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PAO – A Devastating Operation

Reciting the words spoken by William Harris in 1986, orthopedic surgeons persist in their assertions that “Primary hip osteoarthritis (OA) is extremely rare.”1 These doctors continue to claim that “Up to 90% of young patients (<50 years of age) that develop OA of the hip have an underlying structural problem, which in half the cases is dysplasia.”2

A diagnosis of developmental dysplasia of the hip (DDH) is based on the center edge angle of Wiberg3, which is calculated from standard anterior-posterior (AP) radiographs. To obtain the CE angle, a vertical line is drawn through the center of the femoral head, and another to the lateral edge of the ‘sourcil’. (Figure 1)
Figure 1

The sourcil, a French term meaning ‘eyebrow’, is a projection of the anterior-superior acetabular wall. It is a 2-dimensional contrived parameter that the practice of orthopedics actually believes to be the load-bearing aspect of the acetabulum. In reality, the sourcil does not exist as reflected on pelvic x-rays. Its lateral edge, often used to diagnose ‘pincer impingement’, is subject to change with the slightest rotation of the pelvis, as more of the arched acetabular roof comes into view. (Figure 2)
Figure 2

Moreover, the entire AP radiograph, taken in the supine position, is a faulty representation of how the femoral heads are actually contained within the acetabulum. When supine, lumbar curvature flattens and the femoral heads move slightly up and laterally. When standing with lumbar curve in place, the femoral heads move down and medially. There is no way to calculate to what extent individual pelvic rotation will change the CE angle, a configuration derived strictly from the supine x-ray. Yet, it does not matter because orthopedic surgeons are only interested in treating DDH surgically.

After a decade of disastrous results treating dysplasia with arthroscopic surgery to “repair” labral tears4, the standard of care has become the periacetabular osteotomy (PAO). Surgeons believe the goal of treatment “should be the restoration of hip anatomy as close to normal as possible.”5 PAO is the preferred technique “because of its balance between minimal exposure, complications, and ability to provide optimal correction.”6

In reality, orthopedics has an extremely inaccurate view of pelvic orientation, and rather than restoring normal anatomy, PAO changes the pelvis to a configuration that does not occur in nature. Drawn from centuries of misperception, orthopedics believes “Two strong osseous columns of bone surround the acetabulum, transmitting the stresses between the trunk and lower extremities.”7 (Figure 3)

Figure 3 The most current orthopedic literature proclaims that PAO “preserves the posterior column of the acetabulum and therefore allows early weight-bearing post-operatively.”8

Actually, in the standing body the pelvic inlet is in a vertical position, and the so-called bony “columns” are horizontal, not vertical. In 1955 it was recognized that gravitational forces are carried around the linea terminalis (circular pelvic inlet) and distributed onto the femoral heads.9 (Figure 4)
Figure 4

Surgeons contend, “The pelvic ring and outlet are not disrupted by PAO”10, yet anyone who has ever seen a post-PAO x-ray knows the fallaciousness of such statements. Another selling point of the PAO is that, “It can be performed through one incision without violation of the abductors, thus enhancing recovery.”11 The following summary of the steps in the soft-tissue dissection and exposure prior to the actual osteotomy illuminates the devastating and irreversible trauma that accompanies PAO.12

  1. External oblique incision and exposure of iliac crest.
  2. Subperiosteal iliacus dissection.
  3. Detachment of sartorius origin and inguinal ligament attachment through anterior superior iliac spine osteotomy.
  4. Incise fascia of tensor fascia lata muscle.
  5. Dissect tensor fascia lata from intermuscular septum.
  6. Exposure of lateral rectus femoris muscle belly and medial retraction to identify distal hip capsule.
  7. Release reflected head and direct head of rectus femoris.
  8. Incise fascia of capsular extension of iliacus muscle and dissect muscle exposing entire anterior hip capsule.
  9. Subperiosteal dissection of pubic root and entrance into iliopectineal bursa.
  10. Insert Hohmann retractor into pubis, flex hip, and retract psoas muscle. Overly vigorous traction may injure femoral nerve.
  11. Complete dissection of anterior hip capsule and interval between psoas tendon sheath and hip capsule.
  12. Incise periosteum of pubis and perform subperiosteal anterior and posterior pubic dissection reflecting the obturator membrane from the inferior pubis.
  13. Reflect iliopectineal fascia from iliopectineal line.
  14. The iliac nutrient artery located anterior to the distal sacroiliac joint should be cauterized and sealed with bone wax.

