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Combined Hip Arthroscopy and Periacetabular Osteotomy (PAO): One Surgery, One Recovery

When hip dysplasia and labral tears occur together, many patients are told they’ll need two separate surgeries. At Panorama’s Hip Preservation Program, our expert surgeons can often perform hip arthroscopy and PAO in one coordinated procedure, reducing recovery time, anesthesia exposure, and cost—while improving long-term results.

Why Combine Hip Arthroscopy and PAO?

For many patients, hip dysplasia and labral tears occur together — yet most medical centers treat them as two separate problems, requiring two different operations. At Panorama’s Hip Preservation Program, our team can often perform hip arthroscopy and PAO during the same surgery, addressing both the soft-tissue damage and the structural problem in one coordinated approach.

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This means patients benefit from one operation, one hospital stay, and a more efficient recovery, all while improving long-term hip stability and joint health.

Many patients experience a combination of structural problems, soft-tissue injury, and instability—and treating these issues separately may not fully resolve symptoms. A combined hip arthroscopy and PAO is ideal for patients whose pain stems from both bone alignment issues and labral or cartilage damage.

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This comprehensive approach ensures that surgeons address every part of the problem in a single, coordinated procedure.

Conditions That Benefit From a Combined Surgery

Hip Dysplasia: The Root Cause of Many Hip Problems

Medical illustration showing hip dysplasia with a shallow acetabular socket.

Hip dysplasia occurs when the hip socket is too shallow to fully support the femoral head. This increases stress on the labrum and cartilage and often leads to:

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  • Chronic groin or lateral hip pain

  • Feelings of instability (“my hip wants to slip out”)

  • Early arthritis if untreated

  • Labral tears from overload

  • Difficulty with running, sports, or prolonged sitting

A PAO corrects the root cause by repositioning the socket. Arthroscopy simultaneously repairs the secondary damage.

Labral Tears: Often a Downstream Effect of Dysplasia

Medical illustration of a hip labral tear showing damage to the cartilage ring.

The labrum works overtime to stabilize a dysplastic hip, which leads to stretching, fraying, or full-thickness tears. Symptoms often include:

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  • Sharp pain with twisting or pivoting

  • Clicking, catching, or locking sensations

  • Pain after activity

  • Loss of hip motion

  • A deep ache in the groin

Performing a labral repair during the same surgery as the PAO allows surgeons to fix the soft tissue and immediately protect it with proper hip alignment.

Borderline Dysplasia & Hip Microinstability

Medical illustration comparing normal hip anatomy to borderline dysplasia and microinstability

Some patients have a socket that is not fully dysplastic but still unstable — known as borderline dysplasia. These patients may experience:

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  • Pain during or after sports

  • Hip “giving way”

  • Recurrent labral tears

  • Feelings of looseness or joint slipping

  • Difficulty with high-impact activity

A combined procedure helps stabilize the hip and repair soft tissue so patients regain confidence in movement.

Femoroacetabular Impingement (FAI)

Diagram of femoroacetabular impingement showing CAM and pincer deformities.

FAI may coexist with dysplasia or instability — especially in younger athletes. When both are present, symptoms often include:

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  • Pinching pain in the groin

  • Decreased hip motion

  • Pain with squatting or turning

  • Labral tears from repeated impingement

  • Stiffness after training

 

During a combined surgery, the arthroscopy reshapes the femoral head/neck junction (CAM or pincer correction), while the PAO corrects the socket orientation.

Why Combining Surgeries Matters for These Conditions

Graphic illustrating the benefits of combined hip surgery: one surgery, one recovery, better results.

Treating these conditions separately can leave patients with:

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  • Partial improvement

  • Recurrent symptoms

  • Unresolved instability

  • Repeat surgeries

  • Longer overall recovery time

 

By combining arthroscopy and PAO:

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You get the right repair, at the right time, in the right sequence.

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  • The labrum is repaired after the joint is stabilized.

  • Cartilage treatment is protected by new alignment.

  • Impingement work is balanced by a corrected socket position.

  • Patients recover once — not twice.

What Happens During the Combined Procedure?

A combined hip arthroscopy and PAO is a carefully planned, highly coordinated surgery performed by two specialists working together. This approach allows your surgeons to treat both the structural abnormality and the soft-tissue damage in one efficient operation. Each step is designed to support the next, creating a stable, healthy hip joint that functions normally long-term.

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To help patients understand the process, the procedure can be viewed as two complementary phases:

Phase 1: Hip Arthroscopy — Treating the Soft Tissue

Hip arthroscopy is a minimally invasive procedure performed through small incisions. It allows surgeons to visualize and treat the inside of the joint with a camera and specialized instruments.

