Emily

PAO stands for Periacetabular Osteotomy, a surgery used to treat hip dysplasia, a condition where the hip socket does not fully support the ball of the hip joint. During the procedure, the surgeon carefully cuts and repositions the hip socket to provide better coverage and stability. The bone is then secured with screws while it heals.

PAO surgery is typically recommended for people with symptomatic hip dysplasia who still have healthy cartilage and little to no arthritis in the hip joint. It is most commonly performed in teens and young adults, though it is increasingly being performed in adults in their 30s and early 40s as awareness and diagnosis of hip dysplasia improves. The goal is to preserve the natural hip joint and prevent further damage.

A PAO (Periacetabular Osteotomy) is a joint-preserving surgery that corrects the position of the hip socket to better support the natural hip joint. A hip replacement removes the damaged joint and replaces it with artificial components. PAO is typically recommended for younger patients with hip dysplasia and healthy cartilage, while hip replacement is more common when significant arthritis or joint damage is present.

👉 Read my post on PAO vs Hip Replacement HERE

PAO surgery is a major procedure, so some pain is expected, especially in the first few days after surgery. Pain is usually managed with a combination of medications and gradually improves over the first few weeks as the bones begin to heal. Most patients find that the surgical pain slowly decreases and becomes more manageable with time and movement.

👉 I shared my full first-week experience after surgery here.

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👉 Read my complete PAO surgery hospital stay guide here

Most patients stay in the hospital for 2–4 days after PAO surgery. During this time, doctors monitor pain control, mobility, and the early stages of recovery. Physical therapists will also help patients begin safe movements and learn how to use crutches before going home.

👉 Read my complete PAO surgery hospital stay guide here

The incision for PAO surgery is typically about 4–8 inches long and is usually located on the front of the hip near the pelvic bone. The exact size and placement can vary slightly depending on the surgeon and surgical technique. Over time, the scar usually fades and becomes less noticeable. Many patients also have hip arthroscopy (a hip scope) done at the same time, which involves 2–3 small incisions about the size of a buttonhole for the surgical instruments and camera

As with any major surgery, there are some potential risks with PAO. Possible complications can include infection, blood clots, nerve irritation or numbness in the thigh, delayed bone healing, or continued hip pain. While these risks exist, PAO is generally considered a safe and effective procedure when performed by experienced hip preservation surgeons.

During PAO surgery, the surgeon cuts the pelvic bone around the hip socket so it can be repositioned for better joint coverage. Because the bone needs time to heal in its new position, putting weight on the leg too soon could disrupt the healing process or shift the correction. Crutches are used to protect the bone while it gradually heals and stabilizes.

Common recovery equipment includes crutches or a walker, a shower chair, a raised toilet seat, and a grabber tool to help reach items without bending. Many patients also find a wedge pillow, long shoehorn, and handheld shower headhelpful during the early weeks of recovery. The exact needs can vary depending on your home setup and your surgeon’s recommendations.

Most patients are advised to sleep on their back for the first 3-6 weeks after PAO surgery to protect the hip while it heals. Pillows are often used under the knees or around the legs to help keep the hip in a comfortable and supported position. As healing progresses and with your surgeon’s guidance, side sleeping may gradually become more comfortable.

Many patients experience numbness or altered sensation on the outer thigh after PAO surgery due to irritation of the lateral femoral cutaneous nerve during the procedure. This nerve runs close to the surgical area and controls sensation in the skin, not muscle movement. The numbness is usually harmless and may improve over time, though some patients have a small area of permanent numbness.

Recovery after PAO surgery typically takes 6–12 months, though the first few months involve the most healing and restrictions. Patients are usually on crutches for several weeks while the bones heal and gradually regain strength and mobility through physical therapy. Many people return to most normal activities within a few months, with continued improvement over the first year.

Most patients use crutches for about 6–12 weeks after PAO surgery while the pelvic bones heal. During this time, weight bearing is gradually increased based on X-rays and your surgeon’s guidance. The timeline can vary depending on individual healing and the specifics of the surgery.

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Most patients stay in the hospital 2–4 days after PAO surgery, so it’s helpful to bring a few comfort and recovery essentials. Common items include loose clothing, slip-on shoes, toiletries, a phone charger, and any personal comfort items like a pillow or blanket. Many patients also find it helpful to bring a long phone charger, lip balm, and easy-to-put-on clothes for the trip home.

Most patients can return to driving around 6–8 weeks after surgery, once they are off strong pain medications and able to safely control the pedals. The timing may vary depending on whether the surgery was on the right or left hip and your surgeon’s specific guidelines. Always check with your surgeon before resuming driving.

In many cases, the screws used during PAO surgery can stay in permanently and do not need to be removed. However, some surgeons routinely remove the screws after the bone has healed—often around 6–12 months after surgery—whether they are causing irritation or not. Removal protocols vary by surgeon and patient preference, so it’s best to discuss your surgeon’s typical approach before surgery.

Light exercise such as gentle strengthening and physical therapy usually begins within the first few weeks of recovery. Higher-impact activities like running are typically not recommended until 6–12 months after surgery, once the bone has fully healed and strength and mobility have returned. The exact timeline varies depending on healing progress and your surgeon’s guidance.

PAO surgery has strong long-term success rates, especially when performed before significant arthritis develops in the hip. Studies show that 70–90% of patients still have their natural hip joint 10–20 years after surgery without needing a hip replacement. Outcomes depend on factors like age, cartilage health, and how early the dysplasia is treated.

Recovery after PAO surgery happens gradually over several months. The first 6–12 weeks typically focus on protecting the bone while using crutches and slowly increasing mobility, followed by progressive strengthening and longer walking as healing continues. Many patients return to most normal activities over 6–12 months, though timelines vary based on healing and physical therapy progress.

👉 Read my full week-by-week timeline here.