The next step is the osteotomy itself, whereby the acetabulum is sawn in three places and rotated with the intention of better covering the femoral head by the acetabular roof. The established maneuver in PAO is to turn the acetabular fragment into flexion, lateral tilt, and medial rotation. (Figure 5)
Figure 5

“Every effort should be made to orient the acetabular sourcil in a horizontal position relative to the weight-bearing zone of the femoral head. The anterior and posterior walls of the acetabulum should be positioned so that the posterior wall is lateral to the anterior wall.”13

One of the great medical outrages of the 21st century is that what these surgeons are trying to reproduce is not normal anatomy, but the misconstrued reflection of the 2D pelvic x-ray. In the flesh-and-blood standing pelvis, the posterior wall is medial to the anterior wall, due to the oblique nature of the pelvis from the wide anterior superior iliac spines in front, to the more narrow ischial tuberosities in back. (Figure 6)

Figure 6

It is also a tragic irony that the goal of PAO is to get the “femoral head centered under the acetabular roof”14 when this is the natural biomechanical result of sitting, standing, walking, and running with a wide-radius lumbar curvature.

Reinhold Ganz, the orthopedic surgeon who popularized the PAO, recently reported that a 10-year follow-up revealed one-third of his PAO patients had developed femoroacetabular impingement (FAI) as a result of the operation.15 It is logical to assume this would cause orthopedic surgeons to pause and reconsider the long-term benefits of the surgery. Instead, the prevalence of PAO is increasing exponentially. Only now, FAI surgery is being routinely added as an adjunct to the PAO operation. “[Hips] are routinely examined intraoperatively and a femoral neck plasty is performed to maintain or enhance motion and to prevent post-PAO acetabulofemoral impingement.”16

Another recent source tells us, “The longest follow up of PAO to date shows a survivorship, defined as not yet requiring THR or arthrodesis, of 60% at 20 years.”17 These are terrible odds, yet even post-PAO patients seem to be in denial about the realities of the surgery, often encouraging others to submit to the operation. Online support groups serve as funnels, delivering scores of naive victims into the hands of orthopedic hip surgeons.

The theory of acetabular dysplasia has not been challenged since Gunnar Wiberg published his dissertation on the subject in 1939. No one questions that a rudimentary geometric angle drawn onto a 2D x-ray may have no correlation with the reality of the standing body. Or worse, that the natural depression in the front acetabular rim (Figure 7)

Figure 7 is often mistaken for dysplasia and reduced coverage of the femoral head.18 There is no consensus among orthopedic surgeons whether patients with dysplasia benefit from arthroscopy, and what the exact indications for labral repair should be.19

Too often the progression of surgically managed dysplasia is arthroscopy > PAO > THR. Young age is a major risk factor for revision THR, yet untold numbers of post-PAO patients in their teens and twenties are receiving total hips. Many of these surgeries are being conducted in out-patient settings, for which no public records are required to be kept.

The periacetabular osteotomy should be considered a rescue operation to be utilized in the most severe cases of disease and birth defect. The natural history of mild and moderate hip dysplasia has yet to be defined. Moreover, surgeons know “It does seem possible to live a long and asymptomatic life with mild or moderate hip dysplasia.”20


Notes:

