Periacetabular Hip Osteotomy

Periacetabular Osteotomy (PAO): Joint-Preserving Surgery for Hip Dysplasia

The hip joint is one of the largest weight-bearing joints in our body, and its healthy function depends on a perfect fit between the ball (femoral head) and the socket (acetabulum). However, in some individuals, the hip socket does not develop deep enough or does not fully cover the femoral head, either congenitally or developmentally. This condition, called Hip Dysplasia (Developmental Dysplasia or Insufficiency of the Hip), leads to abnormal load distribution in the joint, tears in the cartilage rim called the labrum at its edge, a feeling of instability in the joint, and most importantly, early-onset hip osteoarthritis (coxarthrosis). In the treatment of symptomatic hip dysplasia, which causes hip pain and loss of function especially in young and middle-aged adults, Periacetabular Osteotomy (PAO) surgery — aimed at preserving the hip joint and preventing or delaying the future need for a prosthesis — is one of the gold-standard surgical methods. Prof. Dr. Murat Bozkurt, an Orthopedics and Traumatology Specialist in Ankara, is a physician specialized in the diagnosis of hip dysplasia and PAO surgery.

What Are Hip Dysplasia and Periacetabular Osteotomy (PAO)?

Hip Dysplasia: This is a condition in which the socket (acetabulum) that forms the hip joint is shallow, insufficiently angled, or does not adequately cover the femoral head (ball). Because of this anatomical mismatch, the femoral head cannot remain stable within the socket, excessive load is placed on the joint margins (labrum and cartilage), and over time these structures become damaged.

Periacetabular Osteotomy (PAO): This is a major joint-preserving surgical procedure for the hip. In this operation, careful and precise bone cuts are made in the pelvis surrounding the hip socket (acetabulum). These cuts free the acetabulum from the rest of the pelvis. The freed acetabular fragment is then repositioned (rotated and shifted) so as to better cover the femoral head and correct joint mechanics. Once brought into the ideal position, the acetabulum is securely fixed in its new location with metal screws. This operation is often also called the Ganz Osteotomy, named after the Swiss surgeon Prof. Reinhold Ganz, who first described the technique.

The Goal of PAO:

  • To relieve pain in the hip joint.
  • To improve joint mechanics, providing better coverage and stability for the femoral head.
  • To reduce abnormal loading on the labrum and cartilage.
  • To prevent the development of hip osteoarthritis or significantly delay its progression.
  • To preserve the patient’s own natural hip joint so it remains functional for many years.

Who Is a Candidate for PAO Surgery? Indications

PAO is not suitable for every patient with hip dysplasia. Correct patient selection is essential for this operation to succeed. Ideal candidates generally have the following characteristics:

  • Symptomatic Hip Dysplasia: Patients with dysplasia-related complaints such as hip or groin pain, catching, locking, or a feeling of instability.
  • Age: Young adults and adolescents (typically between 15 and 45-50 years of age) are generally preferred. The potential for joint preservation is higher in this age group.
  • Minimal or No Osteoarthritis: This is one of the most important criteria. Since the goal of PAO is to prevent osteoarthritis, there should be no significant osteoarthritis (advanced cartilage damage) in the hip joint at the time of surgery. Mild, early-stage cartilage damage can be tolerated. In patients with advanced osteoarthritis, hip replacement is a more suitable option than PAO.
  • Adequate Range of Motion: Hip range of motion should be largely preserved before surgery.
  • Failure to Respond to Conservative Treatment: The decision to operate is usually made when conservative methods such as activity modification and physical therapy fail to control symptoms.
  • General Health Status: The patient must be in a general state of health that can tolerate a major operation.

Symptoms of Hip Dysplasia That Suggest the Need for PAO

Common symptoms in patients with symptomatic hip dysplasia include:

  • Pain: The most common symptom. It is usually felt in the groin area or on the side of the hip. It may sometimes radiate to the thigh or the back of the hip. Pain typically increases with activity (walking, running, sports) or after prolonged standing or sitting. It can be sharp and stabbing, or dull and aching.
  • Mechanical Symptoms: A clicking sound, snapping, catching, or locking sensation in the hip (this often indicates an accompanying labral tear).
  • Feeling of Instability: A sense of insecurity, giving way, or the hip feeling like it is “about to pop out.”
  • Fatigue and Limping: A feeling of fatigue around the hip or slight limping, especially after prolonged activity.
  • Restricted Motion: Difficulty or pain when moving the hip in certain directions.

