, not a verdict. Two hips with the same angle can behave completely differently depending on how the socket is turned, how the thighbone is shaped and how much control the muscles have.

Hip dysplasia and early hip osteoarthritis

A shallow socket raises the risk of the joint wearing, and that link has been measured, not assumed. In the Rotterdam study, 835 people aged 55 and over whose hips were normal or near normal at the start were X-rayed again after an average of 6.6 years. Those with a center edge angle below 25 degrees had about 4.3 times the risk of developing hip osteoarthritis on the X-ray (Reijman and colleagues, 2005).

Read that for what it is. The population was older adults, the outcome was a change on imaging rather than an operation, and a risk multiplier across a group says nothing certain about one person. It is still the main reason a shallow socket in a young adult is taken seriously instead of watched, and the reason surgeons talk about correcting the shape before the cartilage is worn, not after. If an X-ray has already shown established wear, the hip osteoarthritis program is a better fit than this page.

What exercise can and cannot do

Nothing in the program below will deepen your socket. What it can do is improve how well the muscles control a joint that is structurally unstable, which is exactly how the dysplasia consensus describes the goal of non-operative care: re-establishing strength and functional control to improve dynamic stability (Disantis and colleagues, 2023). People get stronger, stand and walk for longer and hurt less, with nothing changed on the X-ray at all.

That consensus is a panel of 15 physiotherapists in North America, each treating at least 20 patients with dysplasia a year, who reached agreement on all 16 questions put to them. The authors are open about what it is: expert opinion, with no patient outcome data behind it, in a field they describe as having a paucity of research. So the shape of the program below is well agreed by people who do this work, and the proof that it works is thinner than anyone would like. Where the evidence is thin, this page says so and does not dress it up.

Three of the panel's positions change what a program looks like, and each one catches people out. Stretching is not a focus, because this is an instability problem and the muscles at the front and inside of the hip that feel tight are contributing to stability at the front of the joint. Note where the panel puts that caution: it is about the early stages, and once the muscles at the back and side of the hip have built up, stretching can be added as you tolerate it, with strength and control still carrying most of the work. Strengthening the hip flexors waits until the muscles at the back and side of the hip have improved, and starts with the knee bent rather than with a long straight leg. And progress from both legs to one leg is judged on control, not on the calendar: the double leg version has to happen without the trunk or pelvis giving way first.

The panel asks for one more thing alongside the strength work, and it is the part people drop when the hip hurts. Keep your general fitness going with exercise that does not provoke the hip: cycling, a cross trainer and swimming are the three it names, with a pull buoy if kicking bothers the hip, and running and jumping left until strength and control have improved and the hip has quietened down (Disantis and colleagues, 2023).

How to use this program

First, check this is your page. The stages below are written for a hip that has not been operated on. If you have had an operation on this hip, a periacetabular osteotomy or keyhole surgery, follow the plan your surgeon and physio gave you, because nothing here can set your weight bearing or your movement limits.

A few readers belong somewhere else. If an X-ray has shown established wear, use the hip osteoarthritis program. If you have been told the main problem is the hip pinching at the front and not the socket being shallow, the hip impingement program and the hip labral tear program go into that in more detail. A child or teenager with hip, thigh or knee pain, or a limp, needs to see a doctor first.

The surgery rule above has one exception, for anyone whose operation is years behind them and not weeks. If you have been signed off with nothing left to observe, no weight bearing limit, no movement limit and clearance for normal exercise, then stage 1 is a reasonable place to begin. Begin there even if you feel ready for more: a hip that has been comfortable for a year is still a hip that needed an operation, and the muscles around it are usually weaker than they feel. If you are not certain every restriction has been lifted, or you cannot remember what you were told, ring the team and ask before you start. Do not take the answer off this page.

Then start at stage 1 unless a physio has placed you higher. Move up when the current stage is easy and your hip is no worse the day after. Each stage above gives its own dose, and those numbers are the ones that govern: where an exercise page's starting dose is different from the stage you are working in, use the stage. That matters more than it sounds, because stacking one page's sets on top of another's is how a careful week turns into several times the work you intended.

Some discomfort while you exercise is usually fine, as long as it eases soon afterward and your hip feels no worse the day after. A pinch or catch at the front of the hip means the movement went too deep or turned too far, so make it smaller and do not push on. If the groin is clearly more sore the next morning, drop back a stage for a few days instead of stopping altogether.

A note on the precautions printed under each exercise. Of the 18 exercises here, 17 carry a line about hip surgery, and every one of those lines covers hip surgery in general and not a replacement alone, so if you have had a periacetabular osteotomy or keyhole surgery on the hip the line is written for you as well. The operations differ and so do the limits, and the answer still has to come from your own surgeon, not from a web page. The one exercise without a hip surgery line is the deep stomach muscle hold, where the hip neither moves nor takes weight; it carries a line about recent spine surgery instead.