1 Perry K Trousdale R Sierra R Hip dysplasia in the young adult. The Bone and Joint Journal 95-B(11):21-25 2013
2 Ibid
3 Zou Z et al Optimization of the position of the acetabulum in a Ganz periacetabular osteotomy by finite element analysis. Journal of Orthopaedic Research 31: 472-479 2013
4 Jackson T Watson J LaReau J Domb B Periacetabular osteotomy and arthroscopic labral repair after failed hip arthroscopy due to iatrogenic aggravation of hip dysplasia. Knee Surgery, Sports Traumatology, Arthroscopy June 13 2013 [Epub ahead of print]
5 Perry 2013
6 Ibid
7 Callaghan J Rosenberg A Rubash H The Adult Hip Lippincott-Raven 1998 p.57
8 Perry 2013
9 Davies JW Man’s assumption of the erect posture, its effect on the position of the pelvis. American Journal of Obstetrics and Gynecology 70(5): 1012-1020 1955
10 Perry 2013
11 Ibid
12 Zaltz I How to properly correct and to assess acetabular position: an evidence-based approach. Journal of Pediatric Orthopedics 33(1): S21-S28 2013
13 Ibid
14 Ibid
15 Albers C et al Impingement adversely affects 10-year survivorship after periacetabular osteotomy for DDH. Clinical Orthopaedics and Related Research 471(5): 1602-1614 2013
16 Ibid
17 Perry 2013
18 Vandenbussche E et al Hemispheric cups do not reproduce acetabular rim morphology. Acta Orthopaedica 78(3): 327-332 2007
19 Colvin A Harrast J Harner C Trends in hip arthroscopy. The Journal of Bone and Joint Surgery 94: e23(1-5) 2012
20 Jacobsen S Adult hip dysplasia and osteoarthritis. Acta Orthopaedica 77(324) 2006

{ 22 comments… add one }
  • Sarah November 30, 2016, 4:55 pm

    Thanks so much for this article!! I will be 3 years post op left PAO surgery this February and I’m in so much pain still!!! I have horrible bursitis on the outer side, nerve damage, scar tissue and one area of my pelvis is still fractured. The only relief was the pain from fixing the laberal tear. My surgeon said the surgery was a success because my joint is in the correct position. He basically said there is nothing else he can do for me. I am a 36 year old woman who can barely do any activities now and feel like I have been robbed of my old life. Now they are saying I need spinal surgery but there is no way I’m having another surgery for anything else until I am able to get my hip fixed. I just don’t know what to do now!!??? Please please please any recommendations would be so appreciated!! I live outside Philadelphia, PA. Thank you!!!

  • Happy Hip April 1, 2016, 10:43 pm

    Had a PAO on my left hip 9 years ago at age 26 with an expert surgeon. Successfully carried twins to term, teach yoga, run, bike. All things I would not have been able to do without the PAO. Hip is still doing awesome. No change in my posture would have corrected the problems presented with dysplasia.

  • Elizabeth February 20, 2016, 10:22 am

    I was a little puzzled by the discussion of x-rays being taken in the supine position – the x-rays of my hips have always been taken in a standing position, even right after my PAO. Yes, I did have this “devastating” surgery, and I couldn’t be more pleased. I have actually been more active after having this surgery at 44 than I was in my 20s (and I was pretty active even then). For comparison, a regular bike ride for me at 21 was about 10 miles. I now regularly bike 20 miles at a time and have completed two metric centuries (62 miles in a day). However, I was glad that I only needed this intervention for one hip. One never knows if a surgery will go well or not.

    However, I do appreciate the discussion in this article, and I hope it helps those women who choose not to go through with surgery. It was an interesting read but a little too heavy on medical terminology for this English major to grasp readily.

  • Clyde November 7, 2015, 11:47 am

    I’ve had two PAO’s at age 18, I’m 23 now, I am ruined, I have severe dysesthesia, a condition caused by nerve damage, and I can’t even walk down stairs, the PAO’s stole my life away

    Here is a study detailing complications in people who’ve had this surgery about seven years later, I highly recommend reading the whole thing http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2551712/

  • Sarah September 30, 2015, 10:37 pm

    I had left hip PAO surgery about a year a a half ago. I am still in a ton of pain. My bone is not healing and my surgeon has no answers. I feel defeated and don’t know what steps to take. I work on my feet all day as a hair stylist and don’t know how much longer I can keep going. There is so much more to my story but I don’t want to debate with people who it did work for. It did not work for me. I just need direction and positive advise for my next step.
    Thanks so much

  • admin August 4, 2015, 1:14 pm

    I do not agree with standard orthopedic treatment, nor with several of your assumptions. Who says adults do not respond to brace wearing? If the truth were conveyed that the only way to normalize the joint would be to get the weight off while at the same time providing full range of motion, and that all “hip sparing” surgeries for this progressively worsening condition are highly damaging, well-informed patients would welcome wearing a brace. Unfortunately, no logical, therapeutic brace, nor the conceptual framework exists in orthopedics for reversing common adult hip pain.

