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Am I Too Young or Too Old for PAO?
One of the most common questions patients ask when learning about Periacetabular Osteotomy (PAO) is whether their age makes them a good—or poor—candidate for surgery. Some patients worry they are “too young” to consider a major operation. Others are told they are “too old” and that it is already too late for hip preservation.
In reality, age alone rarely determines whether PAO is appropriate. Hip preservation decisions are based on the condition of the joint itself, not simply the number of years someone has lived. Understanding how age fits into the bigger picture can help patients make informed, confident decisions about their care.
Why Age Alone Is an Incomplete Measure
Age is an easy number to reference, but hips do not age uniformly. Two people of the same age may have vastly different hip anatomy, cartilage health, activity levels, and symptom patterns. Some patients develop symptoms of hip dysplasia in adolescence, while others remain relatively comfortable well into adulthood.
PAO is a joint-preserving procedure, meaning its success depends on whether the hip joint can still be protected and stabilized. The central question is not “How old are you?” but rather, “Is your hip joint healthy enough to preserve?”
Why Cartilage Health Matters More Than Age
Cartilage plays a central role in determining whether PAO will be successful. Healthy cartilage allows the hip to tolerate improved alignment and stability after surgery. When cartilage damage is advanced, even a perfectly corrected hip may continue to cause pain.
Surgeons assess cartilage health using a combination of imaging, physical examination, and symptom history. X-rays help evaluate joint space, while MRI provides detailed information about cartilage and labral integrity. These findings are far more predictive of outcome than age alone.
Being “Too Young” for PAO
PAO is commonly performed in adolescents and young adults, particularly when hip dysplasia causes pain, instability, or functional limitations. In younger patients, the goal of surgery is often preventative: correcting abnormal hip mechanics before significant cartilage damage occurs.
Some patients hesitate because they feel surgery at a young age is excessive or premature. However, delaying correction in a clearly unstable hip can allow damage to progress silently. Labral tears may worsen, cartilage can begin to wear down, and symptoms that were once manageable may become limiting.
For younger patients with persistent symptoms, PAO is not about rushing into surgery—it is about protecting the joint during its healthiest years.
Being “Too Old” for PAO
There is no strict upper age cutoff for PAO. Instead, candidacy in older patients depends largely on the condition of the cartilage and joint space. Some patients in their late 30s, 40s, or even early 50s still have well-preserved cartilage and mechanical symptoms driven primarily by instability rather than arthritis.
In these situations, PAO may still offer meaningful pain relief and long-term joint preservation. Conversely, a younger patient with advanced cartilage damage may not be a good candidate despite their age.
As patients get older, surgeons evaluate more carefully whether PAO will provide durable benefit or whether other treatment options should be considered.
Activity Level, Lifestyle, and Goals
Age does not define how someone lives their life. Some younger patients may have modest activity goals and prefer conservative management. Some older patients remain highly active and want to preserve their native hip joint for as long as possible.
PAO decision-making always incorporates a patient’s goals, including sports participation, work demands, family responsibilities, and willingness to commit to rehabilitation. The best treatment plan is one that aligns medical appropriateness with personal priorities.
The Value of Early Evaluation
One of the most important steps—regardless of age—is early evaluation by a hip preservation specialist. Even if surgery is not recommended immediately, understanding the anatomy of your hip and the health of the joint provides valuable context.
Early evaluation allows patients to monitor progression, plan appropriately, and avoid missing a window where joint preservation remains possible.
How PAO Candidacy Is Determined
At the International Center for Hip Preservation, decisions about PAO are made using a comprehensive, individualized approach. Surgeons consider hip anatomy, stability, cartilage health, imaging findings, physical examination, and patient goals together—never in isolation.
This approach ensures that age is a consideration, but never the deciding factor.
Summary
There is no universal answer to whether someone is too young or too old for PAO. What matters most is the health of the hip joint, the presence of instability, and the potential to preserve long-term function.
If you have been told that age alone disqualifies you from PAO, a hip preservation evaluation may help clarify whether that assessment truly reflects the condition of your hip.