If you have high blood pressure, breathe steadily through every hold and repetition and never hold your breath. Check with your doctor before you start if you have a heart or lung condition, or blood pressure that is not under control. If you have fallen in the past year or feel unsteady, do the standing exercises next to a kitchen counter.

Getting down to the floor and back up again is a transfer of its own, and on a hip that catches or gives way it is the part of a session most likely to drop you. Everything in stage 1 can be done on a firm bed instead. The two exercises on hands and knees in stage 2 cannot, because a mattress gives way under your hands and knees, so if you cannot get down to the floor safely, leave those two out and ask a physio for another way to work the same thing, and do not improvise one. When you do use the floor, get down and up beside something solid you can hold, take the weight through your arms and your better leg, and if you live alone, keep a phone where you could reach it from the floor.

If you are pregnant, check with your midwife or physio before you start. If you are pregnant and past the first three months, check with your physio before exercising flat on your back, which covers three of the five stage 1 exercises, the supine marching in stage 2 and the single leg bridge in stage 3. If you have recently given birth, including by cesarean section, or you have a gap down the middle of your stomach muscles (diastasis recti), ask your physio, midwife or doctor first. The deep stomach muscle hold in stage 1, the two exercises on hands and knees in stage 2 and the side plank in stage 3 all ask the stomach wall and the pelvic floor to work, and a cesarean scar is a healing surgical wound.

Three of these exercises put your body weight through your arms: bird dog and the leg lift on hands and knees in stage 2, and the kneeling side plank in stage 3. After recent heart or chest surgery, get your surgeon's or surgical team's okay before all three, because the weight travels through one or both hands and shears across the healing breastbone. If the breastbone clicks, grinds, shifts or feels as if it is moving while you do it, stop, and contact your surgical team the same day. After a broken wrist, hand or forearm, or surgery on any of them, start those three only when your doctor, surgeon, physio or hand therapist says the bone or the repair is ready to take weight through the arms. The kneeling side plank balances on one hand, so if your shoulder is painful, or you have had shoulder surgery or a dislocated shoulder, check with your physio before you put your weight through that arm.

Read the warning signs at the end of this page before you start, not after something happens. If you have had an operation on this hip, the lines that begin "since your operation" or that name an operation are the ones written for you, and they are more urgent than the general ones that follow.

The exercise program

The exercises below carry their own stop signs and precautions. Open the line under an exercise and read them before you try it.

Periacetabular osteotomy: what the operation does

When the socket itself needs correcting in a younger adult whose joint is not yet worn out, the operation usually discussed is a periacetabular osteotomy, often shortened to PAO and sometimes called the Ganz or Bernese osteotomy. The surgeon makes a series of cuts in the pelvis around the socket, frees it, turns it so that it covers more of the ball, and holds it there with metalwork while the bone joins. The Bernese description sets out a shortened ilioinguinal approach with four osteotomies and one controlled fracture, keeps the back column of the pelvis intact to aid stability and rehabilitation, leaves the birth canal unchanged, and allows the shape of the head and neck of the thighbone to be corrected at the same time (Lerch and colleagues, 2016).

Two things follow from that description, and the whole recovery turns on them. The correction is held by metalwork, not by healed bone, for the first weeks. And the pelvis has been cut in several places, so the bone around those cuts has to unite before it can take your full weight safely.

Long-term results depend heavily on the hip and on the correction. The review of the Bernese technique reports that where the socket was reoriented well and the ball of the hip was still round, 80 to 90% of hips had survived at 10 years. In the very first 75 patients operated on with the technique, 60% had survived at 20 years, and a preliminary look at that same group at 30 years put it near 30% (Lerch and colleagues, 2016). Those last two figures come from one unit's earliest cases followed for three decades, so they are not a prediction for a hip operated on today. Survivorship in a series like that counts the hips that had not yet needed a replacement or declined past a set mark, which is a different question from how any one of them felt.

After a periacetabular osteotomy: weight bearing, movement limits and crutches

Your weight bearing, your crutch time and your movement limits come from your surgeon, and nothing on this page replaces them, whatever numbers you read below. The reason is not caution for its own sake. A systematic review of 63 studies found partial weight bearing was the commonest instruction after this operation, most often for six weeks and next most often for eight, described with at least six different terms across the literature, and concluded that these protocols show substantial variability and imprecise terminology and are not standardized (Leopold and colleagues, 2025). So a figure taken from a protocol is one unit's choice, and yours may be different for good reasons.

The published consensus is still worth reading, because it shows you the usual shape of a recovery, which is a different thing from your own instructions. A panel of 16 physiotherapists in the United States and Canada agreed on limiting weight bearing to 25% foot-flat for 6 to 8 weeks, on limiting hip bending to 90 degrees and turning the leg outward to 20 degrees at that depth for the first 4 to 6 weeks, on full movement being expected by 12 to 16 weeks, on end-range stretching starting somewhere between 8 and 12 weeks, and on holding long-lever hip flexion work back for 8 to 12 weeks (Disantis and colleagues, 2022).

