Ganz osteotomy: Definition, Uses, and Clinical Overview

Posted on February 27, 2026 | by drhip

Ganz osteotomy Introduction (What it is)

Ganz osteotomy is a hip-preserving surgery that reshapes how the hip socket covers the ball of the hip joint.
It is most commonly discussed as the Bernese periacetabular osteotomy (PAO) developed by Reinhold Ganz.
It is used in selected patients with structural hip problems, especially hip dysplasia or certain socket alignment issues.
The goal is to improve joint mechanics while keeping a person’s own hip joint.

Why Ganz osteotomy used (Purpose / benefits)

The hip is a ball-and-socket joint: the femoral head (ball) fits into the acetabulum (socket) of the pelvis. When the socket does not cover the ball well—or points in a suboptimal direction—forces can concentrate on a smaller area of cartilage and labrum (the rim of cartilage around the socket). Over time, this can contribute to pain, instability sensations, labral tears, and degenerative changes.

Ganz osteotomy is used to address the underlying bony alignment problem rather than only treating symptoms. In general terms, the procedure aims to:

Increase or optimize femoral head coverage by reorienting the acetabulum, which can help distribute load more evenly across the joint surface.
Improve hip biomechanics so walking, standing, and athletic movements place less stress on vulnerable parts of the joint.
Reduce pain and mechanical symptoms that arise when abnormal contact or edge loading irritates the labrum and cartilage.
Preserve the native hip joint in appropriately selected cases, potentially delaying or avoiding joint replacement in some people (how long this lasts varies by clinician and case).
Create a better environment for soft tissues (labrum and cartilage) by improving the bony foundation they depend on.

It is important to note that benefits depend heavily on diagnosis, cartilage health, surgeon assessment, and rehabilitation factors. Outcomes vary by clinician and case.

Indications (When orthopedic clinicians use it)

Orthopedic hip specialists may consider Ganz osteotomy in scenarios such as:

Symptomatic acetabular dysplasia (shallow hip socket) in skeletally mature patients
Acetabular malorientation (for example, certain cases of acetabular retroversion) contributing to impingement or instability
Hip pain associated with labral pathology where underlying socket alignment is a primary driver
Mechanical symptoms (catching, clicking) when structural under-coverage or maldirection is present
Early degenerative changes where the hip is still considered potentially salvageable (selection criteria vary)
Persistent hip symptoms despite appropriate non-surgical care, when imaging and exam suggest a correctable structural cause

Contraindications / when it’s NOT ideal

Ganz osteotomy is not suitable for every painful hip. It may be less appropriate, or another approach may be preferred, in situations such as:

Advanced osteoarthritis with substantial cartilage loss (hip preservation procedures may have limited benefit)
Marked joint incongruity (the ball and socket do not match well), depending on cause and severity
Severe hip stiffness or limited range of motion that would not be improved by reorientation alone
Certain complex deformities where a different pelvic osteotomy or a combined femoral procedure is more appropriate
Poor bone quality or medical conditions that raise concern for bone healing (risk considerations vary by clinician and case)
Active infection or uncontrolled systemic illness that makes major surgery higher risk
Patients unlikely to tolerate or complete the necessary postoperative rehabilitation and follow-up (expectations vary by practice)

Only a qualified clinician can determine candidacy, because “not ideal” depends on imaging findings, cartilage status, symptoms, and individual goals.

How it works (Mechanism / physiology)

Ganz osteotomy works through biomechanical reorientation of the acetabulum. Instead of replacing the joint, the surgeon makes controlled bone cuts around the socket, then rotates or repositions the acetabular fragment to improve coverage and alignment relative to the femoral head.

Key anatomy and structures involved include:

Acetabulum (hip socket): The part of the pelvis that forms the socket.
Femoral head (ball): The top of the thigh bone that articulates with the acetabulum.
Articular cartilage: Smooth joint lining that enables low-friction movement; its condition strongly influences suitability.
Labrum: Fibrocartilaginous rim that deepens the socket and contributes to stability and fluid seal.
Pelvic bone columns and surrounding muscles: Important for maintaining pelvic stability and enabling healing.

The physiologic principle is straightforward: changing socket orientation changes force distribution. When the socket better covers the femoral head and points in a more favorable direction, load can be shared across a broader cartilage surface, potentially decreasing focal stress on the rim and labrum.

In terms of onset, duration, and reversibility:

Onset: Structural change occurs immediately at surgery, but functional improvement depends on bone healing and rehabilitation.
Duration: The bony correction is intended to be long-lasting once healed.
Reversibility: Unlike a brace or medication, the osteotomy is not reversible in the typical sense; it is a permanent anatomic change once the bone heals.

