at the top of your thigh bone the femur is a ball-shaped structure called the femoral head which fits in a socket in the pelvis called the acetabulum both of these structures are covered with articular cartilage which minimizes friction as the femoral head rotates within the acetabulum about one in 20 people are born with hips with some degree of instability and two or three out of every thousand will require treatment for hip dysplasia wherein the acetabulum doesn't properly accommodate and cover the femoral head people with acetabular dysplasia may be treated for hip problems as infants or children but the majority progress through childhood to early adulthood without noticeable symptoms after years of repeated stress from the improperly aligned joint hip pain restricted motion and a limp May develop x-rays typically reveal that the upper portion of the acetabulum is angled outward and is too shallow instead of the deep pocket that would properly cover the entire top and front of the femoral head the lack of support of the femoral head may lead to stress of the muscles ligaments laum and cartilage leading to feelings of pain with sitting and activities the thick layer of cartilage surrounding the rim of the acetabulum called the labrum may also be damaged without treatment the arthritis pain and restricted motion may continue to progressively worsen eventually the wear and damage of the cartilage known as osteoarthritis May progress significantly such that the cartilage becomes too thin and results in bone on bone contact a surgical procedure known as per acetabular osteotomy or Pao corrects acetabular dysplasia by carefully cutting the acetabulum from the pelvic bone and repositioning it so that the femoral head will be supported and fit deeper in the hip socket the procedure aims to improve function alleviate pain and delay or prevent osteoarthritis additionally a Pao preserves the natural hip joint postponing or eliminating the need for a total hip replacement the procedure is tailored to an individual specific Anatomy to achieve the desired result prior to a Pao procedure you will meet your pre-operative and surgical team they will make sure you are ready for surgery and they will insert an IV and apply compression stockings that will reduce the chance of blood clots in the legs once in the operating room you will likely undergo Regional anesthesia in which a small tube called an epidural catheter delivers medication to the spinal column numbing you from the waist down a catheter will also be inserted into your bladder to collect urine and will remain for a a day following the operation you will be carefully positioned on your back with your arms and non-operative leg positioned with padding for the duration of the surgery the surgeon will use a portable x-ray device over your hip during the surgery to confirm the position of the bone cuts and to guide the correction of the hip socket confirming it is in the optimal position for your specific Anatomy there are a few variations for the incision for the Pao procedure which differ in how the pelvic bones are accessed and cut in order to reorient the acetabulum this animation will discuss the procedure in which a single incision provides direct access to the hip and pelvis the length of the Pao procedure varies with specific patient anatomy and needs but typically requires 2 and 1/2 to 3 and 1/2 hours an incision approximately 4 to 6 Ines in length will be made along the crust of your hip your surgeon will carefully separate muscles while aiming to protect your nerves the surgeon will dissect around and move the hip flexor muscles out of the way for the procedure careful dissection is continued to expose the pubic bone and provide access to the isum and ilum for the osteotomies the pelvic bone surrounding your acetabulum will be cut with either specialized bone chisels called osteotomes oscillating bone saws or both the pubic bone is typically cut first follow followed by the isum then the ilum and finally the deeper portions of the ilum and isum which completely mobilizes the hip socket so it can be reoriented to the corrected position the cuts are angled with your specific anatomy in mind to allow proper rotation of the acetabulum and so that the separated bones will eventually fuse with the pelvis once they've been repositioned A specialized screw is temporarily placed in the acetabular frag M and used to rotate it into the corrected position two wires will temporarily stabilize the fragment while the precise alignment is checked with x-rays next three or four long screws are added to firmly attach the acetabulum in its corrected position to your pelvis the wires and temporary screws are removed and Bone material that was obtained during the osteotomies or other bone graft material may be added so that the bone will regrow and fill in the space between the cut bones over time The Superficial muscles that have been detached will be reattached finally the incisions are closed in several layers with absorbable sutures and a dressing will be applied to your skin to complete the procedure the typical Hospital stay is 2 to 4 days depending on discomfort and progress getting to and from bed the epidural catheter is typically left in place for self administering pain medication for the first 24 hours of recovery after 2 to 3 days most patients will be able to use crutches or a walker with only 20% of weight bearing on the surgical side the operative leg will feel very heavy as the hip flexors rest for a few weeks and some swelling bruising numbness tingling and clicking or popping noises in the hip are normal following the procedure as is pain once you are discharged from the hospital medication is prescribed to help manage discomfort as the pain reduces over time swelling and bruising generally subside within a few weeks and it may take several months for certain numb areas over the side of the hip to regain sensation compression stockings and medicines may be recommended for up to 3 weeks following surgery to reduce the risk of blood clots during recovery care must be taken to keep weight off your hip for approximately 6 weeks to keep the proper alignment and prevent bending or breaking the screws until the bones are able to fuse in their new position after the six we consultation with the surgeon patients will be directed to start physical therapy and cleared to progress to walking unaided which occurs around 2 to 3 months following the surgery follow-up x-rays typically show Improvement in the joint orientation and a decrease in contact pressures along the acetabulum the vast majority of patients report significant Improvement in pain and function and can walk without pain and limping as opposed to a total hip replacement there are fewer activity restrictions and you may be able to resume sporting activities without pain and with better function than before your surgery