Long lever is worth putting in plain words, because it is a restriction you cannot keep to if you cannot tell what it means: it is lifting the whole leg with the knee held straight, lying down or standing, as against lifting the knee with the leg bent. The same paper states that no studies currently exist supporting specific weight bearing and movement precautions, and that these are expert opinion.

Those figures also describe a PAO on its own. The panel noted that another procedure done at the same sitting, keyhole surgery inside the joint or a microfracture, can lengthen both the weight bearing and the movement limits, and can add limits on taking the hip backward or turning it inward that an isolated osteotomy does not carry.

Read all of that as a description and not as dates you are cleared to act on. None of those numbers is a release. If your own plan is stricter or runs longer, it is the plan written for your pelvis; if it is shorter, that is your surgeon's judgment on bone that has been seen on your own X-rays and in your own operation. The one thing not to do with a borrowed figure is use it to do more than you have been cleared for, because the bone around those cuts is exactly where a fracture after this operation happens. That applies to the movement limits as much as to the weight bearing: if you were told to keep the hip bending below 90 degrees, or to turn the leg out less than 20, or to hold either of those limits for longer than six weeks, yours is the figure that governs and nothing here is permission to go past it.

Two of the numbers invite being read as a start date, so take them the other way round. Eight weeks is the earliest point in the panel's range for end-range stretching, not a date you are cleared to stretch at: the cuts in the pelvis may still be joining then, and the stress fracture described below turns up at an average of nine weeks, so the word to begin stretching comes from your surgeon. And full movement by 12 to 16 weeks is what the panel expected to see, not a target to force. If your range is not back by then, tell your team and keep working at it, rather than pushing the hip into a range it will not yet give you. Coming off crutches, that panel agreed, is judged on X-rays showing the bone has healed and on how you walk, with your surgeon's clearance, and not on a date.

One detail runs against the instinct, and it is also the detail surgeons and physiotherapists genuinely disagree about. The physiotherapy panel says that toe-touch and non-weight-bearing walking should be avoided after this operation and that the foot should stay flat on the floor instead, to keep the hip flexor at the front of the joint quieter (Disantis and colleagues, 2022). Plenty of surgical protocols say the opposite: in the review of 63 studies, 7 prescribed toe-touch weight bearing, 3 tip-touch and 2 touch-down, against 2 that specified flat foot (Leopold and colleagues, 2025). So if your own team told you to keep the foot off the floor, or to touch the toe down only, that is your instruction and you keep to it, because it asks less of the healing bone than 25% does, not more. The figures above are there so you can tell whether your own plan is ordinary, never so you can take more weight than you were told to.

The reason to keep to whatever limit you were given, even when the hip feels fine, is what has been reported when it is not kept to. The same systematic review found that delayed weight bearing went with fewer pelvic fractures than immediate full weight bearing, citing a series in which fractures occurred in 8 of 76 hips allowed immediate full weight bearing against 1 of 80 with delayed full weight bearing, and it also records delayed union being more common with earlier partial weight bearing in another series (Leopold and colleagues, 2025). The evidence there is retrospective and limited, which the authors say themselves. It is enough to make an unnecessary-feeling restriction worth keeping.

That fracture is the part of this operation people are least often warned about, so it is worth knowing what it is. Once the socket has been cut free and turned, load does not travel through the pelvis the way it used to: the consensus panel describes more of it passing through the inferior pubic ramus, the ischium and the back column of the pelvis, which is the reason early weight bearing is restricted at all, and it puts the reported rate of post-operative stress fracture across the literature at 2 to 18.4% (Disantis and colleagues, 2022). The top of that range comes from a series of 348 patients under two high-volume surgeons, in which 64 (18.4%) developed a stress fracture of the inferior pubic ramus at a mean of 9.1 weeks after surgery, with a range from 5 to 55 weeks. Of those 64, 58 healed, and 40 (62.5%) also had the pubic cut fail to join, against 7% of the patients without a stress fracture. Being older and having a larger deformity before surgery both went with a higher chance of it (Malviya and colleagues, 2015).

Take that as a reason to report pain that is building, not as a reason to expect trouble. The practical point is the timing: a mean of 9 weeks is after the usual crutch period ends, so the fracture tends to turn up in the weeks when a reader has decided the risky part is behind her.

Clot prevention belongs in this section too, because it has a warning line of its own further down. What a team gives you after a pelvic osteotomy is not standardized, and the authors of a study that screened for it say so plainly: in 134 adults given aspirin, compression stockings and pneumatic compression, about 1% developed a clot in a leg vein with symptoms, none had symptoms of a clot in the lung, and the authors describe the best preventive measures as not established (Polkowski and colleagues, 2014). Whatever your own team gave you, tablets, injections or stockings, use it exactly as they said and do not stop it on your own. Bleeding more easily is the known trade-off of those medicines, so there is a line about it in the warning signs below.

