What is Periacetabular Osteotomy?

A PAO is a surgical procedure to correct the medical condition of hip dysplasia or acetabular dysplasia. In hip dysplasia, the hip socket, the acetabulum, does not provide sufficient coverage for the femoral head or ball. Instead, the acetabulum is too shallow, which causes the femoral head to receive limited coverage. In a PAO, the acetabulum is repositioned to cover more of the femoral head to stabilize your child's hip joint better. This surgery will improve your child's hip function, reduce hip pain, and prevent damage to the joint that could result in hip arthritis over time.

Who is a good candidate for PAO?

Doctors usually consult your medical history, perform a physical examination, and run one or more tests through imaging before determining whether someone is a good candidate for a PAO procedure.

The doctor then may start asking about symptoms: hip or groin pain, whether such pain happens upon activity, on moving the hip, or when lying down. During physical examination, the doctor would examine the hip closely:

He would rotate the hip joint, test for certain hip positions that cause pain, and observe the patient's gait.

In addition, the doctor will ask for several

Imaging tests: X-rays, a computed tomography scan, magnetic resonance imaging, and/or magnetic resonance arthrography. These tests are useful for doctors to visually examine the bones, cartilage, and other structures within the hip.

Usually, the ideal patients meet the following requirements:

Age: They are 40 or younger, provided such a procedure may be performed on individuals as young as 12.
Healthy articular cartilage; there are no signs of osteoarthritis in the affected joint
Good hip joint congruency, that is, how well the curvature of the femoral head matches the acetabulum's curvature
Active people over 40 with little evidence of osteoarthritis may still be good candidates for the procedure, though PAO is not typically performed on those over 50.

What happens during PAO surgery?

Before the procedure, patients are given general anesthetics so that they do not feel any pain when the surgery is performed.

During the procedure, the patient lies on a radiolucent operating table, which permits doctors to employ X-rays and thus see real-time images of the hip joint during the surgery.

The first incision is made on the skin along the hip. He cuts across the muscles to gain access through the hip joint. Then, he cuts the bone around the acetabulum. These incisions into the bone are known as osteotomies.

Once the acetabulum has been freed from the surrounding bony confines, it is reoriented to cover the femoral head better. The surgeon will then screw the acetabulum back to the surrounding bony structure. This screw holds the bones in place as they heal. Once the bone has been stable, the range of motion of the hip will be assessed by the surgeon.

Sometimes, other hip conditions are present in the patient and should also be addressed. For example, mispositioning of the femoral head might be present. In such a case, a femoral osteotomy could be performed. This is done by cutting the femur and thereby aligning the bones correctly. Other procedures that can be undertaken in the same session include a hip labral tear repair and surgical management of FAI.

At the end of the procedure, the surgeon closes the incision.

How do patients recover from PAO surgery?

Patients generally begin physical therapy the day following surgery. They begin with range-of-motion exercises. PT begins with ambulation: Patients will ambulate on parallel bars, and eventually, they will use crutches. Patients with stairs in the home will be instructed on how to ascend and descend those stairs, and they often are discharged when they can safely do that.

Patients are typically discharged post-PAO with a home exercise program. Patients generally increase their strength slowly over the following weeks and months and can usually start with outpatient physical therapy one month after the PAO.

Crutches are essential, especially during the first few weeks after the PAO, since the bone is entirely healing. Most patients need to use crutches for two months after the surgery.

Most patients can return to their highest level of function before the surgery once the hip has healed following a PAO. Many patients return to competitive sports following a PAO; however, every patient's interest and activity level are unique.

What are some of the possible complications of a PAO procedure?

As with any surgical procedure, there is always a risk for complications both during and after a PAO procedure.

Some common surgical complications may include:

Infection
Blood loss
Blood clots

Other complications that may arise include;

Damage to nerves and blood vessels surrounding the operated area
Bone fracture
Nonunion of bone that got cut as a result of the process
Delayed union of bones that got cut as a result of the process
Osteonecrosis: this is the death of the bone tissue because of avascular flow within the bone
Intramuscular or soft tissue heterotopic ossification; abnormal formation of bone in muscles or other soft tissues
Features of screws, plates, and other hardware
Reduced movement within the operated area
Overcorrection or under correction of the acetabulum

Is there an age ideal for PAO surgery?

A PAO is an alternative for a child after acquiring skeletal maturity. It is generally done on patients between the ages of 12 and 40. Our specialists at Tender Palm Hospital, who specialize in hip preservation, can operate on patients younger than 12 and older than 40.

What are the outcomes for the patient after undergoing a PAO?

Patients leave the clinics with low levels of pain, improved hip activities, and activity-level scores in short-term follow-up studies two years following a PAO. The 10-year results for the PAO procedure demonstrate that 80% to 90% of patients remain osteoarthritically free of end-stage conditions.