    Discussion about lifestyle change improves nothing. The only relevant issue is how to get the center of mass of the body properly situated over the joint. This is the elephant in the room that all of orthopedics has skillfully ignored for 100 years. Obfuscated is much more like it.

    Juvenile osteonecrosis of the femoral head is often treated conservatively by stretching and properly loading the joint. The femoral heads change their shape even after almost totally disintegrating! The acetabular roof grows over an artificial joint! Why can’t dysplastic bone change in these ways? Tell us what the difference is? It is the orthopedic industry itself and people like you who keep the perspective on dysplasia limited and disguised as a static, intractable condition.

    Yes, I understand the grim prognosis of trying to stabilize and reverse highly progressed disease. My message does not concern those cases. Rather, that adult-onset hip pain, according to Wolff’s Law, is much more likely to have its source in poor alignment than in bones that will not change their structure if given the right conditions. Those conditions do not exist in our modern medical system. Ganz himself is realizing that the PAO is fraught with risk and failure, which has not slowed him down. The reality of the lifelong effects of the surgical solution will never cause orthopedics to change. Patients who have had the surgery will not cause the system to change either, because they are now physically and psychologically dependent on being medically managed for the rest of their lives, and therefore must believe in the success of these surgeries.

    Change must come from the outside. And it will come. I just noticed on Facebook the other day that a woman is claiming to have healed her severe, chronic hip condition by learning to hold her abdominal wall forward, as is taught in my book, Save Your Hips. She did not give my work credit, but who cares. The point is, I will not always be the lone ranger crying in the wilderness.

    There is plenty in the literature now illustrating that labral tears are almost ubiquitous and recede on their own. It is also highly questionable whether the labrum is even a source of pain. Add a “hip preservation” arthroscopic surgery with trimming and bone anchors, however, and you literally invite the joint to deteriorate. Which it does over time! There is no question that a huge percentage of these surgeries are finally converted to total hips. To believe otherwise is to ignore the facts.

  • Betsy August 4, 2015, 12:10 pm

    Christine,
    It sounds like you agree with the standard approach to hip dysplasia treatment, which is to try the least invasive treatment first. For babies, this means starting with the Pavlik harness or a brace. Adults don’t respond to brace wear, so alternatives to surgery would be lifestyle changes such as no running, jumping, or high impact exercise.
    Unfortunately, many cases of hip dysplasia are not diagnosed until adulthood when the hips become symptomatic with labral tears and joint pain. (The International Hip Dysplasia Institute is researching ways to catch these cases in early childhood when less invasive treatments can be tried.) Problems in adults can also happen if there is residual hip dysplasia for someone who was treated in childhood. At that point, an orthopedic surgeon would discuss lifestyle changes, assess the patient’s quality of life (how extreme is the pain and disability), and discuss if or when the patient would consider hip surgery.
    Not all adults with hip dysplasia are candidates for PAO, so in some cases even if someone seeks out a PAO, the doctor will explain why it won’t help the patient. Some examples would be that the hip has too little cartilage left due to accelerated wear from the poor mechanics in the joint, or congruency issues if the femoral heads are not round. PAO is major surgery, and anyone who is looking into it should think it over, but it can and does improve life dramatically in many cases. Like any surgery, the most successful outcomes tend to be associated with a surgeon who is experienced in this surgery operating at a hospital where the procedure is done on a regular basis.
    I wouldn’t write off PAO as a treatment option—especially for people who have been suffering with chronic pain and mobility problems.

  • admin August 4, 2015, 8:23 am

    Hi Louise,

    The literature does not confirm your 90% stats. You are working from inside the system, and as I recall are heading toward joint replacement yourself. You are a proselytizer for a damaged and broken system that is blind at its core. The “3-D” images are a sham, and all the surgeries built upon them deeply misconceived. There is no doubt that shaving bone, removing painful ligament and “lengthening” tendon alleviates pain in the joint! It is the long view that is completely disregarded.

    Christine

  • admin August 4, 2015, 8:16 am

    Hi Betsy,

    Yes, I understand that the bones are not shaped correctly, which is the subject of my article above. But my belief is that the reality, the bones are not shaped correctly, should be a starting point in the natural treatment of many people, not the assumption of an end-stage, irreversible condition. Bone is deposited in response to the forces placed upon it. Pediatric dysplasia corrects itself in 99% of cases.

