Periacetabular Osteotomy (or Bernese)
Indications for treatment: Hip Dysplasia/Retroverted Acetabulum. Note: In some cases, the deformity is present on both the socket and head/neck areas requiring that both a PAO and Chondro-Osteoplasty be performed either simultaneously or staged.
Discussion: The word dysplasia refers to malformation or lack of full development. Some patients develop this condition from birth or in early childhood and surgery is performed at that time. In others, the hip becomes painful in early adulthood or they have been treating the painful hip as a groin injury for several years with either physical therapy or anti-inflammatory medication. Symptoms are often unrecognized as hip dysplasia as patients will complain of buttock pain or pain over the lateral aspect of their hip going down the side of the thigh. Some patients are given injections in their greater trochanter or buttock area to relieve the pain.
Diagnosis: Physical findings are similar to labral tears. Xrays will typically reveal the obvious malformation (See Figure 16) and sometimes a small bone rim of the socket will have dislodged. After a careful radiographic review, the location and severity of the dysplasia is established and this will dictate the most appropriate joint preserving procedure.
Treatment and Post-Operative Recovery: The role of pelvic osteotomies for the treatment of hip dysplasia has a long history in orthopedics. Until the advent of the PAO in the mid-1980s, most pelvic osteotomies did not result in reproducible or sufficient corrections. Further, they modified the normal anatomy of the pelvis and often required casting. Trained surgeons are now able to routinely perform the PAO with excellent results and a relatively quick recovery.
A periacetabular osteotomy involves dislodging the hip socket from its bony bed in the pelvis without distorting the normal pelvic anatomy. The socket is then reoriented in the proper position to relieve hip pain and prevent osteoarthritis. This is verified by taking an x-ray during the surgery. When the socket has the correct orientation it is fixed with three screws. Two of the screws can be removed at a later date if they irritate the skin.
The patient ambulates the day following surgery using crutches and under the supervision of a physical therapist. Most patients are discharged four days after the surgery. The internist to whom you are assigned for medical management during your hospital stay will order any necessary medications at the time of discharge.
You will use crutches for eight weeks (i.e., restricted weight bearing) at which time an x-ray will be taken. If you live out of state, then you may be seen by a local surgeon and have the x-rays forwarded to our office. Physical therapy will be prescribed at that time and you can apply full weight on the operated leg. After 4 to 6 weeks of physical therapy, most patients return to regular activities including sports.
Clinical Results: At five to ten years following PAO, 80% of patients have good to excellent results with either no pain or minimal pain and a return to normal function. Patients who did experience better results either had early signs of arthritis prior to the osteotomy or the arthritis had progressed despite the osteotomy.
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