Ganz osteotomy Procedure overview (How it’s applied)

Ganz osteotomy is a surgical procedure (commonly referring to the Bernese periacetabular osteotomy). Exact techniques differ by surgeon and case, but the general workflow often looks like this:

Evaluation and exam – Detailed history (pain pattern, activity limits, mechanical symptoms) – Physical exam assessing hip motion, impingement signs, and stability – Imaging, commonly including X-rays; MRI and/or CT may be used for cartilage, labrum, and version assessment (varies by clinician and case)
Preoperative planning – Determining whether symptoms match the structural findings – Planning the direction and amount of socket reorientation – Discussing expected rehabilitation demands and follow-up schedule
Preparation – General or regional anesthesia (approach varies) – Positioning and surgical exposure based on surgeon preference and anatomy
Intervention – Controlled bone cuts are made around the acetabulum – The socket fragment is reoriented to improve coverage and alignment – The corrected position is fixed (commonly with surgical screws; specific implants vary by material and manufacturer)
Immediate checks – Intraoperative assessment of alignment and hip motion – Imaging checks (often fluoroscopy) may be used to confirm position (varies by case)
Follow-up – Scheduled visits with repeat imaging to monitor healing – A staged rehabilitation plan, often including specific limits on weight-bearing and activity progression determined by the treating team

This overview is intentionally general. Surgical steps and postoperative protocols vary by clinician and case.

Types / variations

In everyday clinical use, “Ganz osteotomy” most often refers to the Bernese periacetabular osteotomy (PAO), but there are meaningful variations in how the concept is applied:

PAO for dysplasia (coverage deficiency): Reorientation primarily increases lateral/anterior coverage when the socket is shallow.
PAO for acetabular malorientation (version correction): Reorientation can address certain alignment patterns such as retroversion, aiming to reduce abnormal contact and improve motion.
Combined procedures: Some patients undergo PAO plus additional work tailored to their anatomy, such as:
Femoral osteotomy (to correct femoral version or head-neck shape in selected cases)
Labral or cartilage procedures (performed either open or arthroscopically, depending on pathology and surgeon approach)
Approach and technique modifications: Incision placement, muscle-sparing strategies, and use of intraoperative imaging/navigation can differ between centers.
Fixation choices: Screw configuration and implant selection can vary by surgeon preference and patient anatomy (details vary by material and manufacturer).

These variations reflect that the core goal is socket reorientation, but the best method depends on the full hip morphology, not a single X-ray finding.

Pros and cons

Pros:

Preserves the patient’s native hip joint rather than replacing it
Targets the structural cause of certain hip problems (socket coverage/alignment)
Can improve load distribution across the joint when alignment is corrected appropriately
May reduce symptoms related to instability or edge loading in selected cases
Can be combined with treatment of labral/cartilage pathology when appropriate
Offers a hip-preservation option for some patients who are too young or unsuitable for arthroplasty goals (selection varies)

Cons:

Major surgery with a meaningful recovery and rehabilitation commitment
Risks of complications such as infection, blood clots, nerve injury, nonunion (bone healing problems), or persistent pain (risk level varies by clinician and case)
Not ideal if there is advanced arthritis or extensive cartilage damage
May not fully resolve symptoms if pain is driven by non-structural causes or mixed pathology
Temporary limits on walking/weight-bearing are common during healing (timelines vary)
Some patients may later still require additional hip surgery, including arthroplasty, depending on joint health and progression

Aftercare & longevity

Aftercare following Ganz osteotomy typically centers on bone healing, restoring strength, and gradually reintroducing load to the hip. While exact protocols vary, outcomes commonly depend on a combination of patient, joint, and program factors.

Key factors that can influence recovery and longer-term durability include:

Severity and type of the underlying deformity: The amount and direction of correction needed can affect rehabilitation demands.
Cartilage and labrum status: Health of joint surfaces is often a major determinant of symptom improvement and durability.
Quality of correction and joint mechanics: Small differences in alignment can matter, but what is “ideal” varies by anatomy and surgeon judgment.
Bone healing capacity: Nutrition, smoking status, metabolic bone health, and certain medical conditions can affect healing (individual factors vary).
Weight-bearing progression: Many protocols include a period of limited weight-bearing, then gradual advancement; the timeline varies by clinician and case.
Physical therapy and adherence: Restoring hip and core strength, gait mechanics, and flexibility is commonly emphasized.
Comorbidities and overall conditioning: Back, pelvic, or knee issues can influence function and perceived outcome.

