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Do Screws Need to Come Out After PAO?
During a Periacetabular Osteotomy (PAO), surgical screws are used to stabilize the repositioned hip socket while the bone heals. A common question patients ask after surgery is:
“Do the screws need to come out?”
In most cases, the answer is no. Many patients live comfortably with their screws long term. However, there are situations where screw removal may be recommended.
Why Are Screws Used During PAO?
Screws play a critical role in PAO surgery. They are used to:
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Hold the reoriented acetabulum in its corrected position
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Maintain stability while the bone heals
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Allow early mobilization and rehabilitation
Once healing is complete, the screws no longer serve an active purpose—but that does not mean they must be removed.
Do Most Patients Need Screws Removed?
No.
The majority of patients do not require screw removal after PAO.
If the screws are not causing symptoms, they are typically left in place permanently.
When Might Screw Removal Be Recommended?
Screw removal may be considered if a patient experiences:
1. Localized discomfort or irritation
Some patients feel irritation from screws under the skin, particularly in thin individuals.
2. Pain with certain movements
Occasionally, hardware can cause discomfort with hip flexion, prolonged sitting, or athletic activity.
3. Prominent hardware
In rare cases, screw heads may be palpable or visible under the skin.
4. Planned future procedures
If additional hip surgery is anticipated, removing screws may simplify future treatment.
Importantly, screw removal is not done routinely—only when symptoms justify it.
When Is Screw Removal Typically Done?
If needed, screw removal is usually considered:
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After the bone has fully healed (often 6–12 months post-op)
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After imaging confirms solid healing
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When symptoms are clearly attributable to the hardware
Your surgeon will confirm healing before recommending removal.
What Is Screw Removal Surgery Like?
Compared to PAO, screw removal is:
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A much smaller procedure
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Typically done as an outpatient surgery
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Associated with short recovery time
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Often followed by rapid return to normal activity
Most patients experience symptom improvement once problematic hardware is removed.
Does Removing Screws Affect Hip Stability?
No.
Once healing is complete, removing screws does not compromise hip stability or undo the correction achieved by PAO.
What If I’m Not Having Symptoms?
If you are not experiencing pain or irritation:
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There is no medical reason to remove screws
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Leaving them in place avoids unnecessary surgery
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Many patients never think about their screws again
How the Hip Preservation Team Decides
At the International Center for Hip Preservation, the decision to remove screws is based on:
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Your symptoms
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Physical exam findings
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Imaging results
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Activity goals
The goal is always to balance symptom relief with avoiding unnecessary procedures.
Summary
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Most patients do not need screws removed after PAO
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Screw removal is only recommended when symptoms are present
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If needed, removal is straightforward and low-risk
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Leaving screws in place is safe when they are asymptomatic
If you are experiencing discomfort or have questions about hardware after PAO, a follow-up evaluation can help determine whether removal is appropriate.