Return to sport in that literature was reported in only a minority of studies, and where it was, the recommendation usually fell between six and twelve months, most often around six (Leopold and colleagues, 2025). A physio leading that progression is recommended by the Zurich consensus for rehabilitation after any hip surgery (Kemp and colleagues, 2020), and it is the stage where measurement beats guesswork.

One more thing people are rarely warned about. A numb, burning or tingling patch on the front or outer thigh after this operation is common, because the nerve that carries feeling to the skin there runs close to the approach. In a prospective series of 40 hips operated on through the front of the hip, half of them, 20 hips, had symptoms from that nerve at one year, and at three years or more 7 of those had fully settled while 13 still had some (Fujita and colleagues, 2024). That is one center's series, so treat it as a rough guide and not a rate.

In the same group, the people whose symptoms were still there at three years scored lower for satisfaction and for mental health than those whose had gone, which is a reason to mention a numb patch to the team and not quietly put up with it. The route for it is on the warning list on this page, at a few days rather than the same day, with the escalations that matter written into the line.

Where hip arthroscopy fits

Keyhole surgery on the hip is a different operation with a different job, and in a dysplastic hip it is the one that needs the most careful thought. The reason is mechanical. The labrum and the capsule are doing more stabilizing work in a shallow socket than they would in a deep one, so an operation that trims the labrum, releases the capsule or takes bone off the rim can leave the hip less stable than it was.

A published case describes exactly that: a patient with mild dysplasia and a labral tear who had a labral repair and partial division of the ligamentum teres, then developed subluxation and joint space narrowing within three months and end-stage arthritis inside a year, going on to a hip replacement (Mei-Dan and colleagues, 2012). One case is not a rate. It is a warning about a direction.

The picture for borderline dysplasia is better than that case suggests. A long-term cohort compared arthroscopy for impingement in 38 hips with borderline dysplasia against 96 matched hips without it and found no meaningful difference in outcome scores at a mean of 9.6 years, with low revision rates, and the authors put that down to preserving the labrum and closing the capsule carefully, and to sorting patients into an impingement group and an instability group before deciding (Selley and colleagues, 2023). The international physiotherapy agreement on rehabilitation after hip arthroscopy names borderline hip dysplasia as a structural factor that should be taken into account, without giving it a protocol of its own, and says plainly that its own guidance is expert opinion (Disantis and colleagues, 2026).

So the practical position is this. Arthroscopy has a place in a borderline hip in the right hands, with the labrum preserved and the capsule closed. In frank dysplasia, where the socket is clearly short of cover, keyhole surgery on its own is not the operation that addresses the problem, and this is stronger than a caution. That same long-term study opens by stating that outcomes after isolated hip arthroscopy in patients with dysplasia have been unfavorable, with iatrogenic instability and conversion to a hip replacement at a young age among the results, and it closes by saying that patients should be sorted into an impingement group or an instability group and treated with arthroscopy or a periacetabular osteotomy accordingly (Selley and colleagues, 2023).

Keyhole surgery done at the same sitting as an osteotomy is a different matter, because the shape of the socket is being corrected as well. If someone has offered you keyhole surgery on its own and your X-ray shows a clearly shallow socket, ask specifically how the instability is being dealt with, and ask whether a surgeon who does osteotomies has seen your X-rays. If you are already recovering from keyhole surgery, hip arthroscopy rehab covers that pathway.

Pregnancy and childbirth

This comes up constantly, mostly because so many people with dysplasia are young women, and the research on it is thin and reassuring in roughly equal measure. A systematic review of five studies found no documented pregnancy or delivery complications after a periacetabular osteotomy when each study was set against population averages, but higher rates of cesarean section, 43 of 115 women across the four studies that reported deliveries, which is 37% (Hutchinson and colleagues, 2024). It graded the certainty of all five studies as low and called the literature low in both quality and quantity. Its conclusion was that cesarean section is more likely after this operation without reliable evidence that it is necessary. Note what that comparison is and is not: none of those studies followed a matched group of women who had not had the operation, so the honest reading is that nothing has been detected, not that nothing is there.

The individual surveys say the same thing. In 31 women with 38 pregnancies after the operation, the cesarean rate was 53% against a national average of about 32%, 17 of the 31 said their obstetrician had voiced concern about their ability to carry to term or to deliver vaginally, and only one woman had a pregnancy complication (Bartosiak and colleagues, 2020). The authors suggest the higher rate may reflect obstetrician preference rather than anything about the pelvis. The Bernese technique is itself described as leaving the birth canal unchanged (Lerch and colleagues, 2016).

None of that is advice for your pregnancy, and nothing here should be read as a reason to argue with your maternity team. What it gives you is the state of the evidence to take into the conversation, which is best had between your obstetric team and your hip surgeon with your own imaging in front of them. If pain in the hip or pelvis arrives during pregnancy, that goes to your midwife or doctor, not into this program.

