Periacetabular Osteotomy (PAO)

Periacetabular osteotomy (PAO) is a surgical procedure designed to treat hip dysplasia, a condition characterized by a misalignment or deformity of the acetabulum, which is the curved portion of the pelvis that forms the socket of the hip joint. Hip dysplasia can lead to pain, restricted mobility, and early degenerative changes such as osteoarthritis if left untreated.

In patients with hip dysplasia, the acetabulum may be too shallow or improperly aligned, failing to provide adequate support and coverage for the femoral head (the “ball” of the hip’s ball-and-socket joint). This misalignment can cause excessive wear on the cartilage and labrum (a fibrous cartilage rim lining the hip socket), leading to pain and restricted movement.

PAO involves making a series of cuts to the bone to reposition the acetabulum within the pelvis, aiming to restore a more normal hip joint anatomy. The repositioned acetabulum is then stabilized with screws, and during the healing process, new bone forms across the cut surfaces to secure the acetabulum in its new position.

The procedure is typically recommended for younger patients (under 40 years old) who have not yet developed advanced joint surface articular cartilage damage. For older patients (50 years and above) with advanced osteoarthritis, total hip replacement may be the best option to alleviate pain and restore mobility.

PAO surgery is a complex procedure that requires careful preoperative planning, including a thorough physical exam, patient history, and imaging studies such as X-rays, MRI, and possibly three-dimensional CT scans. The surgery is performed under X-ray guidance to protect the surrounding nerves and muscles, and patients are usually hospitalized for 2 to 4 days postoperatively. Physical therapy and weight-bearing guidelines are initiated before discharge, and crutches are typically used for 6 to 8 weeks. Most individuals return to school or work after three months and can resume athletic activities between 6 to 12 months. If both hips are affected, surgeries are performed 4 to 6 months apart.

The success of PAO surgery is influenced by several factors, including the severity of hip dysplasia, the presence of any additional hip joint problems, and the patient’s age and activity level. The goal of PAO is to improve hip function, reduce pain, and delay or prevent the progression of osteoarthritis.

PAO is a joint-preserving surgical option for treating hip dysplasia in younger patients, aiming to correct the acetabular deformity, alleviate symptoms, and improve joint function while delaying the need for hip replacement surgery.