Perioperative Management of Patients Undergoing Periacetabular Osteotomy: An Evidence-Based Review

Periacetabular osteotomy (PAO) is an established and effective surgical treatment for symptomatic acetabular dysplasia in adolescents and young adults with healthy articular cartilage. While outcomes and technical surgical considerations are well described, perioperative management practices vary significantly across institutions. The purpose of this narrative review was to synthesize current literature on evidence-based best practices for perioperative management of patients undergoing PAO and to identify knowledge gaps for future investigation.

A comprehensive review of the literature was performed focusing on perioperative care across four phases: preoperative, intraoperative, acute postoperative, and rehabilitation. Areas of emphasis included laboratory evaluation and nutritional optimization, mental health screening, patient education, blood loss mitigation strategies, pain control, venous thromboembolism and heterotopic ossification (HO) prophylaxis, and postoperative rehabilitation protocols. Strong evidence exists to support specific intraoperative practices such as tranexamic acid administration, controlled hypotension, and fascia iliacus blocks for pain control. Conversely, limited or heterogeneous evidence exists regarding preoperative laboratory testing, psychosocial interventions, standardized opioid prescribing, venous thromboembolism prophylaxis regimens, and rehabilitation protocols. Psychosocial health and preoperative educational interventions appear underutilized despite growing evidence of their impact on outcomes. Significant gaps remain, particularly regarding preoperative optimization and rehabilitation strategies. Continued high-quality research is needed to establish standardized, evidence-based perioperative care pathways to further improve outcomes following PAO.