PERIACETABULAR OSTEOTOMY (PAO)

Pelvic Osteotomy or Peri-Acetabular Osteotomy (PAO) A pelvic osteotomy is considered in patients who demonstrate symptomatic acetabular dysplasia with minimal signs of joint degeneration. A pelvic osteotomy in joints with significant joint degeneration is contraindicated and would soon require conversion to a total hip replacement.

A PAO is extensive surgery which requires making three cuts in three different areas of the pelvis in order to free the hip socket, this then allows reorientation of the socket in any plane (direction) required to optimise the coverage over the femoral head. Screws are then used to hold the bones in the correct place whilst they are healing. 

After a PAO, you can expect to be:

• In the hospital for three to five days after surgery.

• Walking and using crutches one to two days after surgery.

• Using crutches for six to eight weeks after surgery.

Risks and Complications

• Nerve Damage: permanent nerve injuries are rare following PAO, some patients may have numbness down the outside of their thigh due to stretching of the nerves to the skin, this usually recovers in 3-6 months. There is a very small risk to the large femoral and sciatic nerves during PAO, which can leave permanent sensory and strength loss to the leg.

• Bleeding: as the pelvic bone has to be cut numerous times, there can be blood loss from this operation. Blood salvage techniques and medications are used to minimize the use of blood transfusions post operatively.

• Fracture: there is a small risk of fracture, which is normally detected at the time of the operation

• Non Union: this occurs when the cut bones do not heal together, this is rare following PAO

• Infection: this is very rare, but can occur any time screws or other foreign material are implanted.  This can normally be simply treated with antibiotics.