Periacetabular Osteotomy (PAO)

What is a periacetabular osteotomy?

A periacetabular osteotomy (PAO) is the main surgical treatment for adolescents and adults with hip dysplasia who experience pain and are limited in their daily function.

During PAO, the hip preservation orthopedic surgeon will make a series of cuts to the bone (osteotomies) around the hip socket to rotate the socket into proper position. Once the socket is in proper position, metal screws are inserted to hold the bone in place.

The goal of this procedure is to allow the hip socket to provide better coverage of the top of the femur (femoral head) and reduce stress on the rim of the hip socket (acetabulum), which is the mechanical cause of cartilage damage.

If you have a labral tear — which is a tear in the cartilage surrounding the hip joint that occurs in some patients with hip dysplasia — your PAO may be combined with hip arthroscopy to treat the tear. Arthroscopy is a minimally invasive operation that allows the surgeon to work inside the joint to repair the labral tear.

If a PAO is performed before advanced hip arthritis is present, it may serve as a lifelong treatment. The long-term goal of the procedure is to preserve the hip joint and decrease the risk of developing arthritis.

What is recovery like?

Physical therapy (PT) usually begins the day after surgery and starts with range-of-motion exercises. Your physical therapist will assist you with walking in parallel bars and then with crutches. If you have stairs at home, you will be expected work in PT on how to go up and down the stairs.

You will be discharged with a home exercise program. Strength returns gradually after surgery, and you should be able to start outpatient physical therapy around one month after the PAO. Crutches are very important for the first several weeks after PAO. Most patients use crutches for 2 two months post-surgery.

After the hip has healed, most patients are able to return to their highest previous level of activity. Many of our patients are able to return to competitive sports after PAO, however, each individual’s level of activity may be different.

How we approach a PAO

The hip specialists in the Child and Young Adult Hip Preservation Program at Boston Children’s Hospital have performed more PAO surgeries than any other hospital in the nation. Our specialists have lead the way in innovations to the PAO surgical technique, including the development of muscle-sparing techniques that preserve the musculature around the hip and aid in the return to activities and reducing pain after PAO.

Our hip preservation orthopedic surgeons collaborate with our Departments of Nursing, Anesthesiology and Pain Management, Physical Therapy, Sports Medicine and Radiology to provide the most comprehensive care possible. After surgery, we work with physical therapists to help get patients back to being active and pain-free.

For patients who, along with their physician, select PAO as the treatment of choice, we expect their pain and function will be greatly improved by the surgery for many years. In all cases, the decision-making process between our patients and their specialist is one of open and honest communication.