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Periacetabular Osteotomy

Periacetabular Osteotomy (PAO) is a surgical procedure used to treat developmental dysplasia of the hip (DDH), a condition where the hip socket does not fully cover the femoral head, leading to instability and pain. During the procedure, the surgeon makes precise cuts around the pelvic bone to reposition the hip socket, ensuring better coverage of the femoral head. This improves joint stability and reduces abnormal wear on the cartilage. Unlike hip replacement, which involves replacing the joint with artificial components, PAO focuses on preserving and optimizing the natural joint. The goal of PAO is to alleviate pain, improve function, and significantly delay or prevent the need for joint replacement in the future, particularly in younger, active individuals.

How is a PAO performed?

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Patients undergoing a PAO typically begin with a minimally invasive hip arthroscopy performed about one week before the PAO procedure to address any damage within the hip joint. Once the initial recovery from the arthroscopy is complete, the PAO is performed under epidural anesthesia. The procedure involves making two well-concealed cosmetic incisions, approximately three inches in length each. Through these incisions, the surgeon repositions the hip socket to better cover the femoral head and stabilizes it with two to three internal metal screws. This procedure typically takes three to five hours, and patients remain in the hospital for three to five days. It is important to understand that a PAO is a formal surgical procedure, distinct from minimally invasive "keyhole" surgeries like hip arthroscopy.

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What is the goal of PAO?

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The primary goal of PAO is to reduce pain, improve hip stability, and decrease the long-term risk of arthritis. One of the greatest advantages of a PAO is that it preserves the natural hip joint rather than replacing it with artificial components. After recovery, most patients can return to their desired activities without restrictions.

 

This procedure is particularly beneficial for adolescents and young adults. At such a young age, undergoing hip replacement surgery would impose significant restrictions and likely require additional surgeries later in life due to wear and tear on artificial components. While a PAO does not guarantee avoidance of a hip replacement in the future, it can extend the life of the natural joint, often delaying the need for a replacement until middle age. By preserving the joint, patients can enjoy an active, unrestricted lifestyle during their younger years.

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What is the typical timeframe for recovery from PAO?

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Recovery from a PAO varies based on the extent of hip damage and individual patient factors. However, the general recovery timeline includes:

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  • Discharge from the hospital within three to five days post-surgery.

  • Resumption of daily household activities within two to three weeks.

  • Use of prescription pain medication for three to six weeks.

  • Return to desk work with intermittent walking at three to four weeks.

  • Driving at around two weeks post-surgery.

  • Walking unassisted and without a limp by three to five months.

  • Starting running at four to six months.

  • Returning to unrestricted sports or physically demanding jobs at six to eight months.

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Will physical therapy be necessary after PAO?

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Yes, physical therapy is essential for achieving the best possible outcome following a PAO. A structured rehabilitation program, guided by a physical therapist, will help you progress safely through various stages of recovery. Your therapist will adapt the protocol to meet your individual goals and ensure that you regain strength, mobility, and confidence in your hip.

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How successful is PAO?

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Scientific studies have consistently shown good to excellent outcomes in 80–90% of appropriately selected patients undergoing PAO, with some studies reporting benefits lasting up to 20 years. The success of the procedure depends on factors such as age, the degree of cartilage damage, and the overall condition of the hip. Outcomes are typically better in younger patients with minimal arthritis and localized structural issues.

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Am I a good candidate for PAO?

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Whether PAO is a suitable option for you depends on several factors, including your age, diagnosis, the extent of cartilage damage, and the severity of symptoms. In general, PAO tends to be most successful in patients under 40 years of age with limited arthritis and focal structural abnormalities. Deciding on the right treatment involves a careful evaluation of your condition, desired activity level, and personal circumstances. Working closely with your healthcare provider, you can develop a treatment plan that aligns with your goals and lifestyle.

 

Choosing the appropriate treatment option is a collaborative process that takes into account your diagnosis, symptoms, and preferences. If you have questions or concerns, take the time to discuss them thoroughly with your care team. They are there to support you every step of the way in restoring your quality of life.

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