Who should have a total hip replacement for hip dysplasia rather than a PAO (Periacetabular Ostetotomy)?

Decision making with regards to hip dysplasia can at times be very difficult. One of the areas that is often not straightforward is in patients who are perhaps a bit older than the norm for this procedure (over the age of 40) and appear to have a good joint on X-ray. In general terms a hip is not suitable for a PAO if there is too much in the way of wear and tear arthritis in the joint. In these circumstances the best way to improve pain and function is to have a hip replacement. Sometimes one has to accept that it is not possible to preserve the native hip joint even when a patient is young and that a hip replacement will give a better longterm outcome.

The concern is that the younger you are when you have a hip replacement the greater the chance that you will require some form of re-do surgery later in life, possibly more than once. The age of 40 is something of a threshold between joint preservation in the form of a PAO and the option of a hip replacement becoming more of a reasonable option with perhaps less of a chance of more than one re-do procedure.

It does appear that the complication rate is a bit higher in patients over 40  undergoing a PAO and recovery somewhat longer than in younger age groups. On the other hand, if a joint still appears to have good cartilage and little wear and tear, then it seems a shame to lose the option of a joint preservation procedure.

Ultimately the decision making comes down to making an individual assessment of the circumstances of the patient. The quality and strength of the bone is important, overall health and activity level of the patient and the willingness to undergo the rehabilitation. The initial recovery after a hip replacement is certainly easier and overall quicker which may be important in some circumstances, however, where a joint remains in good condition and the circumstances are appropriate a PAO with preservation of the native hip is still potentially a good option for patients over 40.