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Periacetabular Osteotomy (PAO)
Preserving the Hip, Restoring Mobility
Periacetabular osteotomy (PAO) is a joint-preserving surgery designed to treat hip dysplasia, a condition where the hip socket doesn't fully support the femoral head. This structural issue can lead to instability, pain, and early arthritis if left untreated.
Unlike joint replacement, PAO repositions the socket to improve coverage, protect cartilage, and maintain your natural hip for as long as possible. It’s a powerful solution for active young adults and adolescents who want to stay mobile—without jumping to artificial components.
What Is PAO and Why Is It Done?
Periacetabular osteotomy (PAO) is a surgical procedure used to treat developmental dysplasia of the hip (DDH)—a condition where the hip socket (acetabulum) is too shallow to fully support the femoral head (the “ball” of the hip joint). This lack of coverage leads to joint instability, abnormal pressure on cartilage, and over time, chronic pain and early arthritis.
PAO corrects this problem by reorienting the hip socket. During the procedure, the surgeon makes precise cuts around the acetabulum and rotates it into a more natural position—improving coverage, restoring stability, and reducing long-term wear on the joint.
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Why Not Just Do a Hip Replacement?
Unlike hip replacement—which removes your natural joint and replaces it with metal and plastic components—PAO is a joint preservation procedure. It’s especially beneficial for younger, active patients who want to protect their natural joint and avoid or delay a lifetime of revision surgeries.
Think of PAO as structural realignment—not a replacement. It reshapes the hip to work better, longer.
Benefits of PAO:
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Preserves your natural joint
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Reduces pain and improves hip function
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Slows or prevents the progression of arthritis
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Supports a return to sport, activity, or labor-intensive work
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Delays or avoids the need for hip replacement surgery
How the PAO Procedure Works
PAO is a technically advanced surgery that realigns the hip socket without replacing any part of the joint. The goal is to reposition the acetabulum so it properly covers the femoral head, relieving stress on cartilage and stabilizing the joint.
While it is a formal open surgery—not minimally invasive—it is highly effective when performed on the right patient by an experienced hip preservation surgeon.
Step-by-Step Overview:
1. Hip Arthroscopy (Optional Pre-Procedure)
In some cases, your surgeon may perform hip arthroscopy 1–2 weeks before PAO to:
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Address labral tears
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Clean up cartilage
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Confirm joint condition
This is a minimally invasive outpatient procedure that improves the outcome of the PAO by preparing the joint.
2. Anesthesia & Positioning
PAO is typically performed under epidural and/or general anesthesia. You’ll be carefully positioned on the table to allow access to the front and side of the pelvis through two small cosmetic incisions, each about 3 inches long.
3. Acetabular Reorientation
The surgeon makes precise cuts (osteotomies) around the pelvic bone to free the acetabulum, then rotates it into a more optimal position for covering the femoral head.
Once positioned, the socket is secured with two to three metal screws that remain in place long term.
4. Closing & Recovery
The incisions are closed with sutures, and you'll stay in the hospital for 3–5 days for pain management and initial recovery. Crutches are used for the first several weeks to allow the bone to heal.
PAO doesn’t just treat the symptoms—it corrects the root cause of dysplasia by realigning the entire socket.
Goals and Benefits of PAO
The primary goal of periacetabular osteotomy (PAO) is to correct the underlying structural cause of hip dysplasia while preserving the natural hip joint. Rather than treating symptoms like pain with injections or waiting for arthritis to develop, PAO is a proactive approach that addresses the root of the problem—socket malalignment.
Why PAO Matters
In patients with hip dysplasia, the shallow socket places too much pressure on the labrum and cartilage. Over time, this leads to:
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Joint instability
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Labral tears
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Cartilage breakdown
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Early-onset hip arthritis
PAO is designed to realign the socket, improving how the femoral head is supported and distributed within the joint. By restoring mechanical balance, PAO:
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Reduces pain
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Slows or prevents joint degeneration
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Supports more natural joint function and longevity
Benefits for Young, Active Patients
This procedure is particularly valuable for:
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Teens and young adults with symptomatic dysplasia
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Athletes who want to avoid activity restrictions
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Patients under 40 looking to preserve the joint and delay or avoid hip replacement
Unlike total hip replacement (THR), which involves removing bone and replacing it with artificial components, PAO allows the natural joint to stay intact—supporting decades of movement without metal-on-plastic wear concerns or revision surgeries.
