Duke offers patients with adult hip dysplasia relief from their pain through an innovative procedure called a periacetabular osteotomy (PAO).
Hip dysplasia occurs when the acetabulum, or hip socket, is too shallow or the femoral head (the ball of the hip joint) is not supported by the socket. The friction caused by this uncovered bone causes the patient immense pain.
The goal of PAO is to reorient the hip socket to relieve the patient's hip pain while preserving the patient's hip joint and joint function.
If the hip dysplasia condition is diagnosed before significant wear of the hip joint or hip arthritis develop, patient's can often have long-term preservation of their own hip joint.
Hip dysplasia is subtle and may not be diagnosed readily in adults. Our doctors use a combination of standard radiography and magnetic resonance imaging (MRI) to image the hip and pelvis to diagnose hip dysplasia.
In certain circumstances an arthrogram (placing dye into the hip joint) can enhance the ability of an MRI to provide information about this hip.
Our orthopaedic surgeons have collaborated with radiologists at Duke to develop a specialized sequence of magnetic resonance arthrogram (MRA) images that best capture the state of the hip.
This sequence of images provides doctors with a complete view of the hip and ensures that patients with hip dysplasia are accurately diagnosed and appropriate treatment plans are established to treat the pain.
In a PAO procedure, an anterior incision is made on the patient’s hip area, and the the pelvis bone is divided in a way that separates the hip socket from the remainder of the pelvis.
Once a patient has completed growing, it is not possible to change the shape of curvature of the hip socket. However, it is possible to separate the socket as a free fragment and move the socket into a more normal position surgically.
When the hip socket is rotated to ensure that the hip socket accurately covers the head of the femur, it is held in place with internal fixation of the bones. Typically this requires the use of three screws. No external cast or other support is required for a standard PAO. Ask your surgeon if you have concerns about this.
In unusual circumstances, the hip socket can cover too much of the ball of the hip joint, rather than too little in hip dysplasia. In general such conditions are referred to with terms such as “retroverted acetabulum” or "femoral-acetabular impingement" (FAI).
In these very unique instances, the PAO procedure can be used to move the hip socket to cover less of the ball of the hip joint. This procedure is known as a reverse PAO in this circumstance.
This procedure is a very complex and technically demanding surgery. Steven Olson, MD, is one of the only surgeons in the state to perform this complicated surgery.
Olson learned the techniques for this procedure from Drs. Reinhold Ganz and Joel Matta, surgeons who created and perfected this procedure. Olson has been performing the PAO procedure himself for more than 15 years.
Call 888-ASK-DUKE (888-275-3853) to make an appointment with a Duke orthopaedic provider in Durham, Raleigh, or Cary, North Carolina.
Physicians offering this service include: