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Periacetabular Osteotomy (PAO)

Hip dysplasia and instability of the hip can cause a lot of pain. People with these conditions might not be able to walk or move well. Your doctor may call this restricted mobility.

People of any age can have these conditions. For success with this surgery, the growth plates of the hip socket are typically almost closed. That most often happens at the beginning of the teen years.

A surgeon may suggest PAO surgery to:

• Treat dysplasia
• Increase stability of the hip
• Treat impingement of the hip
• Reduce pain
• Prevent or delay the need for a total hip replacement

The goal of surgery is to reduce pain and restore function. Another goal is to give patients the ability to move their hip easily again. This surgery often allows patients to live a healthy, pain-free life.

What Can You Expect Before PAO Surgery?

Imaging

After you meet with a surgeon, imaging will be ordered. This includes any or all of the following:

• X-ray
• MRI
• CT scan
• Dynamic ultrasound
• Intra-articular injection

Your surgeon will review the results with you. They will let you know if they feel PAO surgery will be helpful.

Hip Conference

Sometimes there is a question about whether PAO surgery will be a success. When that happens, your surgeon will go over your case during our “hip conference.” Your case will be discussed with hip surgeons, a joint replacement surgeon, radiologist, physical therapist, nurse practitioner, physician assistant and clinical nursing staff.

The goal of this meeting is to cover all aspects of your case. Topics include your age, lifestyle and expectations of and after surgery. We want to make sure that everyone, including the patient and family, agrees that PAO surgery is right for the patient.

Pre-Op Consultation

Once surgery is scheduled, there will be a pre-op visit four to six weeks before surgery. At that visit, the nurse will go over what you need to know before, during and after surgery. The nurse is available by phone and MyChart if you have questions or concerns any time before or after surgery.

What Can You Expect During PAO Surgery?

The surgery will take about four hours.

Anesthesia

For pain control, you will receive a nerve block. This type of anesthesia uses a medication to numb a specific area of nerves in order to block pain. Using a nerve block (rather than an epidural) has been shown to decrease the length of a patient’s stay in the hospital. This also decreases pain medication needs after surgery.

The Procedure

The hip joint includes a ball (at the top of the femur, or thigh bone) and socket (in the pelvis). Hip dysplasia happens when there is a problem between the ball and socket. During a PAO surgery, your surgeon will make three cuts in the pelvis. The goal is to improve the direction and / or amount of coverage the socket provides for the ball. Screws are used to hold the bones in their new position. While you heal, new bone will grow and allow your hip joint to line up correctly. The screws are removed six to 18 months after surgery.

What Can You Expect After PAO Surgery?

• You’ll be in the hospital for two to three days.
• During that time, you’ll see specialists from Orthopaedics, Pain Management, and Physical Therapy / Occupational Therapy.
• You will be on crutches / using a walker / wheelchair for six weeks. You will then gradually return to weight bearing for the next six to 12 weeks.

Post-Op Appointments

• Two weeks post-op: At this visit, your surgeon will check your incision. Your dressing will be taken off. An X-ray of the hip will also be done.
• Six weeks post-op: At this visit, you will have an X-ray of your hip joint. The surgeon will check to make sure you are healing well.

Physical Therapy

To allow the hip to heal, patients do not start physical therapy until four to six weeks after surgery.

Most patients go through six to nine months of physical therapy after PAO surgery. Physical therapy will help:

• Wean you off crutches six to 12 weeks post-op
• Work on your range of motion and hip strength
• Get you back to your normal level of activity

Your therapist and surgeon will watch your healing and will clear you for certain activities as you make progress. Most patients are able to return to normal daily activities within four and a half to six months after surgery. Return to sports often happens six to nine months after surgery depending on the level of competition.

What are the Outcomes from PAO Surgery?

After recovery from PAO surgery, patients have less or no hip pain. They are able to move and walk better than before surgery.