Longevity is best understood as: the bony correction is intended to be lasting, but symptom relief and joint preservation depend on cartilage health and long-term joint loading. For some, it may provide durable improvement; for others, progression of degeneration may continue over time. This varies by clinician and case.

Alternatives / comparisons

Ganz osteotomy is one option within a broader hip-care spectrum. Alternatives depend on diagnosis, severity, and patient goals.

Common comparisons include:

Observation and monitoring
For mild symptoms or uncertain structural significance, clinicians may recommend monitoring with periodic reassessment.
This may be paired with activity adjustments and education (general concepts; individualized plans vary).
Physical therapy and movement-based care
Often used to improve hip strength, pelvic control, and movement patterns.
May reduce symptoms even when bony anatomy is imperfect, but it does not change socket shape or orientation.
Medications
Anti-inflammatory or pain-relief medications may help with symptoms but do not correct structural coverage problems.
Use depends on individual health considerations and clinician guidance.
Injections
Image-guided intra-articular injections can help clarify whether pain is coming from inside the joint and may offer temporary symptom relief.
They do not correct the bony alignment that Ganz osteotomy addresses.
Hip arthroscopy
Can treat labral tears or address cam-type femoroacetabular impingement in selected cases.
In patients with significant dysplasia/under-coverage, arthroscopy alone may not address instability drivers; whether it is appropriate varies by clinician and case.
Other pelvic osteotomies
Procedures such as triple pelvic osteotomy or other reorientation techniques may be used depending on age, anatomy, and surgeon expertise.
They share the general concept of changing socket orientation but differ in cuts, stability, and indications.
Hip arthroplasty (replacement)
Typically considered when joint degeneration is advanced and preservation options are less likely to help.
Compared with Ganz osteotomy, replacement addresses end-stage joint surface damage but replaces the native joint.

The “best” option is not universal; it depends on diagnosis, cartilage condition, functional goals, and risk tolerance, as assessed by a hip specialist.

Ganz osteotomy Common questions (FAQ)

Q: Is Ganz osteotomy the same as a periacetabular osteotomy (PAO)?
In many contexts, yes. “Ganz osteotomy” commonly refers to the Bernese periacetabular osteotomy developed by Reinhold Ganz. Some clinicians may use terms differently, so it’s reasonable to confirm the exact procedure name and goals with the treating team.

Q: What conditions does Ganz osteotomy treat?
It is most often used for symptomatic hip dysplasia or certain acetabular alignment problems. The procedure aims to improve socket coverage and orientation to reduce abnormal joint loading. Suitability depends on imaging findings and cartilage health.

Q: How painful is recovery after Ganz osteotomy?
Pain experiences vary widely. Because it is a major bone procedure, early postoperative discomfort is expected, and pain management plans commonly include multiple strategies. The course and intensity vary by clinician and case.

Q: How long does it take to recover?
Recovery is typically measured in phases: early healing, return to daily activities, and longer-term strength and endurance rebuilding. Bone healing and gait normalization take time, and full functional recovery often extends beyond the first few weeks. Exact timelines vary by clinician and case.

Q: Will I be able to walk right away?
Many postoperative pathways include a period of limited or protected weight-bearing to allow the osteotomy to heal. Walking usually begins early with assistive devices, but how much weight can be placed through the leg depends on surgeon protocol and healing progress. Weight-bearing instructions vary by clinician and case.

Q: When can someone drive or return to work after Ganz osteotomy?
Driving and work timing depend on pain control, mobility, reaction time, side of surgery, and whether a person is using narcotic pain medication. Job demands also matter (desk work versus physical labor). Clearance timing varies by clinician and case.

Q: How long do the results last?
The bone correction is intended to be durable once it heals, but long-term symptom control depends on joint cartilage health and ongoing load over time. Some people experience long-lasting improvement, while others may have symptom recurrence or degenerative progression. Longevity varies by clinician and case.

Q: Is Ganz osteotomy considered safe?
It is a well-known hip-preservation operation performed in specialized centers, but it carries real surgical risks like any major procedure. Complication risks depend on patient factors, anatomy, and surgeon experience. Individual risk assessment should be discussed with a qualified clinician.

Q: What happens if arthritis is already present?
Mild or early degenerative changes may still be compatible with hip preservation in selected cases, but more advanced arthritis often reduces the expected benefit. Imaging findings and symptom patterns are typically weighed together. Thresholds for “too much arthritis” vary by clinician and case.

Q: Does Ganz osteotomy replace the need for hip replacement later?
It can be used with the goal of preserving the native hip and potentially delaying arthroplasty, but it does not guarantee that a hip replacement will never be needed. Whether arthroplasty is avoided depends on cartilage condition, correction, activity demands, and time. Outcomes vary by clinician and case.