PAO recovery timeline, week by week.

weeks 0–2

Weeks 0-2 · the hospital fortnight

The first days are the hardest of the whole arc. A daily diary study that followed PAO patients by automated text message put average pain at 5.9/10 on the first day, 4.7/10 at one week, and 4.1/10 at two weeks — with wide spreads in both directions. Anesthesia teams increasingly use regional blocks (a TAP-block trial cut 48-hour opioid use roughly in half), so your day-one experience depends partly on what was infused before you woke up.

Mobilization starts surprisingly early: most protocols have you up on crutches with foot-flat, roughly 20-25%-of-body-weight contact by day one or two. That isn't walking in any meaningful sense — it's teaching the leg the pattern while the pelvis is protected. Opioid use in the diary cohort peaked around day eight and was essentially zero by week six.

If your pain is rising rather than falling after the first week, or the leg stops tolerating the protected touch-down it previously tolerated, call your surgical team. The modal trajectory is steady decline from day one.

• wk 0 ·Protected partial weight-bearing with crutches (~20-25% body weight, foot-flat) (From POD 1 through 6-8 weeks; 6 wk in ~21% of protocols, 8 wk in ~18%, full published span 2-16 wk)

weeks 2–8

Weeks 2-8 · the long protected stretch

This is the part nobody warns you about emotionally: pain drops to a 2-3/10 plateau by week three and mostly stays there, but you are still on two crutches at a quarter of your body weight, because the bone simply isn't ready. The diary cohort's averages fluctuated between 2.0 and 3.0 from day 20 through day 42 — recovery here is measured on the x-ray, not on the pain scale.

The Delphi consensus that North American hip-preservation physios published in 2022 keeps this phase deliberately boring: hip flexion limited to about 90 degrees and external rotation to about 20 for the first four to six weeks, a stationary bike from week six-ish, and no decisions about weight-bearing made by feel. The protected period ends when your surgeon sees consolidation — six weeks in about a fifth of published protocols, eight in another fifth.

Use the time for the things rehab can legitimately progress: upper body, the non-operative leg, core work within the motion limits, and sleep logistics. People who treat this stretch as a project tend to come out of it less deconditioned than people who treat it as a sentence.

weeks 8–16

Weeks 8-16 · weight comes back

Somewhere in the 8-12 week window — x-ray permitting — you transition to weight-bearing as tolerated, then wean from two crutches to one to none. The physio consensus deliberately refuses to give a calendar date for the last crutch: the criterion is a symmetric gait without a Trendelenburg lean, whenever that arrives. For most people that's somewhere between weeks 8 and 16.

Two practical milestones cluster here. Driving: the only brake-reaction-time study in PAO patients (small, n=26) found most people were not safe at six weeks but had normalized by twelve. And work: in a 242-patient cohort the median return was sixteen weeks, with a quarter back by twelve — desk jobs at the early end, anything physical much later.

Pain in this window is the least-documented of the whole recovery: no study publishes three-month pain scores, so the 2-3/10 you'd expect here is interpolated between the week-six diary data and the six-month cohorts. If your reality is meaningfully above that band — especially groin pain that spikes with each step — flag it rather than assuming it's normal.

• wk 10 ·Full weight-bearing established (8-12 weeks, gated by x-ray consolidation; protocol-dependent)
• wk 11 ·Off crutches / normalized gait (Criterion-based during weeks 6-12 (symmetric gait, no Trendelenburg), not a fixed week)
• wk 12 ·Return to driving (brake reaction time normalized) (Most not yet safe at 6 weeks; normalized by 12 weeks (single n=26 study))
• wk 16 ·Return to work (Median 16 weeks, IQR 12-22 (n=242); 38.6% back by 12 wk, 85.7% by 24 wk (occupation split not reported))

weeks 16–26

Weeks 16-26 · impact, carefully

Running is the gate everyone asks about, and the consensus answer is weeks 20-26, gated on hip-abductor strength reaching roughly 80% of the other side plus your surgeon's sign-off — criteria, not a date. Institutional protocols put elliptical and pool running earlier, around weeks 10-16, which is where most people scratch the cardio itch first.

By six months the Aarhus prospective cohort gives us the first hard pain numbers since week six: rest pain averaging 1.4/10 and activity pain 4.1/10. That gap — quiet at rest, loud under load — is the defining texture of the second half of PAO recovery, and it narrows slowly rather than suddenly.

Heavy or physical work typically restarts in this window or just after it; in the return-to-work cohort, 86% were back by twenty-four weeks across all job types.

• wk 16 ·Return to work (Median 16 weeks, IQR 12-22 (n=242); 38.6% back by 12 wk, 85.7% by 24 wk (occupation split not reported))
• wk 23 ·Start running / impact loading (20-26 weeks, gated on normalized hip strength + functional tasks (the >80% abductor ratio is the later return-to-sport gate))

weeks 26–104

Months 6-24 · sport, bone, and the long tail

Return to sport averages just under nine months across the published series, with return rates between 63% and 91% depending on the sport and the series. The honest footnote: studies measure a real shift from high-impact toward lower-impact sport after PAO — most people get back to being athletes, not always to the exact same athletics.

Bone keeps healing long after function returns. The superior pubic ramus — the slowest of the cuts — shows non-union in roughly half of patients at six months, falling to under 10% by a year, and almost all of those are painless and need nothing. Separately, about one in five patients eventually has the fixation screws removed for irritation, typically a year or more out; it's a small, planned procedure and 75% feel better afterward, so treat it as a common epilogue rather than a complication.

By two years, the Aarhus data shows rest pain at 1.4/10 and the ANCHOR cohort's pain scores at 84/100 — most people are simply living their lives. The fair summary of the literature: expect nine to twelve months before you stop thinking about the hip daily, and up to two years for the last few percent.

• wk 38 ·Return to sport (Mean ~8.9-9 months; RTS rate 63-91%; measured shift toward lower-impact sport)