American Hip Institute

Peri-Acetabular Osteotomy

What is Periacetabular Osteotomy?

A periacetabular osteotomy is used to correct congenital hip dysplasia.

Hip dysplasia is a congenital condition in which the acetabulum or socket is shallow. This creates under-coverage of the femoral head. The weight-bearing portion of the hip becomes overloaded as it is increasingly focused on a small area. Dysplasia can lead to hip instability, labral damage and early-onset arthritis.

The procedure is designed to maintain the hip’s native structures while altering the mechanical alignment to preserve proper hip function.

An PAO candidate must have minimal or no damage to the articular cartilage on the femoral head or acetabulum. A patient with damage to the labrum will likely remain a surgical candidate assuming their articular cartilage is substantially intact. Damage to the labrum may be addressed with hip arthroscopy at the same time of PAO.
A special MRI, (dGEMRIC MRI) can be used to estimate damage to the articular cartilage prior to surgery.

This can determine if a patient has optimal prognosis for a PAO. If the patient does not have enough remaining articular cartilage, the patient is considered to be at a high failure rate for a PAO and may need to consider other treatment options, ranging from conservative measures to hip arthroscopy, or even total hip replacement.

Surgery Step-by-Step

1) Ischial Osteotomy

2) Public Osteotomy

3) Supraacetabular & Retroacetabular Osteotomy

4) Fragment mobilization and Correction

5) Screw placement and Correction Stabilization

After the osteotomies are healed. The patient may begin therapy to regain motion and strength. At this point, the American Hip Institute® encourages the highest level of “reasonable” activity the hip joint will allow.

Postoperatively, the patient can expect to be on crutches for 6-8 weeks.

Data shows that 10 years or more after undergoing a PAO, approximately 90% of patients have a well-functioning hip joint.

In most cases, dislocation is not a risk after a PAO. Therefore, there are no motion restrictions after this procedure, as there may be after a total hip replacement.