QUESTIONS AND ANSWERS

Symptoms

Symptoms of hip dysplasia often include hip pain and limited mobility. While some children are born with it, others may not show symptoms until adolescence or adulthood. On X-ray, the abnormalities can range from mild to moderate, but even subtle changes can lead to significant problems as a child grows.

It’s also worth noting that hip dysplasia is more common in women than in men and is a leading cause of hip pain and arthritis in people under 50. Early diagnosis gives doctors a chance to use less invasive measures to guide socket development, but once the bone hardens, surgical intervention like PAO becomes the preferred option to correct the alignment and reduce future joint degeneration.

How Imaging Guides Diagnosis and Surgical Planning

Doctors use advanced imaging to diagnose hip dysplasia and plan surgery with precision beyond a standard physical exam. X-rays show bone structure and help doctors identify a shallow or misaligned socket, which often indicates hip dysplasia. For more detail, surgeons may order an MRI to examine cartilage and the labrum inside the hip joint. This imaging shows whether abnormal socket shape has caused damage to soft tissues like the labrum or joint cartilage.

Some patients also undergo a 3D CT scan for clearer views of the pelvis from multiple angles. A 3D CT scan helps doctors see if the hip socket tilts forward (anteversion) or backward (retroversion). hese images allow surgeons to understand how each part of the hip joint fits and functions together. This insight helps determine the precise corrections needed during surgery.

Medical imaging—X-ray, MRI, or 3D CT—gives surgeons a full, personalized map of the joint. This thorough evaluation lets surgeons plan procedures like a PAO with the patient’s unique anatomy in mind. Proper planning increases surgical accuracy and sets the stage for the best possible outcome.

What is the Periacetabular Osteotomy procedure?

All patients scheduled for a PAO first undergo a minimally invasive hip arthroscopy to address damage inside the hip joint. After initial recovery from hip arthroscopy, PAO is performed under epidural anesthesia.  Two well-hidden cosmetic incisions, each about 3 inches long, are made. A surgeon makes an incision in the front of the hip joint to expose the hip joint and the surrounding pelvis. He then cuts the bone in four places to reposition the acetabulum in a better position within the pelvis. This helps restore some of the normal hip anatomy.  However, it does not change the actual shape of the acetabular cup or femoral head.

To aid in bone healing, our surgeons frequently add a bone transplant. Our doctors will determine the optimal sites for the osteotomies (cuts to the bone) and reorientation of the hip socket using X-rays during surgery on your child. The surgeon will use three or four screws to secure the acetabulum after it is in its new location. Two to three hours are expected for the surgery. The surgical team will keep the parents informed about their child’s development. After surgery, the majority of children spend 2-4 days in the hospital. It’s crucial to understand that a PAO is a formal procedure rather than a hip arthroscopy.

What is the Goal of Periacetabular Osteotomy Surgery?

A PAO seeks to accomplish a number of objectives, including eliminating pain, increasing hip stability, and decreasing the future risk of developing arthritis. The main advantage of a PAO is that it preserves the hip joint, allowing the patient to keep it rather than having a metal and plastic replacement. This indicates that your child is free to engage in any activity after recovery from the operation. Without replacing the hip, PAO can treat hip dysplasia by changing the architecture of the pelvis and hip joint.

PAO aims to eliminate and reduce pain and increase stability, among other things. Strong evidence supports PAO’s ability to lessen the risk of osteoarthritis or the progression to total hip arthroplasty. By shifting the acetabulum (hip socket) into a healthier position that reduces joint stress, PAO surgery aims to maintain your child’s hip joint. In most situations, this can help prevent your child from needing a total hip replacement and getting arthritis later in life.

Why it’s important

To understand why this is so important, it helps to know how hip dysplasia affects the joint over time. In some cases, the acetabulum does not fully develop, remaining too shallow or misaligned. This means it cannot adequately cover and support the femoral head. Because of this misalignment, the forces that should be distributed evenly across the hip are instead concentrated on the cartilage and labrum, a ring of strong, flexible tissue that lines the hip socket. Over time, this increased stress can cause the cartilage and labrum to wear down, leading to pain, instability, and eventually, early arthritis as the joint surfaces lose their protective coverings and bone begins to rub against bone.

By correcting the position of the acetabulum with a PAO, the surgery helps restore normal joint mechanics and relieves the excessive pressure from the cartilage and labrum. This not only preserves the function of the hip but also reduces the likelihood of degenerative changes, giving your child the best chance at a pain-free and active life for many years to come.

When is Surgery Considered?

Treatment for hip dysplasia includes a range of options, from conservative approaches to surgical correction. For younger patients—typically those in their teens, twenties, or thirties—preserving the natural hip joint is often a priority. If the dysplasia is discovered early and symptoms are mild, doctors might recommend nonsurgical interventions, such as physical therapy or corticosteroid injections, to manage discomfort and encourage proper joint development. In these cases, ongoing monitoring with MRI can help ensure there is no progression of joint damage.

However, if symptoms persist, the hip remains unstable, or imaging reveals more significant dysplasia or joint wear, surgical intervention is generally recommended. PAO is especially considered for patients who have reached skeletal maturity and have a malalignment of the acetabulum but do not yet have advanced osteoarthritis. It is also an option for those whose previous less invasive surgeries, such as hip arthroscopy, have not provided lasting relief, since these procedures cannot address the underlying structural issue.

Comparing PAO and Hip Replacement

Parents have another choice in repairing hip dysplasia. There is also a total hip replacement that a young patient with abnormalities could receive. There are occasions when our doctors will recommend this choice. However, the results with PAO, which preserves the patient’s hip, completely outweigh those of hip replacement. Medical studies have shown that the PAO’s long-term results appear far better than what the patient might have obtained from a hip replacement. The patient’s hip is living tissue with self-maintenance capabilities, whereas deterioration with time is inevitable for a man-made hip replacement.

Individualized Treatment Decisions

Ultimately, the decision to proceed with PAO surgery is shaped by a combination of factors, including the patient’s age, activity level, the degree of hip arthritis, and personal goals. For patients in their forties, the presence and severity of arthritis are especially important in determining whether PAO or hip replacement will provide the best long-term outcome. Our team works with each family to weigh these considerations and choose the most effective treatment plan, always prioritizing your child’s quality of life and long-term mobility.

Who are the Ideal Candidates for PAO

Candidates for a PAO are often in their adolescence or young adult years. Hip replacement surgery at such a young age would almost certainly necessitate a second or third procedure to replace worn-out components later in life. With a second joint replacement procedure, there is always a chance of complications (persistent pain, infection, and dislocation). A PAO gives your child the freedom to do anything they want during their youth. Even though it is not a guarantee that they won’t need a hip replacement later in life. And if a PAO can delay the possibility of hip replacement surgery until they are 50 or 60 years old, that second procedure will probably benefit them for the rest of their life.

If PAO is a wise choice for your child, it will rely on several variables, such as:

• Age.
• Specific injury pattern or diagnosis.
• The degree of cartilage or arthritic damage.

In general, individuals under 40 with isolated or identifiable structural damage and little arthritis had the best results after PAO. Our surgeons can help you navigate the numerous factors and determine whether PAO is the best option for your child. The best course of treatment will depend on your child’s diagnosis and the length and severity of symptoms. In this process, parents are not acting alone, and we will present the medical facts to make the right decision.

Recovering from Periacetabular Osteotomy Surgery

It is important to recognize that recovery speed is highly dependent on the extent and type of hip injury. Recovery from hip replacement surgery takes time and patience, but pain and function usually improve significantly over the years. For the first six weeks after surgery, children use crutches or a walker in combination with a wheelchair. During this time, they cannot put weight on the affected leg. They can just lightly touch the floor with their toes for balance (known as touchdown loading). About six weeks after surgery, your child will begin outpatient physical therapy along with an exercise program at home.

The child can return to school after about 4-6 weeks in a wheelchair. Full recovery takes at least 6 months.  After the hip heals, most kids can return to full activity. Usually, this means doing normal daily activities for him for 3 months and sports for her for 6 months.  If the dysplasia affects both hips, a second PAO surgery must wait for about 6 months after the first.