    The human being develops in such a way that 3 alignments must be maintained and exercised throughout adulthood to prevent degenerative hip disease. We come into the world with a flexion, external rotation contracture of the hip joints. By 6 months stretching of all the soft tissue occurs as the joints are anteriorly rotated to bring them directly underneath the torso in crawling. Then we stand, not by rotating the pelvis backward as it is ARTIFICIALLY portrayed in “3-D” images, but by profoundly curving our lumbar spine. The pelvis remains in its quadrupedal position. Human hips must be continuously exercised in external and internal rotation while maintaining wide-radius lumbar curvature above. This comes naturally in people living in natural ways.

    Shoes, baby carriers, car seats, couches, and soft furniture all prevent the musculoskeletal system from aligning correctly, which eventually causes a very common degeneration in the feet, knees, hips, lumbar and cervical spines. Chronically holding the abdominal wall in does more damage than all of the above.

    The argument that dysplasia is a done deal that can only be treated surgically is completely blind. Understand that Wiberg wrote his dissertation from looking at the first x-rays, which mislead the viewer into believing 3-D data can be correctly interpreted from 2-D images. For 100 years no one ever seriously questioned his conclusions, which completely discount how the body’s center of gravity is properly distributed over the joint.

    Yes, there is the extremely small percentage of joints that could benefit from surgery. However, the fact that the mistake of Wiberg is allowed to go on and on, as millions of young, healthy joints are ruined by irrational surgeries is a true catastrophe. Our medical system should be looking into how to naturalize dysplastic hip joints, which it has absolutely no incentive to do.

    Christine

  • Louise Grant August 3, 2015, 11:58 pm

    If you come along to the international hip preservation conference -ISHA, you would see surgeons present research displaying their in depth 3D understanding of hip joint anatomy; conflicting with what you claim they understand. I have worked with hip patients for many years now and 90% of the PAO patients i have helped rehab have had amazing transformations to their lives, enabling them to get back to a painfree active life. There will always be some patients this surgery does not work for and additional factors that make it not appropriate for every dysplasia case.

  • Betsy August 3, 2015, 2:21 pm

    Christine, do you understand that hip dysplasia involves bones that are not shaped normally? If you have shallow hip sockets, it’s not possible to get the femoral heads into the ideal position for weight-bearing no matter how good your posture is. You can make accommodations in your life to try to slow down the rate of wear on the hip joints (such as not running, jumping, or participating in high-impact exercise), but that doesn’t fix the underlying bone structure that is causing the joint to wear out in the first place.

  • admin May 16, 2015, 10:34 am

    First of all, I would like to know which statements or quotes you believe were taken out of context, as all were drawn directly from peer-reviewed journals.

    It is shocking to become aware that the practice of orthopedics is based on an archaic and deeply flawed understanding of hip anatomy. And furthermore, that more than any other “hip preservation” surgery, PAO represents the extreme end of a century of unsound surgical practice based on that faulty understanding.

    It is a problem that orthopedics does not recognize, consider, teach, or write about the fact that it is the lumbar spine that stabilizes and drives the human hip joints. It is a problem that all hip surgeries are based on a two-dimensional understanding of pelvic anatomy. It is a problem that what orthopedics considers to be the “roof” of the acetabulum is in reality the pathologically stressed anterior aspect of the joint.

    All western exercise and physical therapies are informed by the medical understanding of pelvic anatomy. Generally speaking, neither yoga, Pilates, nor PT are going to help reverse common adult-onset hip pain. None of these modalities recognize that the human abdominal wall is supposed to be held forward, as evidenced by our development as human beings. Only through carrying the center of mass of the body evenly over the arched acetabular roof do the joints develop properly. Form follows function. This is a primary anatomical truth that is completely ignored by modern orthopedics.

    Orthopedics was not always a surgical specialty. Nineteenth century physicians had a very comprehensive understanding of common hip pain and also success in treating it. Radiology brought a huge political shift at the turn of the 20th century, and with it the institutionalization of “The Problem of Wiberg” and the fallacy of the “anterior pelvic plane.” Orthopedics is not an evidence-based practice, for the “evidence” is bought and paid for by the surgical industry.

