Right periacetabular osteotomy: Definition, Uses, and Clinical Overview

Posted on February 28, 2026 | by drhip

Right periacetabular osteotomy Introduction (What it is)

Right periacetabular osteotomy is a hip-preservation surgery performed on the right hip socket.
It reshapes and reorients the acetabulum (the “cup” of the hip joint) to better cover the femoral head.
It is most commonly used for symptomatic hip dysplasia and related instability.
It is typically performed by orthopedic surgeons who specialize in young adult hip conditions.

Why Right periacetabular osteotomy used (Purpose / benefits)

The main purpose of Right periacetabular osteotomy is to improve how the right hip joint carries load by correcting the alignment of the hip socket. In many patients with hip dysplasia, the acetabulum is shallow or angled in a way that provides limited coverage of the femoral head (the “ball”). This can increase joint contact stress, contribute to labral injury (damage to the cartilage rim around the socket), and accelerate wear of the joint cartilage.

By repositioning the acetabulum, the procedure aims to:

Increase femoral head coverage and improve joint stability.
Reduce edge loading and mechanical “overstress” on the cartilage and labrum.
Address pain and functional limitation that can occur with dysplasia-related impingement or instability.
Preserve the native hip joint in appropriately selected patients, potentially delaying or avoiding joint replacement in the short to medium term.

It is considered a reconstructive operation rather than a “repair-only” procedure. The goal is to change the underlying hip mechanics that contribute to symptoms and progression of joint damage. Outcomes and the degree of symptom improvement vary by clinician and case, including how much cartilage damage is present before surgery.

Indications (When orthopedic clinicians use it)

Orthopedic clinicians commonly consider Right periacetabular osteotomy in situations such as:

Symptomatic acetabular dysplasia of the right hip (often with activity-related groin, lateral hip, or buttock pain)
Hip instability symptoms (e.g., pain with pivoting, giving-way sensations, fatigue with standing/walking)
Imaging evidence of inadequate acetabular coverage or malorientation consistent with dysplasia
Labral pathology associated with dysplasia when the underlying bony alignment is a primary contributor
Early degenerative change where the joint is still considered potentially “preservable” (selection varies by clinician and case)
Persistent symptoms despite a course of nonoperative care (e.g., activity modification, guided rehabilitation), when clinically appropriate
Young adult and adult patients with adequate bone quality for osteotomy and fixation (age ranges and thresholds vary by surgeon and center)

Contraindications / when it’s NOT ideal

Right periacetabular osteotomy may be less suitable, or not recommended, in scenarios such as:

Advanced hip osteoarthritis where joint preservation is unlikely to provide durable benefit (assessment varies by clinician and case)
Severe cartilage loss or femoral head deformity that limits the ability to create a congruent, functional joint
Active infection or systemic illness that increases surgical risk
Poor bone quality or metabolic bone conditions that may compromise bone healing or fixation stability
Significant hip stiffness with limited range of motion that suggests extensive arthritic change or poor joint congruency
Certain complex neuromuscular or connective tissue conditions where hip mechanics and stability issues may not be correctable with acetabular reorientation alone (case-dependent)
Inability to participate in postoperative follow-up and rehabilitation (not a “fault” issue, but a feasibility and safety consideration)
Situations where another approach may better match the primary problem (for example, isolated femoroacetabular impingement without dysplasia may be treated differently)

Final candidacy depends on a combination of symptoms, physical examination findings, and imaging features, and it varies by clinician and case.

How it works (Mechanism / physiology)

Right periacetabular osteotomy works through a biomechanical principle: changing the orientation of the acetabulum changes where and how forces are distributed across the hip joint.

Key anatomy and structures involved

Acetabulum: The socket portion of the pelvis that receives the femoral head.
Femoral head: The ball-shaped upper part of the thigh bone.
Articular cartilage: The smooth joint lining that allows low-friction movement.
Labrum: A fibrocartilage rim that deepens the socket and contributes to sealing and stability.
Pelvic bones around the acetabulum: The ilium, ischium, and pubis contribute to the acetabular region and are the areas involved in osteotomy cuts.

Mechanism at a high level

During the operation, controlled bone cuts are made around the acetabulum so that the socket can be repositioned. The surgeon then reorients the acetabular fragment to improve femoral head coverage and optimize joint congruency (how well the ball and socket match). The fragment is stabilized with internal fixation (commonly screws; fixation choices vary by clinician and case).

Onset, duration, and reversibility

This is not a medication or device therapy with “onset” in the usual sense. Structural correction is immediate once the fragment is fixed in the new position. Functional improvement, however, depends on bone healing, soft-tissue recovery, and rehabilitation and is typically gradual. The change to bone alignment is intended to be long-lasting; “reversibility” is not a typical property of this procedure, although revision surgery can be considered in selected circumstances if alignment, healing, or symptoms are problematic.

Right periacetabular osteotomy Procedure overview (How it’s applied)

Below is a general, simplified workflow. Specific techniques and sequences vary by surgeon, patient anatomy, and institutional protocols.

Evaluation / exam – History of symptoms (pain location, activity limits, instability features) – Physical exam assessing hip range of motion, impingement signs, gait, and pelvic mechanics – Imaging review (commonly X-rays; MRI or CT may be used for labrum/cartilage assessment and 3D planning)
Preparation – Surgical planning to determine the desired acetabular correction – Discussion of expected recovery timeline, weight-bearing restrictions, and follow-up schedule (details vary) – Anesthesia planning and perioperative risk assessment
Intervention – Surgical exposure of the right pelvis/hip region – Osteotomy cuts around the acetabulum to mobilize the socket fragment while preserving pelvic stability – Reorientation of the acetabular fragment to improve coverage and alignment – Fixation of the repositioned fragment (commonly with screws; method varies)
Immediate checks – Intraoperative assessment of alignment and hip motion; imaging (such as fluoroscopy) may be used – Confirmation of fixation stability and acceptable positioning – Wound closure and postoperative imaging as indicated by the team
Follow-up – Scheduled visits to monitor incision healing, symptoms, mobility, and bone healing on imaging – Progressive rehabilitation and return-to-activity planning based on healing and function (varies by clinician and case)

This overview intentionally avoids step-by-step surgical detail. The exact approach is individualized and may include additional procedures when clinically indicated.

Types / variations

“Right periacetabular osteotomy” specifies the side (right hip), but several recognized variations exist in technique and in how it is combined with other hip-preservation procedures.

Common variations include:

Bernese (Ganz) periacetabular osteotomy (PAO): A widely used PAO technique designed to reorient the acetabulum while maintaining the posterior column of the pelvis for stability.
Approach variations (incision and soft-tissue handling): Some surgeons use more limited exposures or modified approaches intended to reduce soft-tissue disruption; suitability varies by anatomy and surgeon experience.
PAO with concomitant femoral procedures: If the femur contributes to abnormal mechanics (for example, version abnormalities), a femoral osteotomy may be performed at the same time or as a staged procedure (case-dependent).
PAO with hip arthroscopy or open labral/cartilage treatment: In selected patients, surgeons may address intra-articular pathology (labrum/cartilage) in addition to acetabular reorientation. Whether this is appropriate depends on the underlying mechanics and imaging findings.
Fixation method variations: Most commonly screw fixation is used, but configuration and hardware choice can vary by surgeon and case.

The “best” variation is not universal; it depends on anatomy, degree of dysplasia, cartilage status, and surgeon preference and training.

Pros and cons

Pros:

Addresses the underlying bony alignment problem in dysplasia rather than only treating symptoms
Can improve femoral head coverage and hip stability in appropriate candidates
Aims to redistribute joint forces to reduce edge loading on cartilage and labrum
Preserves the native hip joint, which may be valuable for younger or active patients
Can be combined with other hip-preservation procedures when indicated (varies by case)
Offers a structured pathway to evaluate mechanical causes of hip pain using imaging and physical exam findings

Cons:

Major reconstructive surgery with a meaningful recovery period and rehabilitation demands
Complication risks exist, including blood loss, nerve or vessel injury, infection, blood clots, and heterotopic ossification (risk levels vary)
Bone healing is required; delayed union or nonunion can occur in some cases
Hardware irritation or need for later hardware removal can occur in some patients
Symptom improvement is not guaranteed and depends on factors such as cartilage health and accuracy of correction
Return to high-impact activity may be prolonged and is individualized
Some patients may eventually progress to hip replacement despite correction, particularly if arthritis is present or progresses

Aftercare & longevity

Aftercare following Right periacetabular osteotomy generally focuses on protecting the healing bone, restoring strength and mobility, and monitoring the hip joint over time. While specific protocols differ, several broad factors commonly influence outcomes and durability:

Severity and type of dysplasia: The amount of correction needed and the preoperative joint condition can affect recovery and long-term joint health.
Cartilage and labral status at baseline: More advanced cartilage wear may limit the durability of symptom relief, even if alignment improves.
Fixation stability and bone healing: Osteotomy healing is essential. Clinicians typically use follow-up imaging to assess healing progress.
Weight-bearing status: Many protocols restrict or modify weight-bearing for a period to protect the osteotomy site; the timeline varies by clinician and case.
Rehabilitation participation: Progressive physical therapy commonly targets gait mechanics, hip/core strength, and controlled range of motion. The pace is typically guided by healing and symptoms rather than a single fixed schedule.
Comorbidities and lifestyle factors: Bone health, smoking status, nutrition, and other medical conditions can influence healing and overall recovery.
Follow-up and monitoring: Periodic reassessment helps clinicians evaluate healing, hip function, and signs of impingement or persistent instability.