In the Initial 6 to 8 Weeks, Professional physiotherapy is Not Required.

The patient can work toward giving up his or her crutches after eight weeks following the procedure. At this time, the muscle-strengthening exercises are begun, sometimes with a physiotherapist’s assistance. Walking forward depends on regaining muscle strength. After three months following surgery, the majority of patients can walk alone. Following surgery, there are follow-up appointments scheduled for 6 months, 1 year, 2 years, and then every 5 years after that. Screw removal often takes place with a short surgery with no discomfort after 6 to 8 months.

Parents have another choice in repairing hip dysplasia.  There is also a total hip replacement that a young patient with abnormalities could receive.  There are occasions when our doctors will recommend this choice.  However, the results with PAO, which preserves the patient’s hip, completely outweigh those of hip replacement.  Medical studies have shown that the PAO’s long-term results appear far better than what the patient might have obtained from a hip replacement. The patient’s hip is living tissue with self-maintenance capabilities, whereas deterioration with time is inevitable for a man-made hip replacement.

Determining Success Rates

The PAO procedure provides the best chance of success in individuals under the age of 35 who have shallow joints with matched ball and socket geometries. Joint congruency describes the situation where the femoral head and socket have the same curvature. Our doctors may find that the joint appears too damaged for a PAO if the joint gap is less than 2 mm thick (the usual thickness is around 4 mm). To determine whether the joint’s surface is healthy enough for the PAO to have a decent likelihood of success, an MRI may help.

A Delayed Gadolinium-Enhanced MRI of cartilage (dGEMRIC) scan and T2 mapping are methods for examining the health of cartilage.  The probability of success decreases when the dGEMRIC index is low. The dGEMRIC index is not the only indicator of success, but it might show whether the joint surface has already suffered damage. Even if the odds of success are lessened by severe dysplasia — when the top of the thigh bone protrudes partially from the hip socket — our doctors may still recommend the PAO as the best option for some patients.

Femoral Osteotomy

Femoral osteotomy (the ball facet of the joint) has additionally been successfully conducted in a small percentage of patients. In this method, the top femur gets re-aligned to alter the mechanics and permits weight on a clean part of the femoral head. Femoral osteotomy is not often used in the USA despite the fact that promising effects were obtained in Europe. Usually, the femoral osteotomy is included with a pelvic osteotomy.

Why Choose the Doctors and Surgeons at Medical City Children’s Orthopedics and Spine Specialists

There are several reasons why doctors refer patients with hip dysplasia and other medical conditions to Medical City Children’s Orthopedics and Spine Specialists.

• The practice has a team of experienced and qualified pediatric orthopedists. These professionals specialize in the diagnosis and treatment of children with hip dysplasia. Importantly, these doctors have extensive experience treating children with hip dysplasia, and they are familiar with the latest treatment options.
• The practice has state-of-the-art facilities, equipped with the latest technology for diagnosing and treating hip dysplasia. This includes equipment such as X-ray machines, ultrasound machines, and CT scanners.
• Finally, the practice is located in five convenient locations: Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX.  For families in the Dallas and Fort Worth area, this makes it easy to travel to our offices for appointments.

Expertise and Long-Term Results

For families considering a periacetabular osteotomy (PAO), it’s important to know that, in appropriately screened patients who have not developed significant hip joint arthritis, PAOs can yield excellent results, often lasting 20 to 25 years or more after the procedure. When performed by experienced orthopedic surgeons, the PAO has a strong safety profile and produces reliable, predictable outcomes. At Medical City Children’s Orthopedics and Spine Specialists, our team evaluates a high volume of young hip patients each year and is deeply familiar with PAO and related hip preservation surgeries. This kind of focused expertise is critical to ensuring the best possible results for your child.

Overall, Medical City Children’s Orthopedics and Spine Specialists is the best choice for families who are looking for a pediatric orthopedist to treat their child’s hip dysplasia. Notably, the team is comprised of a team of experienced and qualified doctors, surgeons, nurses, and other healthcare professionals. As an example, the team has achieved numerous awards and is recognized by its peers as the very best.

____________________

Footnote:

National Library of Medicine: Periacetabular Osteotomy