Long-Term Impact
Clinical studies show that:
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80–90% of properly selected PAO patients experience long-term pain relief and functional improvement
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In many cases, the procedure can delay the need for hip replacement by 10 to 20 years or more
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Patients often return to sports, recreational activities, or physically demanding jobs with fewer limitations
The earlier PAO is performed—ideally before major cartilage damage—the better the long-term outcome.
🔗 Related Read:
Patient Stories: Overcoming Hip Dysplasia ›
Get inspired by real people who regained mobility and confidence after undergoing PAO.
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While PAO is a major surgery, the long-term benefits often outweigh the short-term recovery challenges—especially for younger patients.
Recovery Timeline After PAO
Recovery after periacetabular osteotomy (PAO) is a long but highly rewarding process. Because the procedure involves surgically repositioning and fixing bone, the body needs time to heal and adapt to its new alignment.
Patients often describe the first few weeks as the most physically demanding, followed by steady, noticeable improvement over time. With a dedicated rehab plan and proper follow-up, most return to full, unrestricted activity within 6 to 8 months.
🏥 Immediate Post-Op: Hospital Stay (3–5 Days)
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You’ll stay in the hospital for 3 to 5 days for pain control, monitoring, and mobility training.
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A physical therapist will begin gentle movement exercises and teach you how to get in/out of bed, walk with crutches, and perform basic hygiene tasks.
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Pain is managed with a combination of medications, ice, and rest.
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You’ll likely use a walker or crutches before transitioning to crutches alone.
🏠 Weeks 1–2: Home Recovery Begins
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Most patients go home with crutches and begin slowly resuming essential tasks (with help).
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You’ll be partially weight-bearing (as instructed), typically 20–30% of your body weight on the operative side.
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Showering is permitted once wounds are dry and healing. Stairs may be allowed if taken slowly with assistance.
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Fatigue is common—plan to rest often and structure your day around medication, movement, and short walks.
🔄 Weeks 3–6: Transition Phase
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This is when structured physical therapy begins and gradual weight-bearing increases. You’ll move from two crutches to one, then to walking with a cane or unassisted.
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Many patients return to remote or light desk work during this time.
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Driving is often cleared around weeks 3–4, depending on leg strength and surgeon clearance.
💪 Weeks 6–12: Mobility Returns
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This phase is marked by increased independence. You’ll likely be walking short distances without assistive devices.
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Physical therapy focuses on gait normalization, core/glute strength, and stability.
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You’ll be cleared for activities like swimming, stationary biking, or light resistance training.
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Discomfort continues to improve, but energy levels may still fluctuate.
🏃♀️ Months 3–5: Strength and Endurance Phase
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This is when most patients feel like they’ve “turned the corner.”
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You’ll regain strength, stamina, and confidence with walking, stairs, and light fitness activities.
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Sports rehab may begin (low-impact, non-contact).
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Some patients return to part-time or modified labor-intensive jobs at this stage.
🏋️♀️ Months 5–8+: Return to Full Activity
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Jogging, recreational sports, hiking, and heavier gym workouts may be cleared.
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Return to full, unrestricted activity often occurs between months 6 and 8, depending on your progress.
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Athletes may start sport-specific agility training if strength and range of motion have normalized.
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Some patients opt for hardware removal in the future, but most screws are left in without issue.
Emotional & Lifestyle Considerations
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It’s normal to feel discouraged in the early stages—but steady progress happens week by week.
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Support from family, friends, or a caregiver is key during the first month.
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Returning to independence, work, and sport is incredibly rewarding—patients often say PAO gave them their life back.
Recovery isn’t linear. Some days are harder than others, but each milestone builds toward lasting results.
What Contributes to a Successful Outcome?
Physical Therapy After PAO
Physical therapy (PT) is essential after periacetabular osteotomy. It’s not just about regaining mobility—it’s about retraining your muscles, improving joint stability, and restoring confidence in your movement.
Because PAO involves repositioning the hip socket, your entire movement pattern must adjust to the new alignment. A structured rehab plan helps ensure you build strength the right way—safely and progressively.