When to see a physio or doctor

See a GP or physio if hip pain is getting in the way of normal activities or sleep, if it is worsening or keeps returning, if the hip is stiff for more than 30 minutes after you wake up, or if two weeks of home care have not helped, which is the NHS guidance for hip pain in adults. Groin pain with clicking, catching or a hip that gives way is worth getting assessed, as several hip problems can cause it, and a hip that gives way is on the warning list below.

If you are working through a program like this one, the dysplasia consensus suggests referral to a hip specialist when symptoms have not reduced after 4 to 8 weeks of physiotherapy despite strength and neuromuscular control improving, with a minority of the panel preferring at least 12 weeks (Disantis and colleagues, 2023). Referral does not mean stopping the exercise: for hip-related pain generally, the Zurich consensus recommends exercise-based treatment for a minimum of 3 months, physio-led rehabilitation after hip surgery, staying physically active, and decisions made together with you after a proper discussion of what to expect (Kemp and colleagues, 2020). The dysplasia consensus also notes that some hips are too severely affected for a trial of non-operative care to be reasonable, because of the risk of arthritis arriving early, which is a surgeon's call and not a physio's (Disantis and colleagues, 2023).

Some symptoms need faster help than an appointment. The warning signs below say how fast, from calling emergency services to booking within 2 weeks.

For physiotherapists

The non-operative framework on this page follows Disantis and colleagues (2023), the North American Delphi on acetabular dysplasia: 15 physiotherapists, each managing at least 20 patients a year, consensus at more than 75% on all 16 questions, level V. Its evaluation set is reproduced in the body only in part, and the full set is worth having in clinic: supine and prone hip rotation with a prone internal and external rotation difference of about 20 degrees raising the question of femoral version; abductor, extensor, deep rotator and core strength by manual testing or handheld dynamometry, with plank and side plank screened against a 45 second hold; FADIR, FABER, log roll and apprehension testing, understood as screens for intra-articular pain and not as diagnostic; and single leg stance, squat and step-down with observation for a Trendelenburg sign.

The panel's positions that most often change a program are carried onto the page: stretching de-emphasized because this is an instability presentation, with the adductors and iliopsoas framed as anterior stabilizers, and the panel's own second half carried too, that stretching may be initiated as tolerated once posterolateral strength has been established, so the page reads as a staging point rather than a ban for life; hip flexor strengthening deferred until posterolateral strength has improved and irritability has settled, begun in short-lever positions, with long-lever work reserved for specific demands such as dance; progression local to global, isometric to concentric to eccentric, double to single leg on the criterion of no trunk or pelvic compensation; and increased anterior pelvic tilt noted as a potentially useful compensation in this population and not a fault to correct.

The panel gives no sets, repetitions or frequency, so the doses on this page are our own house ranges, declared as the governing numbers to avoid a reader stacking two different doses.

Because they govern, each stage dose was then checked exercise by exercise against the library page it prescribes, and five exercises now carry their own lower figure inside the stage text rather than inheriting the stage range: bird dog at its own page's 1 to 2 sets of 6 to 10, quadruped hip extension held to the same figure rather than its own page's 2 to 3 sets of 8 to 12 because the two are done in the same position for the same purpose, sit to stand at its own page's 2 to 3 sets of 5 to 10, and the kneeling side plank and single leg stance stated as holds rather than as sets of repeats, each at its own page's count.

A single blanket range across a mixed stage multiplies the two exercises that are not rep counters: 3 sets of 12 side plank holds of 30 seconds is 18 minutes a side against the 150 seconds its own page asks for, and 3 sets of 15 bird dogs was more than four times the volume on its page. Stage 2's upper figure also came down from 15 to 12 so that no stage figure now sits above the exercise page it governs, which supine marching at 3 sets of 15 per leg did. No individual figure was out of range, which is why the stage line read as reasonable. Stage 1 now states a once-a-day frequency for the two lifts, because the "once or twice a day" that belongs to the holds also reads as governing the whole stage, which doubles side lying abduction past its own page's once a day.

Stage 3 states the return-to-run criterion with normalized strength inside it, which is where the panel puts it: strength, minimal irritability, single leg control and a normal gait at faster paces are all required before straight line running begins, not just before full sport. The cardiovascular consensus point is carried too, since a page that lists what hurts without naming a tolerable alternative tends to produce a deconditioned reader.

Stage 1 deliberately carries no exercise that loads end-range hip extension. Prone hip extension was prescribed there in an earlier draft and was replaced with an isometric hip extension in supine: the panel's own extensor examples are a gluteal bridge and quadruped extension isometrics, never a prone straight-leg lift, and combined extension with external rotation is the position the same paper uses to test for anterior apprehension, so a long-lever lift from a hip already at zero degrees sat badly beside this stage's own promise that nothing is taken to the end of its range. Quadruped hip extension stays in stage 2, where the hip travels from flexion toward neutral rather than beyond it. The stage 1 caution about the side leg lift and the clamshell when the anterior hip is irritable follows Disantis and colleagues (2022), which cites EMG evidence of substantial hip flexor activity in sidelying abduction in external rotation and in clamshells and advises caution with both in the presence of anterior hip pain.

