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Periacetabular Osteotomy (PAO)

Periacetabular Osteotomy (PAO)

OVERVIEW

PAO surgery is a hip preservation surgery performed to correct a deformity in the acetabulum (hip socket) such as acetabular dysplasia. If this condition remains untreated, secondary arthritis commonly develops. Therefore, in order to relieve symptoms and improve the prognosis of the hip, this surgery is done to correct the bony anatomy and help normalize the load across the joint.

“Periacetabular” means around the acetabulum (hip socket). “Osteotomy” means to cut bone. Therefore, periacetabular osteotomy means to cut the bone around the acetabulum and reposition the hip socket. The PAO is a very effective procedure for the treatment of symptomatic acetabular dysplasia.

Dr Slattery is trained in a minimally invasive form of periacetabular osteotomy using a groin crease incision.  An incision is made across the front of the hip joint to allow exposure of the hip and surrounding pelvis.  Then specialised instruments are used with X-ray vision to perform controlled cuts of the pelvis and free the acetabulum from the pelvis.  The acetabulum is repositioned and fixed in the new position with three or four screws after further checks with X-ray.  This is a highly specialised procedure which is done by only a few surgeons worldwide.  This revolutionary procedure was pioneered in Switzerland  which is where Dr Slattery undertook sub-specialist fellowship training to learn the art of this procedure.

X-rays of a young female with bilateral hip dysplasia are shown (top).  She had PAOs done to both hips  and she has an excellent result in both hips(bottom).
The Purple Line shows the position of the skin incision used for PAO

 

A pelvic model is shown and demonstrates the bony cuts and repositioning of the acetabulum. The gaps between the repositioned bone fill in with new bone, just like the healing of a fracture.

Many patients with hip dysplasia (shallow socket) have other problems within the joint (cartilage tears) and/or may have a deformity of the femoral head (ball) of femur bone. Commonly, these other problems are treated during the PAO procedure.

Occasionally there is also a deformity of the femur that must be corrected at the time of surgery by a proximal femoral osteotomy (PFO). This involves cutting and repositioning the upper portion of the femur (thigh) bone. If this is needed, a second incision is made on the outside of the hip and the femur is repositioned and fixed with a rod, or a metal plate and screws.

The hospitalization time is two to four days and full recovery takes four to six months. The majority of patients experience major relief of pain and become quite active after recovery from surgery. While the PAO is an extremely effective hip preservation procedure, it may not create a completely normal hip. Even if the PAO is effective in adolescence or early adulthood, some patients are likely to require a total hip replacement surgery later in life.

Preoperative x-rays of a 19yr male with deformity of both the hip socket and femur secondary to Perthes Disease (right). 4yrs after surgery with the osteotomies of both the acetabulum and femur, this patient has no hip pain and an excellent result from surgery (left).
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