    I know this influx of commentary has come from the uproar happening at the PAO Facebook group after someone posted a link to this article. The level of anger and outrage at the Whole Woman perspective is certainly not surprising. It is very difficult to wake up to the fact that the practice of orthopedics is fraught with risk and failure. I am certainly not going to argue with anyone’s success with the PAO operation. But as you all proclaim to be living active, pain-free lives post-PAO, I think it is interesting that there is no mention whatsoever of the many, many people (even in your own group!) who suffer from difficult, intractable, and complex pain syndromes after the operation. The drugs being offered to try to combat post-PAO pain are exceedingly dangerous in themselves, yet there is no mention of that either.

    I cannot tell you what you should have done in lieu of surgery. What I am trying to bring to light is the fact that orthopedics does not consider the only therapeutic approach to hip pain that makes any logical sense, and that is to teach patients how to keep their femoral heads pressed down and into the joint. Save Your Hips is the only resource available that thoroughly outlines this anatomic perspective. I am not a doctor or physical therapist. I am a teacher of posture and it is natural human alignment that forms and maintains the hip joints.

    It is well understood that scoliosis is often a result of torsion in the pelvis. PAO produces surgically-induced pelvic torsion, which eventually will result in untoward spinal curvature, sacroiliac joint dysfunction and a host of other skeletal syndromes. The orthopedic view of the hip joint goes no further than the “surgical field.” Yet, the dynamics of the joint can only be considered within the context of the whole spine and pelvis.

  • Skye White May 16, 2015, 3:27 am

    I’ve had two TPO, which is a version of PAO,and it’s given me my life back, and I can bend, twist, drive, run, box, and snowboard. Or I could of accepted a wheelchair, so no comparison really!!

  • Annick May 16, 2015, 2:51 am

    As a survivor of bilateral PAO’s done 6 years ago when I was 46 and 47 respectively, I just wanted to say that without these surgeries, I would be sitting here, probably in pain, possibly in a wheelchair, wondering “what I can’t do today”. As it is, I am sitting here, planning my second marathon since my PAO’S and thanking Johan Witt, my surgeon, for a) being a brilliant surgeon, and b) for understanding that I wanted my life back, my life that I had had prior to my diagnosis. I ran. I didn’t want to just give up what I had worked hard for, I didn’t want to take up knitting, and become sedentary, which is what I had basically been advised by a previous orthopaedic consultant “to wait till the pain got so bad that they would consider a total hip replacement”. I had watched my mother have to do that, and that was not an option as far as I was concerned. It is, ultimately down to the individual, to research this surgery, get 2nd, 3rd opinions, talk to others who are in the same boat, and make their own decision as to whether this surgery is for them. I am a member of a number of on-line groups that have been nothing other than supportive, helpful, and understanding – and they have been somewhere that I could go to chat when the people closest to me didn’t understand what the problem was. It is indeed a long road, but for me it has been worth it and I would do it all again in a heartbeat if I had to. I am proud to be a PAO warrior – we Persevere and Overcome.

  • Sara May 15, 2015, 10:39 pm

    I would have to say that I agree with the sentiments raised by Paul in that this article is very misleading and many things taken out of context. As someone who suffered from lingering hip pain that increased over the years into crippling pain, having a PAO was one of the best decisions I have made (and I know others would say the same as well). For years i tried every non-surgically treatment possible to relieve my pain test -physical therapy, chiropractic care, acupuncture, massage therapy, different diets…high carb, low carb, high protein, low fat, high fat, yoga, pilates…well you get the idea, none of those seemed to alleviate the pain and if they did it was always temporary. It’s unfortunate this article makes two sweeping generalizations and that is 1.) Those that have a PAO are “naive” for making such a decision about their health and 2.) that a PAO will end in devastation for those that have it which is grossly inaccurate.

