Name of the Procedure:

Osteotomy, Periacetabular, with Internal Fixation Common Name: Periacetabular Osteotomy (PAO)

Summary

Periacetabular osteotomy (PAO) is a surgical procedure to correct hip dysplasia—a condition where the hip socket does not fully cover the ball portion of the upper thigh bone, leading to hip instability. This surgical intervention involves cutting and repositioning the bones around the hip socket to improve coverage of the ball and stabilizing the area with screws or hardware.

Purpose

Medical Conditions: PAO treats hip dysplasia and alleviates associated symptoms like pain, limited movement, and a high risk of developing arthritis in the hip joint. Goals: The main aims are to restore normal hip function, enhance stability, alleviate pain, and prevent or delay the onset of arthritis.

Indications

Symptoms: Chronic hip pain that worsens with activity, limp, and limited hip movement. Conditions: Hip dysplasia diagnosed through imaging. Patient Criteria: Typically young adults with a diagnosis of hip dysplasia who have not yet developed significant arthritis.

Preparation

• Pre-procedure Instructions: Patients may need to fast for several hours before surgery.
• Medication Adjustments: Some medications may need to be paused, especially blood thinners.
• Diagnostic Tests: X-rays, MRI, or CT scans are used to assess the hip's structure and plan the surgery.

Procedure Description

1. Anesthesia: General anesthesia is administered to the patient.
2. Incision: A surgical incision is made near the hip.
3. Osteotomy: The surgeon makes precise cuts in the pelvic bone around the hip socket.
4. Repositioning: The hip socket is repositioned to better cover the ball of the femur.
5. Internal Fixation: Screws or other hardware are used to hold the bones in the new position.
6. Closure: The incision is closed with sutures or staples.

Tools Used: Surgical saws, screws, plates, and other fixation devices.

Duration

The procedure typically takes between 2 to 3 hours.

Setting

PAO is performed in a hospital setting, usually within a dedicated operating room.

Personnel

• Primary Surgeon: Usually an orthopedic surgeon with expertise in hip surgery.
• Nurses: Assist with the surgical procedure and monitor the patient's status.
• Anesthesiologists: Administer anesthesia and manage pain control.
• Surgical Technicians: Prepare surgical instruments and assist the surgical team.

Risks and Complications

Common Risks:

• Infection
• Blood clots
• Nerve or blood vessel damage
• Blood loss requiring transfusion

Rare Complications:

• Non-union where the bone does not heal properly
• Hardware-related issues

Benefits

• Reduction in hip pain.
• Improved hip function and patient mobility.
• Decreased risk of arthritis development.

Onset of Benefits: Many patients see an improvement in symptoms within months, though it can take up to a year for full recovery.

Recovery

• Post-procedure Care: Instructions include wound care, activity limitations, and medications for pain and infection prevention.
• Physical Therapy: Begins soon after surgery to aid recovery.
• Recovery Time: Extended recovery might take 6 to 12 months with gradual return to regular activities.
• Follow-up: Regular follow-up visits to monitor healing and adjust rehabilitation plans.

Alternatives

• Non-Surgical Options: Physical therapy, anti-inflammatory medications, and lifestyle modifications.
• Other Surgical Options: Hip arthroscopy or total hip replacement, particularly if arthritis is advanced.

Pros and Cons:

• Pros of Non-Surgical Approaches: Less invasive, no recovery from surgery.
• Cons of Non-Surgical Approaches: May not fully address structural issues.
• Pros of Other Surgical Options: May be more appropriate based on specific patient needs.
• Cons of Other Surgical Options: Longer recovery for total hip replacement, potential for future surgeries.

Patient Experience

During the Procedure: Patients are under general anesthesia and do not feel pain during the operation. After the Procedure: Patients may experience pain and discomfort managed by pain relievers. Physical therapy is commonly required. Pain management includes medications, ice packs, and gradual increase in movement to ensure comfort and healing.