QUESTIONS AND ANSWERS

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 own hip joint. In most situations, this can assist your child from needing a total hip replacement and getting arthritis later in life.

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 a number of 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 are able to 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 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 definitely occasions when our doctors will recommend this choice.  However, the results with PAO, which preserves the patient’s own hip, completely outweigh the 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 own 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 alternate 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 four convenient locations Arlington, Dallas, 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.

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 their peers as the very best.

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Footnote:

National Library of Medicine: Periacetabular Osteotomy