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What the arthroscopy addresses:

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  • Labral repair or reconstruction
    Torn or frayed labral tissue is repaired to restore its sealing and stabilizing function.

  • Cartilage treatment
    Damaged cartilage is smoothed, treated, or stabilized depending on severity.

  • FAI correction (CAM or pincer lesions)
    Bone overgrowth is reshaped to prevent pinching and improve joint motion.

  • Capsular management
    For unstable hips, the capsule may be tightened (capsular plication).
    For FAI, it may be carefully balanced to restore normal mobility.

  • Assessment of hip stability
    Surgeons evaluate how the joint behaves dynamically to plan the PAO precisely.

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Why this step comes first:

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Treating the labrum and cartilage before the PAO ensures the repaired tissue sits in a corrected, structurally stable environment once the hip is realigned.

Hip arthroscopy illustration showing minimally invasive instruments inside the joint.
Phase 2: Periacetabular Osteotomy (PAO) — Correcting the Bone Structure

Once the arthroscopy is complete, the second surgeon performs the PAO — a procedure that reorients the acetabulum (hip socket) to provide proper coverage of the femoral head.

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What the PAO accomplishes:

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  • Repositions the hip socket to improve stability and support the labrum

  • Restores normal joint biomechanics to prevent early arthritis

  • Reduces excessive load on cartilage and repaired soft tissue

  • Corrects dysplasia or borderline instability at the structural level

  • Protects the labrum long-term, reducing future tears or re-injury

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During this phase, the pelvis is preserved (no bone removed), and the socket is rotated into ideal alignment. Once positioned, it is secured with screws to allow proper healing.

Medical illustration showing periacetabular osteotomy repositioning the hip socket.
How These Two Phases Work Together

A holistic approach to hip preservation

When performed in sequence during one surgery, the two procedures complement each other perfectly:

  • The arthroscopy repairs what’s damaged.

  • The PAO fixes what caused the damage.

  • Both support healing and long-term joint health.

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Benefits of this coordinated strategy:

  • More predictable recovery

  • Better long-term outcomes

  • Preservation of the native hip joint

  • Reduced risk of future labral tears

  • Faster return to normal activities

  • Less cumulative pain and downtime

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What Patients Can Expect During Surgery

  • Total operative time: typically 3–5 hours, depending on complexity

  • Regional and general anesthesia for maximal comfort

  • 2–3 day hospital stay (mostly for PAO recovery)

  • Early mobility with crutches

  • Dedicated hip preservation PT starting soon after surgery

This integrated approach ensures patients receive the most complete and modern treatment available, all in one operation.

Why Choose Panorama’s Hip Preservation Program?

Choosing where to undergo a combined hip arthroscopy and PAO is just as important as deciding whether to have surgery. These complex procedures require extraordinary coordination, surgical volume, and a team deeply experienced in treating young, active patients with hip dysplasia, labral tears, and instability.

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At Panorama, patients gain access to one of the few programs in the country capable of performing these procedures safely and efficiently in a single surgical setting.

A Specialized Team Focused Exclusively on
Hip Preservation

Our surgeons are national leaders in hip preservation surgery, performing high volumes of:

  • PAO (Periacetabular Osteotomy)

  • Hip arthroscopy

  • Labral reconstruction and repair

  • Complex instability procedures

  • Combined arthroscopy + PAO cases

This experience allows for exceptional precision and collaboration in the operating room.

One of the Few Centers Offering Combined Surgery

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Most orthopedic centers cannot coordinate these surgeries due to limited expertise, low case volume, or lack of a multidisciplinary team. Panorama stands apart by offering:

  • Two fellowship-trained hip preservation surgeons working together

  • A streamlined single-session surgical model

  • Specialized anesthesiology and OR teams

  • Dedicated post-operative pathways designed specifically for PAO patients

This ensures safer surgery, less time under anesthesia, and more predictable recovery.

Integrated Imaging, Diagnostics, and Surgical Planning

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Your evaluation includes access to advanced hip imaging and motion analysis, allowing surgeons to identify:

  • Labral and cartilage damage

  • Subtle instability

  • Borderline dysplasia

  • FAI deformities

  • Biomechanical abnormalities

This precise imaging allows for accurate surgical planning and tailoring the procedure to each patient’s anatomy.

A Comprehensive Hip Preservation Ecosystem

Panorama’s program includes everything a patient needs before, during, and after surgery:

Pre- Surgery

  • Accurate diagnosis

  • Personalized surgical planning

  • Prehabilitation programs

  • Education on expectations and timelines

During Surgery

  • Tight coordination between two surgeons

  • Evidence-based protocols

  • Emphasis on preserving the native hip

After Surgery

  • PAO-specific physical therapy

  • Progress tracking

  • Return-to-sport guidance

  • Long-term follow-up care

Patients receive continuous support every step of the way—never left guessing or navigating recovery alone.

