What Is a Periacetabular Osteotomy?

Medically Reviewed by Dan Brennan, MD on July 24, 2022

Hip dysplasia causes your hip to dislocate, causing chronic pain and inflexibility. But there is a treatment option available that prevents major hip replacement.

Since its development in the 1980s, periacetabular osteotomy (PAO) surgery has been the preferred treatment option for moderate hip dysplasia

The Hip and Hip Dysplasia

Your hip joint has two main parts: the ball and socket. The ball is the knob at the top of your thighbone, and it fits into the socket of your pelvic bone.

When the hip socket doesn't completely cover the ball of your thighbone, the hip joint falls out of place and dislocates. Complications in the last month of gestation cause the hip socket to form incorrectly around the joint, leading to hip dysplasia.

Over time, dysplasia damages the cartilage lining around the hip joint. Periacetabular osteotomy aims to realign the hip to fully cover the hip joint and slow the hip's degradation.

Periacetabular Osteotomy Steps

Pre-surgery imaging. Before the surgery, your doctor will use X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans to diagnose your hip dysplasia. These exams also prepare your surgeon for the procedure.

The diagnostic images reveal the anatomy of your hip and give your doctor a better idea of what's going on. They can use the images to create a surgical plan for the PAO. 

Surgery preparations. Your doctor will walk you through the surgery's details and what you need to do to prepare.

You should stop taking NSAIDs (nonsteroidal anti-inflammatory drugs) a week before the surgery. NSAIDs prevent blood clotting and can cause complications during surgery.

Always tell your doctor about any medications you're taking. They may prescribe a dose of Naprosyn to prepare you for the surgery.

Your doctor will also tell you not to eat or drink before the surgery. You may need to fast starting at midnight the night before.

You'll need to wear loose clothing for your appointment. Don't wear makeup or jewelry.

You'll have to spend a few days in the hospital to recover. You'll need to pack comfortable clothing, toiletries, and other necessities for your stay.

Periacetabular osteotomy technique. Your doctor will tailor the surgery to fit your needs. Generally, all PAO surgeries follow the same steps and take about two to three hours.

  1. The surgeon will cut the bone around your hip socket. Osteotomy is the procedure of cutting bone. The cuts are called osteotomies. 
  2. These cuts let the surgeon rotate the segment of bone and put it into a position that completely covers the joint. 
  3. The surgeon puts in metal screws to hold the socket in place. 

Severe hip dysplasia can sometimes lead to tissue damage like a labral tear. Your surgeon may perform additional surgeries during the PAO to treat tissue damage.

If necessary, your surgeon may add a bone graft to help the healing process. 

Periacetabular Osteotomy Complications

All surgeries have risks. Your surgeon will take all the necessary precautions. Still, there's always a possibility that your body could react negatively to the surgery.

Surgeries like POA can lead to the following complications:

  • Shock caused by a severe drop in your blood pressure
  • Hemorrhaging of the surgical site
  • Infection of the surgical site
  • Deep vein thrombosis (DVT) caused by a blood clot that forms in a large vein
  • Lung problems like chest pains, coughing, or wheezing
  • Trouble urinating or urinary retention
  • Allergic reaction to anesthesia

Alternate Treatments for Hip Dysplasia

PAO is the primary hip dysplasia treatment for adults. It repositions the joint to make sure worse symptoms don't develop.

Babies younger than 6 months with hip dysplasia may get a brace or harness. The brace holds the hip joint in place while the baby develops, preventing the need for surgery later in life. 

For mild hip dysplasia, physical therapy can help relieve symptoms. Physical therapy can strengthen the joints, improve the joints' flexibility, and prevent hip dysplasia from getting worse.

You may need a total hip replacement if your hip dysplasia is severe. This surgery involves replacing the entire hip joint with an artificial joint.

Periacetabular Osteotomy Recovery

Recovering from a PAO is a long process. You'll get back to your typical level of activity after about six months if your recovery goes well.

Early recovery. You'll start by spending at least two days in the hospital or as directed by your doctor. You'll start light physical therapy during this time, which includes gentle exercise and practicing sitting, standing, and walking with crutches.

You'll likely be on a few medications in the early weeks of recovery to help the healing process. Some of the medications you may get include:

NSAIDs can sometimes slow the healing of your bones. Only take medications as recommended by your doctor to avoid any complications.

As you transition from the hospital to your home, you'll need 24-hour care for at least a week. You'll continue to move your hip gently to help the healing process, but moving around can still be difficult.

At-home recovery. While at home, you'll gradually transition from crutches to a cane. Gentle exercise, walking, and stretching are vital for the transition process.

You can return to work after around three months. The level of work depends on your job and recovery. 

You can go back to your typical activities after around six months. You'll still want to avoid running and jumping until approved by your doctor.

Checkups. Your doctor will advise you on how often you should return for a checkup. Generally, you'll need to visit your doctor after two weeks, six weeks, three months, six months, and one year.

Your doctor will likely recommend biennial checkups to observe your hip health. After that, you can go about your typical activities, with special consideration for how much your hip can tolerate.

Prognosis of PAO

Most patients who get PAO report fewer dysplasia symptoms like pain and stiffness. They also have improved activity and hip function.

PAO doesn't guarantee a fixed hip. There's a chance that you'll need a hip replacement later in life, but a PAO delays the need for as long as possible. 

PAO is an effective treatment option for hip dysplasia. With enough time and recovery, you'll be back to your favorite activities in no time. 

Show Sources


Boston Children’s Hospital: “Periacetabular Osteotomy (PAO).”

The Children's Mercy Hospital: “Periacetabular Osteotomy (PAO) Surgery for Hip Dysplasia.”

Cleveland Clinic: “Hip Dysplasia.”

HSS: “Periacetabular Osteotomy: An Overview.”

Johns Hopkins Medicine: “Preparing for Surgery.”

The Journal of Bone and Joint Surgery: “Natural history of the dysplastic hip following modern periacetabular osteotomy.”

Mayo Clinic: “Hip dysplasia.”

Stanford Children’s Health: “Periacetabular Osteotomy (PAO).”

University of Utah: “Periacetabular Osteotomy (PAO).”

UR Medicine Orthopaedics & Physical Performance Center: “Periacetabular Osteotomy (PAO) Instructions.”

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