Periacetabular osteotomy (PAO) is a major joint-preserving operation to reposition the hip socket to provide better coverage of the femoral head. It is performed for hip dysplasia — a condition where the socket is too shallow, causing pain and predisposing to early arthritis.
An incision is made at the front of the hip. The acetabulum (hip socket) is cut free from the surrounding pelvis using controlled osteotomies (bone cuts), rotated into a better position to cover the femoral head, and fixed with screws. The operation is technically demanding and takes two to three hours.
PAO is recommended for symptomatic hip dysplasia in young adults (typically 15-40 years) with preserved joint cartilage. It aims to improve hip mechanics and prevent or delay arthritis.
Physiotherapy, activity modification, pain management, and observation. However, symptomatic dysplasia tends to progress to arthritis without correction.
Specialised hip X-rays and CT scan for planning. This is a major operation performed at specialist centres.
Improved hip coverage, reduced pain, and delayed or prevented arthritis progression. Long-term studies show approximately 75-85% of patients have a well-functioning hip at 10-20 years.
This is a major bone operation. Full recovery takes six to twelve months.
Numbness on the outer thigh occurs in approximately 20-30% of patients. Usually improves.
Significant. Transfusion may be needed.
The osteotomy may fail to heal. Risk approximately 2-5%.
The acetabulum may be positioned suboptimally.
Rare but potentially serious.
Wound or deep infection.
DVT or pulmonary embolism.
Unwanted bone formation.
Despite correction, some patients still develop arthritis.
General anaesthesia. Epidural may be used for post-operative pain management.
Non-weight-bearing or partial weight-bearing for six to eight weeks. Crutches for eight to twelve weeks. Physiotherapy throughout for hip range of motion and strengthening. Return to desk work at six to eight weeks. Return to sport at six to twelve months.
Regular X-rays at six weeks, three months, six months, and one year. Long-term follow-up to monitor hip joint.
PAO is most beneficial for patients under 40 with preserved cartilage. Older patients or those with significant arthritis may be better served by hip replacement.
No. PAO is a highly specialised operation performed at a limited number of centres with expertise in young adult hip preservation.