Diagnosis and Preoperative Evaluation

Before PAO surgery, a comprehensive evaluation is performed to determine the degree of hip dysplasia, the condition of the cartilage and labrum in the joint, and the patient’s suitability for surgery:

  • Detailed History: The onset, character, and location of pain, triggering factors, feeling of instability, history of childhood hip problems, and family history are reviewed.
  • Physical Examination: The patient’s gait, leg lengths, active and passive range of motion of the hip joint (particularly restriction in internal rotation and flexion), muscle strength, and instability and impingement tests (FADIR, FABER, etc.) are carefully assessed.
  • Imaging Methods:
    • X-ray: The primary method for diagnosis and planning. Special weight-bearing pelvis and hip radiographs (AP Pelvis, False Profile, Dunn lateral, etc.) are obtained. Many measurements are made on these images, including the depth and inclination of the acetabulum, the degree of femoral head coverage (such as the Lateral Center-Edge Angle – LCEA), the shape of the femoral head, and signs of early osteoarthritis. The type and severity of dysplasia are determined.
    • Computed Tomography (CT): Frequently used to see the bone anatomy in three-dimensional detail, to fully understand the position of the acetabulum and femoral head, and for precise planning of the surgical cuts.
    • Magnetic Resonance (MR) Imaging or MR Arthrography (MRA): Very important for evaluating the soft tissues within the joint (labrum, cartilage, ligaments). MRA (contrast-enhanced MRI) is the gold standard for demonstrating the labral tears and degree of cartilage damage that frequently accompany dysplasia. These findings influence the surgical strategy.
  • Diagnostic Intra-articular Injection: A local anesthetic injection may be performed to confirm that the pain definitively originates from the hip joint.

How Is Periacetabular Osteotomy (PAO) Surgery Performed?

PAO is a technically demanding, major hip operation that requires experience. It generally involves the following steps:

  1. Anesthesia: General anesthesia or spinal/epidural anesthesia is administered.
  2. Surgical Approach: A single surgical incision, usually made at the front of the hip (anterior approach), is used. The muscles are carefully separated to reach the pelvic bone.
  3. Osteotomy Cuts: Guided by specialized cutting instruments and imaging (fluoroscopy – live X-ray), the surgeon makes planned, precise cuts in the pelvic bone surrounding the acetabulum (in the ischium, pubis, and ilium). These cuts free the acetabulum so that it can move independently from the rest of the pelvis. Throughout this step, the blood supply to the acetabulum and important nerve structures are protected.
  4. Repositioning the Acetabulum: The freed acetabular fragment is carefully rotated and shifted so as to better cover the femoral head and correct joint mechanics. The ideal position is verified with fluoroscopy.
  5. Fixation: The repositioned acetabulum is securely fixed to the pelvic bone, typically using 3 to 5 long metal screws.
  6. Simultaneous Hip Arthroscopy (Frequently Performed): In a large proportion of PAO operations, before or after the osteotomy, a camera is introduced into the hip joint through small portals (arthroscopy) to repair the accompanying labral tear and to correct any other minor intra-articular problems (cartilage irregularities, small bony prominences that could cause impingement), if present. This is an important step that increases the success of PAO.
  7. Closure: The wound layers are closed, and a drain may be placed.

This operation should be performed by surgeons with specialized expertise in hip-preserving surgery, such as Prof. Dr. Murat Bozkurt.

PAO Surgery: Risks, Benefits, and the Very Long Recovery Process

PAO is an operation that offers significant benefits but, being a major surgery, also carries potential risks.

  • Benefits:
    • Significant and lasting reduction in pain caused by hip dysplasia.
    • Improved stability and mechanics of the hip joint.
    • Preservation of the patient’s own natural hip joint.
    • Prevention of hip osteoarthritis, or delaying its development for many years (15-20 years or more).
    • Improved function and the ability to return to many activities.
  • Risks:
    • General surgical and anesthesia risks (infection, bleeding, clotting – DVT/PE).
    • Nerve Injury: During surgery there is a risk of stretching or injury to the sciatic nerve, femoral nerve, or the lateral femoral cutaneous nerve, which causes numbness on the side of the thigh (usually temporary but rarely can be permanent).
    • Nonunion or Delayed Union: Failure of the cut bones to heal, or slow healing.
    • Malunion: Healing of the acetabulum in an undesired position.
    • Fixation Hardware (Screw) Problems: Loosening, breakage, or skin irritation from the screws (they can be removed later if necessary).
    • Fracture: Fracture occurring at the osteotomy line or screw sites (rare).
    • Vascular Injury (rare).
    • Persistent Pain or insufficient symptom relief.
    • In the long term, osteoarthritis or the need for hip replacement may still develop (however, PAO significantly delays this need).
  • Recovery Process: Recovery after PAO is a very long (6-12 months or more), demanding process that requires the patient’s full commitment.
    • Hospital Stay: Generally 3-5 days.
    • Weight-Bearing Restriction: This is the most important restriction. For the bone cuts to fully heal, the patient must use crutches and place NO weight on the operated leg (non-weight bearing) or only touch-down weight bearing for 6 to 12 weeks after surgery. Adhering to this rule is vital.
    • Motion Restrictions: Certain hip movements (excessive flexion, rotation) are restricted initially.
    • Intensive Physical Therapy: This is the foundation of rehabilitation and lasts for months. It begins immediately after discharge from the hospital. It starts with passive movements, and as bone healing progresses, the patient very slowly and in a controlled manner transitions to active movements, balance exercises, and muscle strengthening (particularly of the hip abductors and core muscles). Working with a physical therapist experienced in hip PAO rehabilitation is essential.
    • Timeline: Return to desk work may take 2-3 months. Return to driving may take a similar amount of time. Return to a normal walking pattern can take 3-4 months. Return to more strenuous activities or sports, such as running, generally takes at least 12 months.

Periacetabular Osteotomy (PAO) in Ankara and Prof. Dr. Murat Bozkurt’s Approach

Periacetabular Osteotomy (PAO) is one of the most important and technically most demanding operations in hip-preserving surgery, and in Ankara it is performed at centers specialized in this field. As an experienced physician in hip dysplasia and PAO surgery, Prof. Dr. Murat Bozkurt adopts the following approach:

  • Accurate Diagnosis and Rigorous Patient Selection: He recognizes that correct patient selection is the most critical step for PAO’s success. He carefully evaluates the patient’s symptoms, expectations, and detailed radiological measurements (especially the degree of osteoarthritis) to decide whether the patient is genuinely suitable for PAO. He specifically targets young patients without advanced osteoarthritis.
  • Precise Surgical Planning and Execution: Through detailed preoperative planning using methods such as 3D CT, he makes precise cuts and corrections during surgery to bring the acetabulum into the most ideal position. He ensures stable screw fixation.
  • Simultaneous Arthroscopy: He aims to increase the success of the operation by treating the labral tears and other intra-articular problems that frequently accompany dysplasia arthroscopically in the same session.
  • Comprehensive Rehabilitation Management: He provides close guidance and support to the patient throughout the very long and critical rehabilitation process after PAO, working in collaboration with experienced physical therapists.

Periacetabular Osteotomy (PAO) is a highly effective surgical method for relieving pain caused by hip dysplasia and preventing osteoarthritis by preserving the hip joint in properly selected young patients. However, because it is a major operation requiring a very long and patience-demanding rehabilitation process, it is essential to discuss all the details with a specialist physician before making a decision. In Ankara, you can benefit from Prof. Dr. Murat Bozkurt’s experience in hip dysplasia and PAO surgery.

For detailed information and appointments, you can contact Prof. Dr. Murat Bozkurt at 0312 502 70 74.

Frequently Asked Questions

It is a congenital or developmental condition in which the hip socket (acetabulum) is shallow or does not adequately cover the femoral head.

It is a major hip-preserving operation in which the bones surrounding the hip socket are cut to correct hip dysplasia, allowing the socket to be repositioned and fixed in place with screws.

Generally, patients under 45-50 years of age who have pain and complaints related to hip dysplasia but have not yet developed significant osteoarthritis in the hip.

This is the primary goal of PAO. A successful PAO operation can delay the need for hip replacement for many years (15-20 years or more) or eliminate it entirely.

No. Because PAO requires bone cuts, it is an open surgical method. However, arthroscopy is frequently performed in the same session to correct intra-articular problems such as labral issues.

Bone cuts are made in the pelvis around the hip socket, the socket is freed, repositioned to better cover the femoral head, and fixed in place with screws.

Recovery is very long. You must avoid bearing weight for approximately 6-12 weeks while using crutches. Full functional recovery and return to sports can take up to a year, or longer.

For the bones to heal, you will generally need to use crutches without bearing weight, or bearing very little weight, for 6 to 12 weeks.

Since it is a major operation, general risks such as infection, blood clots, and bleeding exist. There are also specific risks such as nerve injury, nonunion of the bone, malunion, and screw-related problems.

To be examined by Prof. Dr. Murat Bozkurt and get detailed information about the status of your hip dysplasia, whether PAO surgery is suitable for you, the process, risks, and expectations, you can call 0312 502 70 74.

You can contact us for information about diagnosis and treatment processes.

Contact

Ankara Periacetabular Osteotomy (PAO): Hip-Preserving Surgery with Prof. Dr. Murat Bozkurt

Periacetabular osteotomy (PAO) is a procedure used in cases of “hip dysplasia,” where the hip socket (acetabulum) is shallow, in which the socket is surgically cut, repositioned, and brought to the most ideal angle. This operation is one of the most advanced and effective surgical techniques for preserving the hip joint. Ankara periacetabular osteotomy (PAO) is a field in which Prof. Dr. Murat Bozkurt has extensive international experience, and he applies this method particularly in young, active patients to prevent joint osteoarthritis (arthrosis) and eliminate the need for a prosthesis.

Unlike traditional methods, PAO aims to preserve the patient’s own natural joint. When the hip socket is brought to the depth and angle it should have, the load on the femoral head is balanced; this relieves pain while extending the joint’s lifespan by decades. At our center in Ankara, we carry your hip health into the future with millimeter-precise planning and advanced surgical techniques.

Hip Dysplasia and Candidates for PAO Surgery

Hip dysplasia is a condition in which the socket (acetabulum), within which the femoral head sits, is not sufficiently deep or develops at an incorrect angle. This shallow structure causes body weight to be concentrated onto a very narrow area of the hip joint. Over time, this excessive loading causes tearing of the cartilage tissue that protects the joint and of the gasket-like structure called the “labrum,” ultimately leading to early-onset osteoarthritis. Ankara periacetabular osteotomy (PAO) is precisely the procedure of surgically freeing this shallow socket and repositioning it to better cover the femoral head.

So, who is a candidate for PAO surgery?

  • Young, Active Adults: Patients generally between the ages of 15 and 45, in whom hip osteoarthritis (arthrosis) has not yet begun or is only at a very early stage, are the most ideal candidates.

  • Those with Persistent Hip and Groin Pain: Deep pain felt in the groin area, especially after prolonged standing or sports activity, can be an early warning sign of hip dysplasia.

  • Patients with Preserved Cartilage: The primary goal of PAO is to preserve the joint. If the joint cartilage is completely worn away, prosthetic surgery may be a more suitable option in that case. Prof. Dr. Murat Bozkurt analyzes cartilage quality using advanced imaging techniques to determine, before surgery, how much benefit the patient will gain from PAO.

  • Those Experiencing Marked Hip Looseness: Patients who feel as though their hip is about to slip out of place, or who experience instability (a feeling of insecurity) while walking.

This operation is technically one of the most demanding and precise procedures in orthopedics. Fully separating the socket (acetabulum) from the pelvis and rotating it through millimeter-precise angles relies on the surgeon’s extensive experience and deep biomechanical knowledge. At our center in Ankara, we perform anatomical measurements for our patients down to the finest detail, targeting that “golden angle” that will maximize the joint’s lifespan.

How Is PAO Surgery Performed? Technical Details and Success Factors

Periacetabular osteotomy, also known in the medical world as the “Bernese Osteotomy,” is a procedure that requires a high level of surgical skill. Prof. Dr. Murat Bozkurt makes four strategic cuts in the bone during this operation to separate the hip socket (acetabulum) from the rest of the pelvis. The key feature of these cuts is that they do not damage the posterior column of the pelvis, thereby preserving the structural integrity of the hip joint.