  • Cathy May 15, 2015, 9:51 pm

    As a very active person who’s life has been given back because of this surgery I would like to say that there is a bit of inaccuracies in this article. Simply put its a mislead research article with no actual evidence to strongly back her comments. I am a huge evidence based junkie and if I am actually going to take actual evidence based science related journals over anything somebody simply “blogs” about. I AM a survivor of HD and I am back to a long healthy normal life. Yes the journey was long and I had tons of ups and downs bilateral PAOs gave me back my life and the ability to go back and work in a hospital that produces over 50 total joint replacements a week. Sorry you were 1 in 200 PAOs where the procedure didn’t work as with all surgeries there is a risk and they are high but you should not trash or deter others away from something that could potentially help them until you personally run an actual scientific research study of how people are doing. This procedure is only about 30 years old and the best breakthrough techniques have only started to appear in about 2102. Come back with real concrete evidence and than we can talk because in 10 years I can guarantee that the majority of us will still have our pain free healthy active lifestyles. REMEMBER: WITH ANY SURGERY THERE IS ALWAYS A RISK THAT EVERYONE MUST WEIGH PRIOR. THEY ALWAYS DON’T COME OUT AS PLANNED AND THAT SUCKS BUT ITS FAR AND FEW IN BETWEEN. I’m going on an enjoyable hike with my new reclaimed hips tomorrow because my life has been given back to me pain free!

  • Katie May 15, 2015, 6:53 pm

    What I want to know is, as a ‘naive victim’, what else do you suggest instead of getting a PAO? A THR at a very early age? You can only get up to two THRs on either side in your LIFETIME- otherwise you tend to run out of bone. So if I read your article right, I shouldn’t have gotten the PAO and should have done what, sit in a wheelchair for the rest of my life until I’m old enough to get a THR? Also, my surgeon’s op notes are completely different than what you’ve provided, every single surgeon does things a little differently- that’s what second and third opinions are for. I would say rather than ‘naive’, we are extremely informed in our PAO support groups, we don’t hide complications, and we share successes. Without this surgery, a ton of us don’t have ANY OTHER OPTION. I say before you continue trying to convince people not to get this surgery that you at least talk about alternatives- although, the whole point of the surgery is that those alternatives don’t work!! Cortisone shots, PT, hip braces… You tell me when you stop being able to walk that you aren’t going to be trying anything and everything to get better. This article was obviously written by someone who does not have dysplasia…

  • Laura May 15, 2015, 6:17 pm

    Can I ask what your qualifications are to claim youre understanding of both DDH and the PAO are far beyond that are extensively trained orthopaedic surgeons specialized in hips? I know many women who have gained their quality of life back, including myself, thanks to this procedure. Freedom from pain from the simplest of movements has been truly a blessing.

  • Paul September 10, 2014, 8:50 am

    I am someone who has been contemplating PAO surgery. Before having this surgery I did a lot of research to help me decide if I wanted to have the operation. During the research I read this article. I found it slightly misleading as it seemed to be taking quotes from studies that I had read, but taking them out of context. If the author of this website believes they have new insights into the effectiveness of PAO surgeries I suggest they submit them as a peer reviewed journal so they can be subject to the same rigour as the studies they choose to criticise. When doing so I suggest they do not use emotive and condescending language ‘naive victims’ and also declare their conflict of interest of making money from alleged alternatives. People who are contemplating PAO surgery need facts – not opinion. I view this article as scaremongering and (at best) misleading and I hope that the author allows my comment to remain to, in part, to act as a counterbalance to her article.

  • Lindy January 7, 2014, 3:37 pm

    Thank you Christine for condensing a massive amount of research into this article. I can see the implications of correct pelvic and spinal alignment apply as much to hip joint health as it does to pelvic organ support. Which is logical when you think about it. It seems hard to believe that modern treatments for hip joint disorders are primarily surgical based on a mis-understanding of normal hip alignment and common causes hip joint problems – and yet that appears to be the case. Obviously this is not intentionally the case. I hope the reality of our anatomy is understood and becomes mainstream asap so many more people can be treated less painfully and more successfully. This article is an important step in that direction – although some of us may take some time to fully understand the academic and medical descriptions in the article!

  • admin January 7, 2014, 2:34 pm

    Thanks so much for your comments, Margie! If you are on Facebook, be sure to join our new group, which you can find here:

    https://www.facebook.com/groups/1382734768645128/

  • Margie January 7, 2014, 1:32 pm

    This is great information going back in time showing the history of this. Am very glad, to have found your website. And as a result, am walking away from this surgery. There are so many negatives to this surgery, told to me by the doc and by their literature. Pretty scarey stuff.
    Just for one example. I love bending over to garden. And I was told, if I did that; I would end up in emergency to have the hip joint put back in. That sent flags up. I’d be just the one to end up there. They also said if this happens too often, it would do damage to the hip mechanism.
    Thanks, for alerting. I’ll be sharing this info.

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