If your child is born with congenital hip dysplasia or concerns become apparent in the first few years of life, a healthcare professional may recommend applying a brace or harness to correct any structural differences.
In more extreme cases, the hip joint will need repositioning or even reconstruction. This typically happens through periacetabular osteotomy (PAO) surgery.
This is major surgery. It is usually done only when severe symptoms arise or other treatments haven’t worked. In this article, you will learn what to expect during the surgery and recovery period if you or your child needs this operation.
PAO is a surgery to correct hip dysplasia. The phrase “periacetabular osteotomy” in the name of the surgery refers to the specific location on the hip where surgery happens and how the surgery corrects the problem:
- “Periacetabular”: This term refers to the acetabulum, the part of the hip that is near the curved, cup-shaped socket of the joint where the pelvis connects to the femur (thigh bone).
- “Osteotomy”: This term means the cutting or removal of bone during surgery.
During PAO, a surgeon repositions the acetabulum to cover more of the femoral head. This will improve the stability of the hip joint. PAO surgery improves hip function, decreases hip pain, and stops the damage occurring inside the joint that can lead to hip arthritis over time.
The curved shape of the acetabulum allows the hip joint to move with a ball-and-socket motion.
In people who have some form of dysplasia, the joint does not fit correctly into this joint socket. It may cause mobility problems and pain.
PAO surgery is most often used to correct:
- symptomatic acetabular dysplasia
- developmental dysplasia of the hip
Both conditions result from atypical development or positioning of the hip joint. Although injury can cause hip dysplasia and other positioning concerns, most of these conditions are congenital or develop even before birth.
Congenital hip dislocation or dysplasia are two conditions that may appear in newborns and young infants. With both conditions, the hip does not form or is not positioned correctly.
This can happen for a number of reasons, including:
- breech positioning in the uterus
- a family history of congenital hip dysplasia
- being firstborn
- being female at birth
- swaddling too tightly in infancy
This condition can be present without obvious symptoms at birth, but symptoms that do appear include things like:
- legs that turn outward or appear to be different lengths
- limited range of motion
- uneven folds on the legs and buttocks when the legs are extended
- delayed gross motor development, especially with walking or crawling
There are several methods for treating congenital hip problems, including bracing or harnessing and surgical repositioning.
If these techniques are not effective as your child ages — or if you had untreated congenital hip issues at birth that worsened over time — your surgeon may need to reshape the hip bone by performing PAO.
Before undergoing PAO, your surgeon will use imaging studies like CT scans or X-rays to create images of the displacement in your hip joint.
They will also take measurements of the displacement. Usually, a certain degree of displacement is required to be considered for surgical correction.
If you and your surgeon have decided that PAO is the best treatment option for you, you will be scheduled to have the surgery in a hospital or surgery center.
It’s a major surgery that will take a good deal of time to recover from, so you will likely spend at least a few days in the hospital after surgery and possibly some time in a rehabilitation center after that.
On the day of surgery, you’ll receive a type of anesthesia to numb the nerves of the area of your surgery so you do not feel pain.
A healthcare professional will drape you with sterile cloths and a surgeon will make an incision just under the top edge (iliac crest) of the pelvis. They will remove soft tissue and muscle to expose the acetabulum, then cut and reshape the bone to correct the dysplasia.
At one time, open surgery was common. Today, new minimally invasive techniques are often used to decrease the amount of tissue damage and recovery time after surgery.
Minimally invasive techniques have the potential to reduce the size of the initial incision from 10 to 20 centimeters (cm) to about 9 cm, according to one study from 2017.
Once the reshaping of the bone is complete, the surgeon will secure bone and ligament pieces with surgical-grade hardware, then close the incision.
After your surgery, you will be taken to a recovery area. Depending on your overall health and how the surgery progressed, you may need to spend a few days in the hospital before going home or to a rehabilitation program.
While in the hospital and in the weeks after surgery, your post-operative care will focus on:
- managing your pain
- treating the wound to prevent infection and other complications
- doing exercises to regain your strength and mobility
PAO is major surgery, and the use of opioid medications is a common choice for pain management after surgery. This may include medications like:
- hydrocodone-acetaminophen 5-324
These medications are usually taken for about 2 weeks after surgery, per 2019 research, but may be needed for as long as 6 weeks.
Your surgeon will give you specific instructions on how to care for your incision after surgery.
They will use staples or sutures to close the wound. Your surgeon will remove these when you have started to heal.
Blistering and surgical site infections are some of the most common concerns with post-operative wound healing, so your surgeon may choose a specialty dressing that promotes healing while reducing infection risk. The most common forms of these dressings are adhesive and antimicrobial foam products.
Other options include a simple dry dressing or keeping the incision open to air after the first few days. Your surgeon will give you a list of problems to watch for that could signal an infection or poor healing, such as:
- opening of the wound
Physical therapy and rehabilitation
As you begin the healing process, part of your recovery will involve moving your repaired hip joint to improve strength and mobility. You may even be asked to move or walk in the first few hours after surgery.
You won’t do this alone, though. A physical therapist will guide you on how to move and exercise safely after surgery so that you will heal well without developing any additional complications.
Bleeding, infection, and injury are all possible complications after PAO surgery.
You may have post-operative pain and movement issues in the immediate period after surgery. Other complications can include things like:
- blood clots
- nerve damage
- poor wound healing
- stress fractures
- reopening (dehiscence) of the surgical wound
- loss of surgical correction
Most people who have PAO surgery are young adults, so there is also the chance that arthritis or additional concerns will develop on the operative hip later in life. Talk with your surgeon about post-operative measures you can take to reduce the risk of long-term complications.
Measuring the success of PAO surgery with scans or tests is difficult. The majority of people who have this surgery report significant improvements in things like:
- overall quality of life
- physical activity and abilities
The 2017 study mentioned earlier looked at 151 people who had minimally invasive PAO surgery. It found that:
- 77.1% were very satisfied with their functional improvements after surgery
- 16.7% were “quite satisfied”
- 6.3% were not satisfied with the surgery
Still, nearly all of the people who participated in this study — 95.8% — would recommend PAO surgery to someone with the same hip conditions.
When to call your doctor
As with any surgery, your healthcare professional will give you specific instructions on when to return for a follow-up examination and what possible complications to watch for.
The following concerns usually warrant an immediate call to your surgeon or a visit to an emergency medical center:
- foul-smelling or yellow/green drainage from the wound
- wound reopening
- shortness of breath
- chest pain
Is PAO surgery a permanent fix?
PAO surgery usually results in significant improvements in quality of life, pain, and movement of the hip joint. In some cases, additional correction may be needed after the first surgery.
How will I know the PAO surgery was successful?
There are no real tests to evaluate how successful PAO surgery is. Many people who have this operation report an improvement in their symptoms compared with before the surgery.
Can congenital hip problems be prevented?
Although positioning and tight swaddling after birth may contribute to hip dysplasia concerns, most of the damage is done before you’re even born. Breech births, birth order, and sex assigned at birth can all contribute to congenital hip conditions, but you cannot prevent or avoid any of these factors.
PAO surgery is a major operation that is most often used to correct problems with your hip structure and function. These issues usually develop before birth but can take time to become obvious or cause enough disability to warrant surgery.
If you are having PAO surgery, plan on needing several weeks of pain management, wound care, and physical therapy for your recovery.