Peri-Acetabular Osteotomy Surgery for Developmental Dysplasia
Peri-acetabular osteotomy (PAO) is similar in many respects to open hip reconstructive surgery, however, the incision is a lot shorter and the work is done primarily on the socket side and involves the pelvis. The wound management is as for all procedures with absorbable sutures, skin glue, suture strips and waterproof dressings required for two weeks and allows showers. Postoperatively, again movement in a continuous passive motion (CPM) machine to facilitate mobilization. Weight protection as for open hip surgery with six weeks double crutches followed by six weeks single crutch and thereafter none if all is well. Movement is important whenever operating on a joint and we will be reinforcing this every step of the way. Again 24 hours of intravenous antibiotics for infection risk minimisation as well as one month’s worth of blood thinners in order to prevent clots of the veins (DVTs).
As with open hip cases, you will be admitted to High Care Unit for 24 hours and then transferred back to the general ward. This is primarily for initial monitoring and pain control. We often provide patient controlled analgesia, i.e., a button you can press which will then result in a delivery of painkilling medication but is designed to not allow any overdosing. This gives you a measure of control in respect of your pain. Over and above this you will be given numerous medications to assist in this regard.
In PAO surgery and the surgical approach there is one particular nerve which is often quite stretched and and/or injured during the procedure. This is an entirely unavoidable. This will result in a numbness on the outer aspect of the thigh. In most cases this recovers but can be a permanent feature. This nerve is purely sensory and not functional and often there will be compensation from the surrounding branches. All open hip procedures and in particular, the reconstructive procedures and the PAO operations can result in a fair amount of bleeding. We do however use a cell saver and this is a process where the blood sucked up from the wound is circulated through a series of special filters in a closed system and at least 45% of your blood is then returned via an intravenous infusion. This dramatically lowers the risk for blood transfusions from the blood bank. I advise all patients to go onto vitamin C, iron and vitamins B complex supplementations as far ahead of time in respect of the surgery in order to minimise anaemia. This holds true for any open operation including joint replacements.
Pre and Post PAO xrays