Periacetabular Osteotomy

Overview

Periacetabular Osteotomy (PAO) is a procedure designed to correct a patient with a shallow hip socket (hip dysplasia) in a skeletally mature individual. Peri- means around, acetabulum is the cup of the hip socket, and osteotomy is cutting bone. So in this procedure, four bone cuts are made around the acetabulum and reoriented to correct the dysplasia and provide a more normal coverage of the hip joint. 

If the dysplasia in left untreated, the abnormal stresses on the cartilage due to the dysplasia can lead to problems with the labrum or wear the cartilage down leading to early arthritis. Although a big surgery, a PAO can be a very successful surgery in young active patients having pain due to their dysplasia and when there is not damage to the joint. Often times, a PAO is done in conjunction with a hip arthroscopy in order to address any labral tears or other issues within the hip joint. 

Typically patients stay 1-3 days in the hospital after a PAO and will be able to work with physical therapy to learn to move around after surgery. Patients  typically use a walker or crutches initially as patients are only allowed to bear about 20-30 pounds on the operative leg for the first 6 weeks. After those first 6 weeks, it may take a couple of weeks to progress to full weight bearing.  Weightbearing too early can lead to the screws bending or breaking and losing the correction. 

Potential Implications:

Blood loss (sometimes more than a liter), infection, damage to nerves or blood vessel including numbness over the lateral (side) of the thigh, nonunion (bone doesn’t heal), intraoperative or postoperative fracture, deep vein thrombosis (DVT), and need for additional surgery.