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What Is Periacetabular Osteotomy?

Periacetabular osteotomy is hip-preservation surgery that reorients the acetabulum, or hip socket, to improve coverage of the femoral head. The surgeon makes several controlled cuts in the pelvis around the acetabulum while keeping the socket attached to its blood supply. The socket fragment is rotated into a more favorable position and secured with screws. The procedure is commonly used for symptomatic acetabular dysplasia in skeletally mature adolescents and young adults.

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What Is Periacetabular Osteotomy?

Periacetabular osteotomy is hip-preservation surgery that reorients the acetabulum, or hip socket, to improve coverage of the femoral head. The surgeon makes several controlled cuts in the pelvis around the acetabulum while keeping the socket attached to its blood supply. The socket fragment is rotated into a more favorable position and secured with screws. The procedure is commonly used for symptomatic acetabular dysplasia in skeletally mature adolescents and young adults.

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Why Is Periacetabular Osteotomy Performed?

The procedure is considered when hip dysplasia causes pain, instability, mechanical overload, or progressive damage despite appropriate nonsurgical treatment. Candidates generally have a hip joint that can still be preserved, with limited arthritis and enough healthy cartilage to benefit from improved coverage. Imaging is used to measure acetabular orientation, femoral-head coverage, joint congruence, cartilage condition, and other structural features. Advanced osteoarthritis can make total hip replacement more appropriate than a joint-preserving osteotomy.

How Is Periacetabular Osteotomy Performed?

The surgeon makes a series of bone cuts around the acetabulum while preserving the posterior column of the pelvis. The acetabular fragment is rotated to improve femoral-head coverage and distribute joint forces more evenly. Fluoroscopy and direct assessment are used to confirm the new position, and screws hold the fragment while the osteotomies heal. Hip arthroscopy or a femoral procedure can be added when labral, cartilage, or femoral-shape problems also require treatment.

What Is Recovery Like After Periacetabular Osteotomy?

Patients use crutches and limit weight-bearing during the early period while the pelvic cuts heal. Physical therapy progresses hip motion, walking mechanics, muscle strength, and later higher-level activity. Follow-up X-rays are used to confirm healing and maintenance of the corrected acetabular position. Return to running and impact sports generally takes several months and depends on bone healing, strength, symptoms, and associated procedures.

What Are the Risks and Complications?

Possible complications include bleeding, infection, blood clots, delayed union, nonunion, heterotopic ossification, and injury to nearby nerves or blood vessels. Temporary numbness from irritation of the lateral femoral cutaneous nerve is relatively common after the anterior surgical approach. Inadequate or excessive correction can leave abnormal joint loading, while cartilage damage can continue to progress despite improved coverage. Some patients eventually require total hip arthroplasty if arthritis develops or symptoms remain severe.

Frequently Asked Questions About Periacetabular Osteotomy

Is periacetabular osteotomy a hip replacement?

No. It preserves the patient's native hip joint by reorienting the acetabulum rather than replacing the femoral head and socket with implants.

Who is a typical candidate for periacetabular osteotomy?

Typical candidates have symptomatic acetabular dysplasia, a congruent hip that can still be preserved, and limited arthritis. Age and cartilage condition also affect candidacy.

Are screws used after periacetabular osteotomy?

Yes. Screws commonly hold the reoriented acetabular fragment in position while the pelvic osteotomies heal.

Can hip replacement still be needed after PAO?

Yes. PAO can delay or reduce progression of symptoms in selected patients, but it cannot guarantee that osteoarthritis or the need for later hip replacement will never develop.

References

PAO Surgery (Periacetabular Osteotomy). Hospital for Special Surgery. https://www.hss.edu/health-library/conditions-and-treatments/pao-periacetabular-osteotomy. Date Accessed August 13, 2026.

Hip Dysplasia in Adolescents and Young Adults. Hospital for Special Surgery. https://www.hss.edu/health-library/conditions-and-treatments/hip-dysplasia-adolescents-young-adults. Date Accessed August 13, 2026.

Periacetabular Osteotomy: A Systematic Literature Review. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC2706361/. Date Accessed August 13, 2026.

Periacetabular osteotomy to treat residual dysplasia in adolescents and young adults: indications, complications, results. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC6090197/. Date Accessed August 13, 2026.

Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. PubMed. https://pubmed.ncbi.nlm.nih.gov/19723987/. Date Accessed August 13, 2026.