Imaging and classification follow Reiman and colleagues (2020): acetabular dysplasia and hip instability as one of three groups of hip-related pain, AP pelvis and lateral head-neck radiographs as initial imaging, advanced imaging for definitive diagnosis or surgical planning, and limited diagnostic utility of examination and imaging in isolation. The LCEA thresholds quoted (below 20 degrees dysplastic, 20 to 25 borderline) are Disantis and colleagues (2023), carried with the authors' own caveat that the angle oversimplifies the diagnosis. The osteoarthritis risk figure is Reijman and colleagues (2005): 835 participants aged 55 and over with Kellgren and Lawrence 0 or 1 at baseline, 9.3% incident radiographic OA at a mean 6.6 years, and a reported risk about 4.3 times higher (95% CI 2.2 to 8.7) for a center edge angle below 25 degrees, independent of age, sex and BMI. The population is older than most readers of this page and the outcome is radiographic, both of which are stated on the page and not left for the reader to infer.

On the surgical side, the page hands every number that governs a patient's own recovery to the operating surgeon and cites the reason: Leopold and colleagues (2025), 63 studies, partial weight bearing in 41 (65%), most commonly six weeks (14 studies) then eight (12 studies), at least six distinct descriptors, crutches reported in 30 studies (48%), bracing in 3, return to sport reported in 9 and usually recommended between six and twelve months. The Disantis and colleagues (2022) PAO Delphi figures are given with its own statement that no studies support specific weight bearing and ROM precautions, with its restriction to an isolated PAO and its note that concomitant arthroscopy or microfracture may prolong both the weight bearing and the ROM limits or alter them to add extension and internal rotation restrictions, and with its foot-flat rationale, which is that toe-touch and non-weight bearing gait are avoided after a PAO to limit iliopsoas irritation.

Those figures are printed as description and never as permission: the page says in terms that none of them is a release, that a stricter or longer plan of the reader's own wins, and that a borrowed number is not a reason to do more than she has been cleared for. The one number the sibling page conditions/hip-arthroscopy-rehab withholds, a weight bearing percentage, is given here because this page's own reason for withholding would not hold: a PAO reader whose team has given her nothing has no way to tell whether 25% foot flat for six weeks is ordinary, and the restriction it describes only ever asks for less than full weight. The fracture and union data are quoted from Leopold's extraction of individual series rather than presented as pooled rates. Fujita and colleagues (2024) is cited for LFCN symptoms after anterior-approach PAO as a proportion in 40 hips, not a rate.

The arthroscopy section is deliberately two-sided. Mei-Dan and colleagues (2012) is a single case of iatrogenic instability progressing to arthroplasty within a year and is presented as a mechanism and a direction, never as an incidence. Selley and colleagues (2023) is a matched cohort in borderline dysplasia with no significant between-group difference at a mean of 9.6 years, attributed by its authors to labral preservation and capsular closure and to separating impingement from instability presentations. The ISHA physiotherapy agreement (Disantis and colleagues, 2026) names borderline dysplasia as a factor to consider and excludes several concomitant procedures from its scope; it does not exclude dysplastic hips, and this page does not claim that it does.

The pulmonary embolism line is carried here in the recorded house wording because this page has post-operative readers and the clot line on its own only reaches a reader whose leg has swollen: breathlessness, pleuritic chest pain or a faint weeks after a pelvic osteotomy, with a normal looking leg, otherwise had no route on the page.

Three other things about the warning list are worth a reviewer's attention. The post-PAO line is written for a correction or a fixation that is failing quietly: pain building over days with no single moment, and weight bearing going backward week on week, which is how a pelvic stress fracture, a loss of fixation or a delayed union presents rather than as a sudden event. It tells the reader to offload as far as she can while keeping the foot flat, which follows the same paper's reason for avoiding toe-touch gait, and it routes her to the surgical team the same day with urgent care or an emergency department as the fallback. The emergency line for a leg that looks shorter or a foot that turns, which a surgeon reviewer asked about, is carried word for word from conditions/total-hip-replacement-rehab rather than folded into the PAO line, because those signs point to a dislocation or a displaced fracture and not to the slow failure that line describes, and because every other emergency item here needs either a fall or severe pain, so a reader who saw a short or rotated leg without either had no route. The hip that gives way is left at a few days, which is the recorded wording: on this page giving way is a feature of the condition itself rather than a change of state, the acute versions are already routed above it at emergency and same-day levels, and what protects her while she waits is the falls precaution the line carries in its own words.

Hutchinson and colleagues (2024) is cited for what its comparator can actually carry. Every included study set its results against population averages rather than against a matched group of women who had not had the operation, which the page now says, so no reader takes an absence of detected complications for evidence of safety. Its GRADE certainty was low for all five studies; the moderate rating in the same paper is a MINORS methodological score rather than a certainty rating, and the page attributes each to the right instrument. The cesarean figure is given as 43 of 115 women across the four studies that reported deliveries, which is the denominator the 37% comes from.

Five surgical points were settled on this page rather than left general. The quiet post-operative failure line now names a stress fracture of the inferior pubic ramus, because that is the commonest structural complication of this operation and not a rare one: Disantis and colleagues (2022) puts the literature range at 2 to 18.4%, and the upper figure is Malviya and colleagues (2015), 64 of 348 patients at a mean of 9.1 weeks (range 5 to 55), 58 of the 64 healing, pubic nonunion in 40 of them (62.5%) against 7% of the rest, with older age and larger pre-operative deformity associated. The mean of 9.1 weeks is the reason it is named: it falls after the usual crutch period, so a reader who has been discharged from protected weight bearing is exactly the reader this line has to reach.

The foot-flat point is now given as a genuine disagreement rather than a rule, since the physiotherapy panel says toe-touch and non-weight-bearing gait should be avoided in favour of a foot-flat pattern to reduce iliopsoas activity while Leopold and colleagues (2025) records 7 studies prescribing toe-touch, 3 tip-touch and 2 touch-down against 2 specifying flat foot, so the page tells a reader on a toe-touch instruction to keep to it and says why it is not less protective. The anticoagulant bleeding line was added from the house record, byte identical, because thromboprophylaxis is given after a pelvic osteotomy without a standard regimen (Polkowski and colleagues, 2014: aspirin, stockings and pneumatic compression in 134 adults, symptomatic deep vein thrombosis about 1% with no symptomatic pulmonary embolism, the best preventive measures described as not established), and this page previously told post-operative readers nothing about the other side of that medicine. The lateral femoral cutaneous nerve line keeps its few-days tier, since nothing about a sensory patch is treatable out of hours and its dangerous differentials, spreading numbness, motor weakness, severe pain and any perineal or bladder change, are already routed above it, but its mechanism sentence attributed the injury to arthroscopic traction alone, which is false for the anterior-approach osteotomy reader it mainly serves, and its "most of these patches settle" contradicted Fujita and colleagues (2024), where 13 of the 20 affected still had symptoms at three years or more. And the arthroscopy section now carries Selley's own background position, that outcomes after isolated hip arthroscopy in dysplasia have been unfavorable with iatrogenic instability and conversion to arthroplasty at a young age, with its conclusion that patients be sorted into impingement or instability groups and treated with arthroscopy or a periacetabular osteotomy accordingly, which is stronger than "can make instability worse" and is the paper's own wording, not ours.

Four populations the page had named but not routed now have one. A reader whose operation is long behind her and who has been formally signed off is sent to stage 1 rather than left with an instruction to follow a plan she no longer has, with the condition stated as every restriction lifted and the default being to ring the team if she is unsure. A reader with no access to a physio is told which return-to-run criterion she cannot self-assess, normalized strength, and given building walking distance and then speed as the default, which is one of the paper's own criteria.

The postnatal reader is reached with the recorded POSTNATAL-ASK sentence, byte identical at 183 characters, which no exercise on this program carries: this page generates that reader by telling her cesarean section is more likely after the operation, and stage 1's deep abdominal hold, stage 2's two four-point exercises and stage 3's side plank all load the abdominal wall and pelvic floor. The pregnancy warning sentence (PREG-WARN-EX, verified byte identical at 743 characters against the house record and against the copy on conditions/diastasis-recti) is added to the warning list, because its only route onto this page was the collapsed gate block on one exercise, sit to stand, so reduced fetal movements and pre-eclampsia reached a pregnant reader of an 18-exercise program only if she opened a disclosure. And floor transfers are addressed in their own paragraph: all five stage 1 exercises and two of stage 2's are done on the floor, the page's own text names deep bending with a twist as a usual aggravator, and getting up off the floor is exactly that, with nothing on the page about it. The two four-point exercises are the ones told to be left out rather than moved to a bed, because a mattress gives way under hands and knees.

Two gates visible for one exercise and collapsed for others was the display fault found here. The per-exercise blocks are closed by default, and the page's own prose had lifted the sternum and wrist weight bearing checks out for bird dog alone, while quadruped hip extension carries the sternum line and the kneeling side plank carries the sternum, shoulder and wrist lines in blocks a reader has to open. All three are now named together in that paragraph. Counted on the built page rather than the sources: 18 of 18 prescribed exercises render a gate block, 17 of them a hip surgery line.

Lerch and colleagues (2016) is an abstract read in the original: the 80 to 90% at 10 years is conditional in the source on a well-placed reorientation and a spherical head, and only the 20-year 60% and the preliminary 30-year figure belong to the first 75 patients, which is how the page now attributes them.