Torn Paper Texture

Designed for Young, Active Patients

Our program specializes in treating:

  • Athletes

  • Young adults

  • Teens

  • Active individuals wanting to avoid hip replacement

The goal is not just to fix the hip—but to help patients return to the life and activities they love.

High Success Rates and Proven Outcomes

Our outcomes consistently show:

  • Improved hip stability

  • Reduction in pain

  • Return to sports and activity

  • Prevention of early arthritis progression

  • High patient satisfaction

This is the result of a program built specifically for complex hip disorders—not generalized orthopedic care.

Frequently Asked Questions (FAQ)

Can hip arthroscopy and PAO really be done in one surgery?

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Yes. At specialized centers like Panorama, both procedures can be performed safely in a single, coordinated operation. This allows surgeons to repair the labrum, address cartilage damage, correct impingement, and realign the hip socket all at once—leading to one recovery instead of two.

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What are the benefits of combining the surgeries instead of doing them separately?

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A combined approach offers significant advantages, including:

  • One anesthesia session

  • One hospital stay

  • One rehabilitation timeline

  • Faster overall recovery

  • Lower overall cost

  • Improved protection for repaired soft tissue

  • Better long-term hip stability

 

Most importantly, combined surgery ensures the labrum is repaired and then protected by proper bone alignment.

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How long is the recovery after a combined hip arthroscopy and PAO?

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Recovery varies, but most patients follow this general timeline:

  • 2–3 days in the hospital

  • 6–8 weeks on crutches

  • 3 months to return to low-impact activity

  • 6–12 months for full return to running, impact sports, or competitive athletics

Your surgeon and physical therapy team will tailor a plan based on your healing.

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Is the combined procedure safe?

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Yes. When performed by experienced hip preservation surgeons, the procedure is considered safe and effective. Performing both surgeries together actually reduces risks associated with multiple anesthesia sessions, multiple recoveries, and two separate operations.

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Who is a good candidate for combined surgery?

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You may be a good candidate if you have:

  • Hip dysplasia

  • Borderline dysplasia

  • Labral tears

  • Hip instability

  • Femoroacetabular impingement (FAI)

  • Pain that interferes with sports or daily activity

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Patients with both structural alignment issues and soft-tissue injury typically benefit most from a combined approach.

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Will I need physical therapy after surgery?

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Yes. Physical therapy is a critical part of recovery.
Patients follow a structured, PAO-specific rehab program designed to:

  • Restore strength

  • Protect the repaired labrum

  • Improve hip stability

  • Rebuild safe movement patterns

  • Support return to sports

 

Panorama’s PT team specializes in hip preservation protocols.

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Will combining the surgeries shorten my recovery?

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Yes. Instead of recovering twice from two separate operations (arthroscopy first, PAO months later), you recover once. Although PAO is the main driver of healing time, combining surgeries significantly reduces the overall burden on your body.

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Does combined surgery reduce the risk of future hip problems?

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In many cases, yes. Correcting the socket alignment while repairing the labrum:

  • Reduces abnormal joint loading

  • Protects cartilage

  • Restores normal biomechanics

  • Helps prevent early arthritis

  • Decreases risk of repeat labral tears

 

It is one of the most effective long-term strategies for preserving the natural hip.

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Is the combined surgery more difficult or complex?

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The surgery requires a highly specialized team with extensive training in hip preservation. Panorama is one of the few centers capable of performing this procedure routinely thanks to:

  • Two fellowship-trained surgeons

  • High surgical volume

  • Dedicated imaging and planning

  • A unified hip preservation protocol

 

For the patient, the experience is more streamlined, not more complex.

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How do I know if this is the right surgery for me?

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The best way to know is through a comprehensive evaluation that includes:

  • X-rays

  • MRI to evaluate the labrum and cartilage

  • Assessment of hip stability

  • Measurements of socket coverage (LCEA)

  • Review of symptoms and activity goals

 

Panorama’s hip preservation specialists will explain whether a combined surgery is recommended or if another treatment is more appropriate.

If you’ve been living with hip pain, instability, or a labral tear caused by dysplasia, you deserve a clear path forward—and a team who understands every part of your condition. Our surgeons at Panorama are nationally recognized for their expertise in combined hip arthroscopy and PAO, offering patients the opportunity to correct both the structural and soft-tissue problems in one coordinated procedure. With a comprehensive team, advanced imaging, and a tailored recovery plan, we’re here to help you return to the activities and lifestyle you love with confidence, safety, and long-term hip health.

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