Return to work after periacetabular osteotomy: workload as a determinant of occupational trajectories

Aims Occupational outcomes after periacetabular osteotomy (PAO) remain underexplored. The aims were to: 1) to determine rate and duration to return to work (RTW) after PAO; 2) to analyze frequency and reasons for occupational change; and 3) assess career trajectories of students undergoing PAO. Methods We retrospectively analyzed 117 patients who underwent PAO between January 2015 and June 2017, with a mean follow-up of 63.2 months (SD 10.2). A total of 90 patients were employed; 27 were students. Work-related outcomes were assessed via questionnaire, including RTW status, duration of work absence, occupational change, and whether PAO was considered reason for job change. Preoperative workload was assessed by the Reich Committee for Working Time Determination (REFA) classification. Returnees and non-returnees were compared, and predictors of occupational change were assessed with logistic regression. Results Among 90 employed patients, 58 (64.4%) returned to their preoperative occupation, while 32 (35.6%) changed jobs. Overall, 14 patients (15.6% of all employed patients) reported that the hip that had undergone PAO was the reason for occupational change. Non-returnees reported higher preoperative pain (Numeric Rating Scale for pain 7.9 vs 7.0, p = 0.027), worse Hip disability and Osteoarthritis Outcome Score (HOOS)-Symptoms (42.3 vs 55.6, p = 0.038) and HOOS-Activities in daily living (44.1 vs 60.5, p = 0.015), higher workload-grades (0 (0 to 1) vs 2 (1 to 3), p < 0.001), and longer work absence (33.4 vs 26.7 weeks, p = 0.024). Logistic regression identified workload as the only independent predictor of occupational change (odds ratio up to 13.1 for heavier workload). The median time to job change was 86 weeks (IQR 10 to 208). Most changes occurred between one and two years postoperatively. Among students, 87.5% were employed at follow-up, most in sedentary (50%) or light (43%) occupations. Only one reported that PAO had influenced career choice. Conclusion PAO enables the majority of young adults to RTW, but more than one third adapt their occupation in the mid-term, with higher preoperative workload being the key determinant. Despite improved hip function, occupational adaptations remained common, while long-term career trajectories in students were largely unaffected. Cite this article: Bone Jt Open 2026;7(6):704–712.