Peri-acetabular osteotomy...PAO

Danny will have his right hip PAO on Friday. He started having hip pain as a teenager. His family doctor overlooked hip dysplasia and he was dismissed with, "don't be so hard on your body". He always felt his hips weren't alligned.

Educational moment....If you or someone you know is in hip pain GET IT LOOKED AT!! Go to specialists. Don't take "just deal with it" for an answer or wait until it gets worse. An x-ray was able to easily detect his dysplasia. Congenital Hip Dysplasia is usually treatable in infants and children. The older you get the worse it becomes. Your cartilage wears which can result in arthritis. Replacements aren't the best answer for a relatively young person since they don't last very long.  Be an advocate for your health or a loved one if you suspect hip dysplasia.

We had a miracle two years ago when Danny started to have severe pelvis and testicular pain. He went to specialists to figure out what was going and came back with the answer... hip dysplasia. He was told that if left untreated, his left hip would most likely become arthritic in a couple of years and unable to save.

His left hip was done two years ago. It was originally more painful and severe and now feels better than his right hip. This gives him hope for the upcoming surgery and recovery. His previous recovery was within normal limits. The surgeons cut a nerve and tried to repair it which caused a very painful neuroma. Danny couldn't take it one day, called the surgeon and they operated that week to sever the nerve. It made all the difference. He is planning all telling the surgeon to leave any damaged nerves instead of trying to stitch them up. The loss of sensation sometimes bothers him but nothing he can't live with.

He was in the hospital for five days. His surgery took about six hours. He was severly anemic following the surgery which caused an irregular SP wave in his EKG (a normal response). The neroma caused the most pain. He wasn't able to bear weight for 6 weeks, light weight bearing for another 6 weeks and was able to walk without crutches within 3 months. I think he was in bed for about a month with little jonts around the house.

He is excited to get the surgery behind him and be out of the daily pain that he lives in. He is in pain after walking 20 feet. He never complains but doesn't want to do anything that involves walking. We have friends who live in daily arthritis pain. At times crawling around the house because it is too painful to walk. We recognize that Danny is very blessed that their is a cure for hip dysplasia. There are so many diseases that don't have a cure yet . We are a family that truly understands the significance of all the doctors and researchers that spend their lives dedicated to finding cures to improve the lives of others. Thank You!


We have been blessed to be able to financially save for his surgery and time off work.  We are blessed and grateful for family that is able to help during recovery.  My parents will watch the kids while we are in the hospital, Danny's dad is coming out for a couple of days when he gets home from the hospital and we have countless friends who are ready to do whatever we need to make life easier.  


We will keep you updated.  

Here is some educational information on hip dysplacia and PAO....

Hip dysplasia

Hip dysplasia is a developmental condition that is often recognized and treated in infancy. It is caused by an abnormal development of the hip joint. Normally, the hip socket or acetabulum develops its shape in response the head of the femur. If the head of the femur is positioned abnormally, the acetabulum can form with an angulated roof that slopes upward. This can lead to increased pressures on the cartilage of the hip as well as a persistent tendency for the femoral head to slide in and out of the hip with daily activities. This mechanical problem leads to a greater tendency to develop arthritis in middle age.(See Figure 1 )

In younger patients, this abnormality can lead to increased pain in the hip as well as tears of the labrum. When this condition is diagnosed in adulthood and the hip is still in the non-arthritic phase, there is still a chance to intervene prior to full blown arthritis. Standard radiographs only show the damage in its final stages. Newer types of studies such as MRI (See Figure 2) can show early damage to the structures in the hip.

Periacetabular Osteotomy

The most successful, safe, and predictable of these operations is termed the "periacetabular osteotomy", also called the "PAO". It was developed by two ingenious surgeons, Professor Reinhold Ganz and Dr. Jeffrey Mast in the early 1980’s. An osteotomy is the surgical division of a bone and periacetabular described the application of the osteotomy "around" the hip socket or “acetabulum”. The procedure involves making a series of angular cuts on the pelvis, separating the hip socket from the pelvis and allowing free rotation of the socket in three dimensions. It has proven to be one of the most effective surgical procedures in the treatment of hip dysplasia in adults. The major advantage of the procedure is the flexibility of placement of the hip socket in essentially any position and the preservation of the stability of the pelvic ring. The ability to freely position the hip socket gives your surgeon the ability to customize the correction of the anatomy to the specific deficiencies of that pelvis.

Advantages of PAO
After PAO, patients can bear weight much earlier than with other procedures and females who undergo the procedure can have normal future vaginal deliveries rather than requiring a Cesarean section.


Recovery After PAO
Most patients require hospitalization for 3 to 4 days and can get up with physical therapy on the day after the procedure. Crutches or a walker are usually continued for 6 weeks until there is some evidence of healing of the osteotomy site. After the 6 to 8 week mark, if there is evidence of healing of the osteotomy site on the xrays, patients can resume weightbearing. In many cases, they may have some slight muscle weakness which responds well to physical therapy. By three to four months, nearly everyone walks without a cane. The most gratifying part of the operation is to see patients return to high level activities and occupations without even thinking about their hip.


Potential Complications After PAO
Although the PAO is a relatively major hip operation, in many ways, it is the safest in the long run. The biggest risks are from damage to the nerves, arteries, or veins that run in the pelvis. This risk is minimized by performing all the cuts with full xray guidance in the operating room as well as extensive experience with the operative procedure.