Goals of Post-PAO Physical Therapy:
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Normalize walking and joint loading patterns
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Improve hip and pelvic muscle strength (especially glutes, abductors, and core)
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Regain full range of motion
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Reduce compensatory movements from years of poor alignment
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Prepare for a return to high-level activity or sport
What Rehab Typically Looks Like:
🗓 Weeks 1–4:
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Passive range of motion
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Gentle stretching
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Seated or supine exercises (e.g., quad sets, glute bridges)
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Gait re-education using crutches
🗓 Weeks 5–10:
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Begin weight-bearing progression
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Core stabilization and low-resistance strength work
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Aquatic therapy or recumbent biking may be added
🗓 Weeks 10–16+:
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Functional strength exercises (squats, step-ups, bands)
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Single-leg stability and balance work
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Return-to-run or sport-specific drills
Patient Tip:
Many patients benefit from working with a hip-specific physical therapist—someone experienced in post-PAO protocols. Recovery is not just about checking boxes—it’s about rebuilding movement that protects your joint for years to come.
“Physical therapy after PAO isn’t optional—it’s your key to long-term success.”
How Successful Is PAO?
When performed on the right patient—at the right time—periacetabular osteotomy (PAO) has excellent long-term results. This procedure is one of the most effective ways to preserve the hip joint, especially in young adults with hip dysplasia who have minimal arthritis.
Success Rates from Research:
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80–90% of appropriately selected patients report significant pain relief and improved function
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Studies show that many patients remain pain-free for 10 to 20 years or more after surgery
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A large percentage are able to return to active lifestyles, including recreational sports and demanding work
Realistic Expectations:
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PAO does not “cure” dysplasia, but it realigns the hip to function more naturally, slowing or preventing joint degeneration
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Some patients may eventually require a hip replacement later in life, but PAO can delay that need by decades
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A small percentage of patients may experience lingering stiffness or reduced range of motion—typically when surgery is performed later or after cartilage damage has occurred
The goal is not perfection—it’s preservation. PAO can give you back a stable, pain-free hip for the years that matter most.
Who Is a Good Candidate for PAO?
PAO is an effective and powerful procedure—but it’s not for everyone. The best outcomes come when the surgery is done for the right patient, at the right time, for the right reason.
At its core, PAO is designed to preserve the natural hip in young, active people who have clear signs of hip dysplasia but minimal joint damage.
You May Be a Strong Candidate If:
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You are between 15–40 years old
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You’ve been diagnosed with hip dysplasia or acetabular undercoverage
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Imaging shows little to no arthritis
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You have persistent pain with activity, walking, or prolonged sitting
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You’ve tried non-surgical care (physical therapy, injections) without lasting relief
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You are healthy, motivated, and able to commit to rehab after surgery
You May Not Be a Candidate If:
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You have advanced arthritis or significant cartilage loss
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You have non-structural hip pain or diffuse symptoms not clearly linked to dysplasia
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You have a neurological or muscular disorder affecting joint function
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You are unable to safely undergo surgery or commit to post-op rehabilitation
How Diagnosis Is Confirmed:
A comprehensive workup typically includes:
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Physical exam by a hip preservation specialist
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X-rays to measure socket coverage (LCEA, acetabular index, etc.)
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MRI to assess labral and cartilage health
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Occasionally a diagnostic hip injection to isolate the pain source
Take the Next Step
Considering PAO? Get a Second Opinion First.
PAO is a life-changing surgery—but also a major one.
If you’ve been told you might need periacetabular osteotomy (PAO), we offer second opinion consultations to help you understand your condition, risks, and long-term options.
Peace of mind starts with clarity.
Still not sure if PAO is right for you?
👉 Take our “Am I a Surgical Candidate?” quiz ›
It’s a quick, helpful tool to guide your decision and start a conversation with your care team.
When it’s the right surgery for the right patient—PAO can be life-changing.
📞 Take the Next Step Toward Long-Term Hip Health
If you’ve been diagnosed with hip dysplasia—or you’ve been living with persistent hip pain and instability—periacetabular osteotomy (PAO) could be the treatment that changes everything.
PAO is not a short-term fix. It’s a long-term investment in joint preservation, mobility, and quality of life. If you’re under 40 and looking for answers, this may be the solution you’ve been waiting for.
✅ Ready to Get Started?
We’re here to help you preserve your joint, reduce your pain, and reclaim your movement—for the long run.