Periacetabular Osteotomy (PAO)
What is a periacetabular osteotomy?
Periacetabular osteotomy is a surgical procedure which involves cutting and repositioning the bones around the hip joint to improve the alignment and stability of the joint. Periacetabular means "around the acetabulum (socket)" and osteotomy means "cutting bone".
If hip dysplasia is left untreated, arthritis can develop as a secondary condition to the original malalignment, so a realignment surgery is good for not only restoring the function and activity of the joint, but may also protect against arthritis.
How is the periacetabular osteotomy performed?
Periacetabular Osteotomy is done through a groin crease incision, where a set of special instruments are used under X-ray guidance to make controlled cuts through the pelvis, freeing the acetabulum from the pelvis, and allowing correction of the acetabulum. This is then, most commonly, held in place with 4-5 screws.
The majority of patients are in hospital for 2-5 days and are allowed partial weight bearing with crutches. Full recovery takes between 4 and 12 months. The majority of patients experience relief of pain and a return of activity.
Here is an animation of the process, courtesy of Dr Jit Balakumar and Dr Kemble Wang.
Meet Nathan
He has subspecialty, post-fellowship training in hip preservation surgery and joint replacement, including robotic & technology-assisted surgery across all approaches, including the direct anterior approach. Through compassion, communication, collaboration & competence, Nathan aims to build patient-surgeon trust, helping you understand your condition and the options available to empower you to make better treatment decisions toward your personal recovery goals. With stronger, better-informed patient-surgeon relationships, evidence-based surgical techniques and the latest assistive technology, Nathan aims to provide patients with the best possible care.
Comprehensive Surgical Care
A joint decision between you and Dr Eardley-Harris has been made to proceed with surgery after discussion of the risks and benefits of the procedure.
You may need special equipment to prepare your home for your return.
Comprehensive Surgical Care
Frequently Asked Questions
Partial weight bearing and walking with crutches is allowed immediately after a Periacetabular Osteotomy. We routinely see patients walking on the day of or the day after their operation, but only under the guidance of the physiotherapist.
Your ability to drive will depend on the side of your operation, the type of vehicle you drive, and what type of pain relief you are taking. Dr Eardley-Harris will discuss this with you at your first post-operative appointment but the typical recommendation is to not drive for a minimum of 2-6 weeks.
Complete recovery can take 4-12 months, but patients can return to sports such as swimming and cycling from 6 weeks and jogging at 3 months, provided the bone is healing.
The wounds are usually healed within 2 weeks. Most patients improve dramatically in the first 6 weeks. There may be occasions of a sore hip with activity but it should settle again as part of the normal healing process. Improvements following PAO surgery are expected for 12-18 months.
Rehabilitation starts right away with dedicated exercises to start in the hospital. This may include use of specific exercise machines to help increase the motion in the hip. Physiotherapy can be booked for the second post-operative week to continue your rehabilitation journey.
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