A surgeon may suggest PAO surgery to:

• Treat dysplasia 
• Increase stability of the hip 
• Treat impingement of the hip 
• Reduce pain 
• Prevent or delay the need for a total hip replacement

 The goals of surgery are to reduce pain, restore function, and help patients easily move their hip. This surgery often allows patients to live a healthy, pain-free life.

 After you meet with a surgeon, imaging will be ordered, including any or all of the following: X-ray, MRI, CT scan. Your surgeon will review the results with you and let you know if PAO surgery will be helpful.

If there is a question about whether PAO surgery will be successful, your surgeon will discuss your case with: 

• The Division of Orthopaedics director 
• Two co-directors of our Hip Preservation Program 
• A joint replacement surgeon 
• Clinical nursing staff 
• Lead radiologist 

The goal is to cover all aspects of your case to make sure that everyone, including the patient and family, agrees that PAO surgery is right for the patient.

Once surgery is scheduled, you’ll meet with a nurse, who will explain what you need to know before, during, and after surgery. The nurse is available by phone and email if you have questions or concerns any time before or after surgery.

 You will also have a physical therapy visit to learn what to expect after surgery, including: 

• Home exercise 
• Precautions to take 
• Any post-op equipment needs

The surgery will take about four hours. At Cincinnati Children’s, two experienced attending surgeons perform this surgery together.

 For pain control, you will receive a nerve block anesthesia to numb a specific area. Using a nerve block (rather than an epidural) has been shown to decrease the length of your hospital stay and decrease pain medication needs after surgery.

The Procedure

The hip joint includes a ball (at the top of the femur, or thigh bone) and socket (in the pelvis). Hip dysplasia occurs when there is a problem between the ball and socket.

Your surgeon will make several cuts in the bones of the hip joint to improve the direction and/or amount of coverage the socket provides for the ball. Screws are used to hold the bones in their new position. While you heal, new bone will grow and allow your hip joint to line up correctly.

You’ll be in the hospital for two to three days after surgery. During this time, you’ll see specialists from Orthopaedics, Pain Management, and Physical Therapy/Occupational Therapy. You’ll be on crutches for six to eight weeks.

 Post-Op Visits 

Two weeks after surgery, your surgeon will check your incision, and your dressing will be removed. An X-ray of the hip will also be completed. 

Six weeks after surgery, you’ll have an X-ray of your hip joint. The surgeon will check to make sure you are healing well. 

Physical Therapy 

Patients start physical therapy six weeks after surgery. Sometimes physical therapy begins earlier, depending on a patient’s individual needs.

Most patients go through six to nine months of physical therapy after PAO surgery to help: 

• Wean you off crutches
• Work on your range of motion and hip strength 
• Get you back to your normal level of activity 

 Your therapist and surgeon will watch your healing and will clear you for certain activities as you make progress. Most patients are able to return to normal daily activities within 4½ to six months after surgery. Return to sports often happens six to nine months after surgery, depending on the level of desired competition.

Our Hip Preservation team has created physical therapy protocols for you to follow. You’ll be able to take these protocols with you if you have traveled from out of town for surgery. Your therapist may contact our therapists for assistance. 

Outcomes

After recovery from PAO surgery, patients have less or no hip pain. They are able to move and walk better than before surgery.