Will You Need a Hip Replacement After PAO Surgery?

One of the most common questions patients ask before undergoing a periacetabular osteotomy (PAO) is:

"Will I eventually need a hip replacement after PAO surgery?"

It's a reasonable concern. After all, PAO is a major surgery, and many patients wonder whether it's simply delaying the inevitable.

The encouraging news is that PAO is specifically designed to preserve your natural hip joint, often delaying—or even preventing—the need for a total hip replacement (THR). While every patient is different, many people enjoy decades of improved hip function after surgery.

➡️ Learn more about PAO surgery and how it treats hip dysplasia

Why Hip Dysplasia Often Leads to Hip Replacement

Hip dysplasia occurs when the hip socket doesn't fully cover the ball of the hip joint. Because the socket is too shallow, the joint experiences abnormal forces every time you walk, run, or exercise.

Over time, this can lead to:

• Increased stress on the cartilage

• Labral tears

• Progressive joint damage

• Early arthritis

• Chronic hip pain

Without treatment, many patients with moderate to severe hip dysplasia develop arthritis much earlier than expected and may require a hip replacement after PAO surgery would otherwise have been considered unnecessary.

Some individuals require a total hip replacement in their 30s or 40s, decades earlier than patients without hip dysplasia.

➡️ Read our guide to What Is Hip Dysplasia?

How PAO Surgery Helps Prevent Hip Replacement After PAO Surgery

The goal of PAO isn't simply to relieve pain.

Its primary purpose is to correct the structural problem causing damage in the first place.

During surgery, the hip socket is carefully repositioned to provide better coverage of the femoral head. This improves the mechanics of the joint and distributes weight more evenly across the cartilage.

As a result, PAO can:

• Improve hip stability

• Reduce joint stress

• Slow cartilage wear

• Delay arthritis progression

• Preserve the natural hip joint

By addressing the underlying cause of hip dysplasia, PAO often delays the need for hip replacement after PAO surgery by many years—and for some patients, it may eliminate the need altogether.

Will Everyone Need a Hip Replacement After PAO Surgery?

The answer is no.

Many patients never require a hip replacement.

Whether you'll eventually need one depends on several important factors.

Arthritis Before Surgery

Patients who already have significant cartilage damage or advanced arthritis before PAO are more likely to require a hip replacement later.

PAO works best before irreversible arthritis develops.

Your Age at Surgery

Younger patients generally experience better long-term joint preservation because there is less existing cartilage damage.

Joint Health After Surgery

Protecting your hip after surgery is equally important.

Maintaining muscle strength, staying active, and following your rehabilitation plan all contribute to better long-term outcomes.

Individual Healing

Every patient's biology is different. Genetics, activity level, body weight, and overall health all influence how long your natural hip continues to function.

How to Delay Hip Replacement After PAO Surgery

Although PAO significantly improves joint mechanics, you also play an important role in protecting your hip.

Stay Committed to Physical Therapy

Rehabilitation strengthens the muscles that stabilize your hip and improves movement patterns.

➡️ Learn more about The Role of Physical Therapy in Hip Preservation

Choose Joint-Friendly Exercise

Activities such as:

• Swimming

• Cycling

• Walking

• Pilates

• Strength training

help maintain mobility while minimizing unnecessary joint stress.

Maintain a Healthy Weight

Every extra pound increases the force placed across the hip joint.

Maintaining a healthy weight reduces cartilage wear over time.

Schedule Regular Follow-Up Visits

Routine X-rays and evaluations allow your surgeon to monitor your hip and identify any early signs of arthritis progression.

When Is Hip Replacement Still the Best Option?

Although PAO is an excellent joint-preserving procedure, there are situations where a total hip replacement remains the better choice.

Patients with:

• Advanced arthritis

• Severe cartilage loss

• Significant joint degeneration

• Persistent pain despite conservative treatment

may benefit more from hip replacement than hip preservation surgery.

Your hip preservation specialist will determine which option offers the best long-term outcome based on your imaging, symptoms, and age.

Final Thoughts on Hip Replacement After PAO Surgery

For many patients with hip dysplasia, PAO offers the opportunity to keep their natural hip for decades longer than would otherwise be possible.

While no surgery can guarantee you'll never need a hip replacement, PAO dramatically improves the odds of delaying joint replacement until much later in life—or avoiding it altogether.

If you've been diagnosed with hip dysplasia, talking with a hip preservation specialist early can make all the difference. The earlier structural problems are corrected, the greater the chance of preserving your natural hip and maintaining an active lifestyle for years to come.

➡️ Read next: Comparing PAO Surgery and Hip Arthroscopy