Common questions

References

1. Disantis AE, Martin RL, Enseki K, Spaid V, McClincy M. Non-operative rehabilitation principles for use in individuals with acetabular dysplasia: a North American based Delphi study. International Journal of Sports Physical Therapy. 2023;18(6):1331-1345. https://doi.org/10.26603/001c.89265
2. Disantis AE, Ruh E, Martin R, Enseki K, McClincy M. Rehabilitation guidelines for use following a periacetabular osteotomy (PAO): a North American based Delphi consensus. International Journal of Sports Physical Therapy. 2022;17(6):1002-1015. https://doi.org/10.26603/001c.38043
3. Leopold VJ, Hildebrandt A, Hubner E, Grammatopoulos G, Beaule PE, Perka C, Hardt S. Postoperative weight-bearing restrictions and rehabilitation after periacetabular osteotomy: a systematic review. Journal of Orthopaedic Surgery and Research. 2025;20(1):944. https://doi.org/10.1186/s13018-025-06448-x
4. Malviya A, Dandachli W, Beech Z, Bankes MJ, Witt JD. The incidence of stress fracture following peri-acetabular osteotomy: an under-reported complication. Bone and Joint Journal. 2015;97-B(1):24-28. https://doi.org/10.1302/0301-620X.97B1.34525
5. Polkowski GG, Duncan ST, Bloemke AD, Schoenecker PL, Clohisy JC. Screening for deep vein thrombosis after periacetabular osteotomy in adult patients: is it necessary? Clinical Orthopaedics and Related Research. 2014;472(8):2500-2505. https://doi.org/10.1007/s11999-014-3614-x
6. Reiman MP, Agricola R, Kemp JL, et al. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. British Journal of Sports Medicine. 2020;54(11):631-641. https://doi.org/10.1136/bjsports-2019-101453
7. Kemp JL, Risberg MA, Mosler A, et al. Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018. British Journal of Sports Medicine. 2020;54(9):504-511. https://doi.org/10.1136/bjsports-2019-101458
8. Reijman M, Hazes JM, Pols HA, Koes BW, Bierma-Zeinstra SM. Acetabular dysplasia predicts incident osteoarthritis of the hip: the Rotterdam study. Arthritis and Rheumatism. 2005;52(3):787-793. https://doi.org/10.1002/art.20886
9. Lerch TD, Steppacher SD, Liechti EF, Siebenrock KA, Tannast M. Bernese periacetabular osteotomy: indications, technique and results 30 years after the first description. Orthopade. 2016;45(8):687-694. Article in German; English abstract. https://doi.org/10.1007/s00132-016-3265-6
10. Mei-Dan O, McConkey MO, Brick M. Catastrophic failure of hip arthroscopy due to iatrogenic instability: can partial division of the ligamentum teres and iliofemoral ligament cause subluxation? Arthroscopy. 2012;28(3):440-445. https://doi.org/10.1016/j.arthro.2011.12.005
11. Selley RS, Day MA, Olsen R, Buza SS, Sink EL, Ranawat AS, Kelly BT, Nawabi DH. Long-term outcomes after arthroscopic treatment of femoroacetabular impingement for patients with borderline dysplasia. American Journal of Sports Medicine. 2023;51(6):1531-1537. https://doi.org/10.1177/03635465231161348
12. Fujita J, Doi N, Kinoshita K, Seo H, Doi K, Yamamoto T. Incidence and clinical outcome of lateral femoral cutaneous nerve injury after periacetabular osteotomy. Bone and Joint Journal. 2024;106-B(5 Suppl B):11-16. https://doi.org/10.1302/0301-620X.106B5.BJJ-2023-0621.R1
13. Hutchinson K, Baig K, Smith C, Malviya A. Sexual function and pregnancy outcomes after periacetabular osteotomy: a systematic review. Journal of Hip Preservation Surgery. 2024;12(1):74-80. https://doi.org/10.1093/jhps/hnae039
14. Bartosiak K, Stockburger C, Stockburger J, Putnam S, Conner S, Clohisy J. Is previous periacetabular osteotomy associated with pregnancy, delivery, and peripartum complications? Clinical Orthopaedics and Related Research. 2020;478(1):68-76. https://doi.org/10.1097/CORR.0000000000000921
15. Disantis A, Bonin N, Byrd T, et al. The 2024 International Society for Hip Preservation physiotherapy agreement on post-operative rehabilitation following hip arthroscopy for femoroacetabular impingement syndrome. Journal of Hip Preservation Surgery. 2026;13(3):288-294. https://doi.org/10.1093/jhps/hnaf055
16. NHS. Developmental dysplasia of the hip. Page last reviewed 11 March 2026. https://www.nhs.uk/conditions/developmental-dysplasia-of-the-hip/
17. NHS. Hip pain in adults. Page last reviewed 20 November 2025. https://www.nhs.uk/symptoms/hip-pain/
18. NHS. Anticoagulant medicines. Page last reviewed 9 September 2024. https://www.nhs.uk/conditions/anticoagulant-medicines/

Written and checked by the PocketPhysio editorial team. Last updated 2026-10-29.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.