Rehabilitation following periacetabular osteotomy for acetabular dysplasia: a qualitative interview study exploring challenges, hopes, and expectations among patients in Denmark and Australia

Introduction
Guidelines have been proposed for post-operative rehabilitation following periacetabular osteotomy (PAO). However, the perspectives of individuals undergoing PAO have not been considered.

Aim
The present study aimed to explore the perceived challenges of everyday life and hopes for and expectations of post-PAO rehabilitation from the perspective of individuals with acetabular dysplasia living in Denmark and Australia.
Methods
In this qualitative study, we used a hermeneutic phenomenological approach with semi-structured interviews to explore the perspectives of 25 participants (four males), aged 16-43 years, who underwent a PAO. Purposeful sampling was used to provide variations in age and sex. Inclusion criteria were age above 15 years, radiographic evidence of acetabular dysplasia, PAO within the last seven weeks and undergoing post-operative rehabilitation. Inductive content analysis was adopted to code and analyse interviews.

Results
The analysis of the interview transcripts revealed four major themes: different expectations, self-confidence, tailored rehabilitation and aligning expectations. Several subthemes emerged within each theme, and similar patterns with minor variations were identified across countries. However, the financial burden of self-funded surgery and rehabilitation challenged some Australian participants, whereas none of the Danish participants mentioned this challenge.

Conclusion
Our findings elucidate the diverse range of hopes and expectations in individuals undergoing PAO, and how these relate to their perceived challenges. In particular, the findings highlight the importance of aligning expectations between individuals and clinicians when designing the rehabilitation.