Longevity is influenced by the underlying biology of the joint (cartilage health), the mechanical correction achieved, and how the hip is loaded over time. Expectations should be individualized, and durability varies by clinician and case.

Alternatives / comparisons

Right periacetabular osteotomy is one option within a broader “hip preservation” and “hip arthritis” care spectrum. Alternatives depend on diagnosis, symptom severity, activity goals, and imaging findings.

Common comparisons include:

Observation / monitoring
May be considered when symptoms are mild, intermittent, or when imaging findings do not clearly match the pain pattern.
Does not change acetabular alignment, but can be appropriate in selected cases.
Physical therapy and activity modification
Often used to address hip and core strength, movement patterns, and symptom management.
May reduce symptoms but does not reorient the socket; effectiveness depends on whether instability or mechanical overload is the main driver.
Medications
Anti-inflammatory or analgesic medications may help symptom control for some patients.
They do not correct the structural alignment issue.
Injections
Intra-articular injections can be used diagnostically (to clarify whether pain originates inside the joint) or therapeutically for temporary symptom relief.
Response varies, and injections do not alter bony mechanics.
Hip arthroscopy alone
Can treat labral tears or certain cartilage problems.
In true dysplasia, arthroscopy without correcting inadequate coverage may not address the underlying instability; appropriateness depends on severity and biomechanics.
Femoral osteotomy (without acetabular osteotomy)
Considered when femoral alignment (such as version or neck-shaft angle) is a major contributor.
Sometimes used in combination with PAO rather than as a complete substitute.
Total hip arthroplasty (hip replacement)
Commonly considered when arthritis is advanced or when joint preservation is unlikely to provide durable benefit.
Replaces the joint rather than preserving it; trade-offs differ, especially for younger patients.

Choosing among options typically requires aligning the diagnosis (dysplasia vs impingement vs arthritis) with the intervention’s mechanism (realignment vs symptom control vs joint replacement).

Right periacetabular osteotomy Common questions (FAQ)

Q: Is Right periacetabular osteotomy the same as PAO?
Yes, it refers to a periacetabular osteotomy performed on the right hip. “PAO” is a common abbreviation, and specific techniques (such as the Bernese/Ganz PAO) may be used. The side designation matters for documentation, imaging, and surgical planning.

Q: How painful is the recovery?
Pain experiences vary widely by individual, surgical technique, and pain-control strategy. Many patients have significant postoperative soreness because this is a bony reconstruction. Clinicians typically use multimodal pain management and rehabilitation planning to support early recovery.

Q: How long does it take to recover and return to normal activities?
Recovery is usually gradual because bone healing and strength rebuilding take time. Many people progress through phases, such as protected mobility, then strengthening, then higher-level activity. The overall timeline varies by clinician and case and depends on healing, function, and job or sport demands.

Q: Will I be non-weight-bearing after surgery?
Weight-bearing restrictions are common after PAO to protect the healing osteotomy. Some protocols use partial or limited weight-bearing for a period, followed by gradual progression. The exact plan varies by clinician and case.

Q: When can someone drive or return to work after Right periacetabular osteotomy?
Driving and work timelines depend on pain control, mobility, reaction time, side of surgery (right-sided procedures can affect driving sooner for many people), and medication use. Desk-based work may be possible earlier than physically demanding jobs, but timing is individualized. Clinicians typically base clearance on functional readiness and safety considerations.

Q: How long do the results last?
The bony correction is intended to be durable, but symptom relief and joint longevity depend on cartilage health, degree of correction, and ongoing joint loading. Some patients do well for many years, while others may have persistent symptoms or progression of arthritis. Durability varies by clinician and case.

Q: Is Right periacetabular osteotomy safe?
All major surgeries have risks, and PAO has recognized potential complications such as bleeding, infection, nerve or vessel injury, blood clots, and healing problems. “Safe” is relative and depends on individual risk factors and surgical experience. A personalized risk discussion is typically part of preoperative evaluation.

Q: What does Right periacetabular osteotomy cost?
Total cost can include surgeon, facility, anesthesia, imaging, implants, physical therapy, and potential time away from work. Insurance coverage and out-of-pocket expenses vary widely by region, plan, and hospital system. For cost questions, patients usually need estimates from the treating facility and insurer.

Q: Will it prevent arthritis or stop progression completely?
The procedure aims to improve mechanics that can contribute to cartilage wear, but it cannot “reset” cartilage that is already damaged. Some patients may experience slowed progression, while others may still develop arthritis over time. Outcomes depend heavily on preexisting cartilage status and other factors.

Q: Could I still need a hip replacement later?
Yes, some people ultimately undergo total hip arthroplasty after a PAO, especially if arthritis progresses or symptoms persist. PAO is generally considered a hip-preservation strategy, not a guarantee against future replacement. Whether and when that might occur varies by clinician and case.