Pediatric Orthopedic Surgeons Performing Periacetabular Osteotomy



Periacetabular Osteotomy is surgery for Children to correct a condition called hip dysplasia

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Periacetabular Osteotomy Surgery

Periacetabular Osteotomy (PAO) is a hip preservation surgery used to treat a hip issue that either a child is born with or develops over time. This surgery is performed on teenagers and young adults with painful hip dysplasia.  These patients will exhibit mild to moderate abnormalities on an X-ray scan. Doctors can use less intrusive steps to promote proper socket development if dysplasia is discovered early in childhood. However, dysplasia that goes undetected in adolescence or adulthood is more difficult to treat, as the socket becomes abnormally flat/small and hardened. By repositioning the defective socket to a more optimal orientation, a procedure known as PAO, painful instability of the hip caused by dysplasia, can become treated

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 and 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 anatomies but 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 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.

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 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.

Am I a good candidate for Periacetabular Osteotomy?

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.

Determining Success Rates

The PAO procedure provides the best chance of success in individuals under the age of 35 who have shallow joints with the 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.

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