The technical advantages and process of the operation include the following:

  • 360-Degree Freedom of Movement: Once the socket has been completely freed from the bone, the surgeon can rotate it in any direction (anteriorly, laterally, or externally). This ensures the most ideal coverage of the femoral head.

  • Preservation of Blood Flow: In the PAO technique, the vessels and nerves supplying the socket are meticulously protected. This ensures rapid bone healing and preserves the viability of the joint.

  • Minimally Invasive Approach: At our center in Ankara, the joint is reached through the smallest possible incisions. This speeds up postoperative wound healing and minimizes cosmetic concerns.

  • Titanium Fixation: Once the socket has been brought to the ideal “golden angle,” it is fixed in its new position with 3 or 4 special titanium screws. These screws are generally permanent and do not cause the patient any discomfort.

The most critical factor in the success of this operation is that the socket is neither “over-corrected” nor “under-corrected.” Prof. Dr. Murat Bozkurt uses fluoroscopy (X-ray) devices and digital measurement tools during surgery to achieve that precise balance capable of eliminating the need for a prosthesis for a lifetime.

Recovery After PAO: A New Future Through Patience

Periacetabular osteotomy is a major operation that “rebuilds” the hip joint. For this reason, the recovery process must be managed with patience and discipline, like a marathon. Prof. Dr. Murat Bozkurt personally oversees postoperative follow-up at our center in Ankara, supervising every stage of bone healing and functional recovery.

Recovery Timeline and Critical Periods:

  • Hospital Stay (4-6 Days): Postoperative pain management and the first attempts at movement begin in the hospital. Our patients are generally helped to stand with the assistance of a physical therapist on the 2nd day after surgery.

  • Crutches and “Partial Weight-Bearing” (6-8 Weeks): It is vital that full weight is not placed on the leg so that the cuts in the pelvis (osteotomy lines) can heal together. During this period, the patient walks with crutches, placing only “touch-down” level weight on the leg.

  • Physical Therapy Program: Within our Ankara physical therapy protocols, the patient progresses from passive movements to active exercises to prevent weakening of the muscles around the hip (abductor muscles).

  • Full Weight-Bearing and Sports (From the 3rd Month Onward): Once bone healing is confirmed by X-ray, walking with full weight-bearing begins. Low-impact sports such as swimming are generally permitted at the 4th month, while high-impact sports are usually permitted after the 1st year.

Frequently Asked Questions About Periacetabular Osteotomy (PAO)

How much do PAO surgery prices cost in Ankara? The cost of PAO surgery varies depending on whether the procedure is unilateral or bilateral, the 3D modeling technologies used in surgical planning, the cost of the titanium screw sets, and the length of the hospital stay. Since this is a complex surgical procedure, a clear budget is established after a comprehensive preliminary examination.

PAO or hip replacement? Which should I choose? If you are young (under 40-45) and severe osteoarthritis has not begun in your joint, PAO is the best option for you. A prosthesis is an “artificial joint,” while PAO preserves “your own living bone.” You can play sports with your own joint and live without motion restrictions.

Can a natural (vaginal) delivery be performed after PAO surgery? Yes. Although PAO alters the structure of the pelvis, when performed by experienced hands it does not adversely affect the birth canal. In fact, stabilization of the hip joint allows the increased load during pregnancy to be carried more healthily.

Ankara Periacetabular Osteotomy (PAO) Appointment and Contact

Suffering from hip pain at a young age is not your destiny. Hip dysplasia (a shallow socket), when treated with a PAO operation performed at the right time, can completely eliminate the future need for a prosthesis. By contacting Ankara periacetabular osteotomy specialist Prof. Dr. Murat Bozkurt, who has mastery of the worldwide literature in advanced hip-preserving surgeries, you can extend the lifespan of your hip.

Entrust your hip health to professionals with an accurate diagnosis and millimeter-precise surgical planning.

For Appointments and Detailed Information: Contact us right away, and let’s plan together the most modern method to relieve your hip pain and preserve your joint.