PAO Surgery (Periacetabular Osteotomy)
PAO is a surgical procedure that can reduce pain and improve the way you move your hip. It can also help you avoid a total hip replacement.
Before deciding whether to have PAO surgery, it is important to consider your age and lifestyle. It is also important to discuss your expectations with your surgeon.
What is a PAO?
Periacetabular osteotomy (PAO) is a surgical procedure that improves hip function, decreases pain and stops the wear and tear inside the hip joint that can lead to arthritis. The surgery repositions the acetabulum (the bowl-shaped socket of the hip where the pelvis meets the femur) to naturally cover more of the femoral head.
The procedure is performed in a hospital or surgery center and requires general anesthesia. The surgeon uses fluoroscopy (continuous X-ray images displayed on a monitor) to help direct the bone cuts and confirm correct reorientation of the hip socket.
Typically, PAO is used to treat mild to moderate hip dysplasia in patients 40 years of age or younger who have not responded to non-surgical or other surgical treatments. It is not recommended for people who have advanced dysplasia, arthritis or other conditions that cause hip joint problems.
How is a PAO performed?
A periacetabular osteotomy, or PAO for short, is a surgical procedure that repositions the hip socket so that it provides more coverage of the femoral head (the top of your thigh bone) than the femur (the long bone that joins to the leg). The resulting improved coverage of the ball and socket allows the ball and socket to function more effectively together, reducing the risk of a hip replacement down the road.
The best way to determine if you’re a candidate for this surgery is to have you and your doctor discuss the details of your situation. Your surgeon will also take into account your age, lifestyle, and expectations. Often, your doc will be able to tell you whether you are likely to get a PAO from the results of an MRI. Alternatively, your doc may recommend a more thorough consultation with an orthopedic specialist in this field, such as a joint surgeon, sports medicine physician or physical therapist.
What are the benefits of a PAO?
For young children, teenagers and young adults with hip dysplasia, periacetabular osteotomy (PAO) surgery is an option for improved long-term outcomes with fewer side effects. PAO surgery repositions the hip socket to improve coverage of the ball in the hip joint, improving hip functionality and reducing pain and other symptoms.
Performing a PAO also helps delay or prevent hip replacement surgery later in life, as it is a less invasive procedure that preserves the natural hip joint. It is highly recommended in patients who have not had osteoarthritis yet and who want to avoid the potential complications of a total hip replacement.
During a PAO, controlled cuts are made to loosen the acetabulum and the socket is repositioned. The acetabulum is then fixed in its new position using screws. X-rays during the surgery help direct the bony cuts and confirm that the hip is in its correct position.
What are the risks of a PAO?
PAO surgery is a safe procedure that has similar long-term success rates to total hip replacement (THA) for patients with arthritis. However, there are some risks that should be considered before you decide to have a PAO.
Bleeding, infection, and injury are possible complications. These problems can cause pain, swelling, stiffness, or weakness in the operative hip.
A blood transfusion may be needed in rare cases (less than 5% risk). These problems are often treated with medication to reduce the chance of them happening.
Usually, you will be in the hospital for a few days after surgery to recover from your operation. Your recovery will include physical therapy and medications to help with pain. After you are healed, your doctor will give you instructions on when to return for follow-up tests. These will help your doctor determine if you need another PAO surgery or another option, such as a THA. Then, they can work together to find the best treatment for you.
