When you hear about chronic or persistent hip pain, a total hip replacement is usually the first thing that comes to mind. But if you’re a teenager, a college athlete, or an active young adult struggling with deep hip discomfort, the problem often isn’t a worn-out joint—it’s possibly an overlooked alignment issue known as hip dysplasia.
Because symptoms often mimic common muscle strains or tendon issues, the underlying structural issue may go unnoticed during initial medical visits, leading to delayed diagnosis. According to the Journal of Bone and Joint Surgery (JBJS), adult hip dysplasia affects roughly 3% to 5% of the population.
Fortunately, there is a highly effective, joint-preserving surgical option available: Periacetabular Osteotomy, or PAO. As one of the very few orthopedic surgeons trained to perform PAO in the state of Oklahoma, I want to share a basic overview of how this specialized procedure can protect your natural joint, eliminate pain, and keep you active for years to come.
What is Hip Dysplasia?
In a normal, healthy hip, the ball (at the top of the thigh bone) fits snugly inside a deep, cup-shaped socket (the acetabulum). If you have hip dysplasia, that socket is too shallow or improperly positioned. Because the socket doesn't offer enough coverage, there is excessive stress on the cartilage and the rim of the socket (the labrum). Over time, this edge loading causes labrum tearing, inflammation in the hip joint, and early arthritis. Hip dysplasia is the second leading cause of labrum tearing and hip osteoarthritis.
How Does a PAO Help?
Instead of replacing your natural joint with metal and plastic, a PAO fixes the structural root of the problem. During the procedure, precise cuts are made in the pelvic bone around the shallow socket. This allows us to free the socket, rotate it into a better position to fully cover the ball, and secure it safely with surgical screws.
By realigning the joint, we evenly distribute your body weight across a larger surface area. This immediately takes the stress off the overused edges of the socket, protects your remaining cartilage, and significantly delays—or entirely prevents—the need for a total hip replacement later in life.
Who is a Candidate for PAO?
Because PAO is a joint-preservation surgery, it is highly specific to a patient's age and joint health.
Age: It is most successful in adolescents and young adults, typically ranging from their teenage years up to their 30s or early 40s.
Joint Condition: Candidates must have skeletally mature hips with minimal to no existing osteoarthritis. If severe arthritis has already worn away the cartilage, a total joint replacement is usually a more effective choice.
Symptoms: Persistent, deep groin pain that worsens with activities like walking, running, or prolonged sitting.
A Rare and Specialized Procedure
If you feel like you haven’t heard of a PAO before, you aren’t alone. It is a highly specialized, technically demanding procedure. Nationally, only a small fraction of orthopedic specialists undergo the advanced fellowship training required to perform pelvic osteotomies safely.
Because of its complexity, PAO is relatively rare. In fact, within the entire state of Oklahoma, I am part of a select, small handful of orthopedic surgeons with the specific training to offer this advanced treatment.
Your Next Steps
Dealing with chronic hip pain at a young age can be incredibly frustrating. The great news? You don’t have to simply live with the discomfort or jump straight to a total joint replacement. If you or a loved one are experiencing persistent hip pain, a thorough evaluation with specialized imaging can determine if hip dysplasia is the culprit and if a joint-preserving PAO is right for you.
