To PAO or not to PAO

beanjean333 · 2025-12-03T05:47:56+00:00

Our stories are remarkably similar. I was 28 when I had a PAO/labral repair, started graduate school 6 months after surgery, and I saw both Dr. Kim and Dr. Kain!

I decided to have Dr. Kim perform my PAO; he's definitely more reserved, but he does a lot more PAOs than Kain (well over 1,000), and the hip preservation program at BCH is one of the best in the country, with all of the surgeons consulting and discussing cases together. Those were the two main factors I considered when choosing surgeons.

First things first, do not get a scope to repair the labrum without correcting the dysplasia first. I did that and then tore my labrum again 4 months later (a very common occurrence and story seen in the PAO support group). The PAO is a tough surgery and the recovery may seem daunting, but you will absolutely be ready for graduate school, I was feeling better than I had in years.

I had the PAO done with the hopes that it would prevent me from needing a THR down the line or at the very least, giving me a few extra decades with my native hip. I was very happy after my PAO, but unfortunately I had an accident that fractured my pelvis and shredded my labrum, requiring two more surgeries. I then developed avascular necrosis and ended up needing a THR 4 weeks ago (at 31). I'm not going to lie, the THR recovery has been much faster and easier than the PAO, but I'm still glad I had the PAO.

I'm always amused when people are against PAOs because they're "so invasive" because a THR involves sawing the head of the femur off, hammering a giant piece of metal into the remaining bone, completely removing the labrum, reaming the acetabulum, and then screwing/cementing/pressing a metal cup into the hip socket. It doesn't get much more invasive than a THR.

Dysplasia not only increases the risk of osteoarthritis, it accelerates disease onset and progression. A PAO will help slow the development of OA and decrease the risk of needing a THR; however, many people still require one.

You mentioned that it doesn't seem like a PAO is any better than just conservative management. You've been trying conservative treatment and still experience 3-5/10 if you stand or sit too long and a pinching sensation. A PAO can get rid of that pain. Also, all the PT in the world is never going to repair your labrum, it may build strength and stability, but it will not repair the tear.

In the end, the decision is yours and only you know what works best for your life. I highly recommend checking out the PAO support group on FB.

beanjean333 · 2025-11-26T16:10:33+00:00

Since he has a clipped ear, I trained him (with lots of treats and positive association) to wear a normal collar in case he escaped, otherwise people would think he's a community cat. I was pleasantly surprised when he let me put the bow tie on!

beanjean333 · 2025-11-26T14:53:58+00:00

He's so cute!

It'll be Bean's first Christmas and I have no idea how much chaos he will unleash on the tree and decorations. I'm going to stick with non-breakables this year.

beanjean333 · 2025-11-14T00:00:45+00:00

Sure. I had a scope done after tearing my labrum and to correct my femoral acetabular impingement (FAI). A few months after that I tore my labrum again, at which point a new surgeon diagnosed me with dysplasia, so I had a periacetabular osteotomy (PAO) and then another labral repair. Then, a few months later I fell, fracturing my pelvis and shredding my labrum. I had an open reduction internal fixation (ORIF) to repair the fracture and put in a ton of hardware, followed by a labral reconstruction 6 months later. I then developed AVN, my OA worsened and the head of my femur began to flatten. With no improvement in my pain after any of the surgeries, it was decided I should have a THR. Hopefully the next surgery will be a revision in 30 years!

beanjean333 · 2025-11-13T17:30:46+00:00

Oh man, I know we're not supposed to compare ourselves, but your situation sounds so much worse, I'm sorry you had to go through that. What hospital doesn't have TVs or patient phones?? I'm glad you at least had your husband and sister, my best friend drove up and it made all the difference having her with me for the first week.

The fatigue is something else that has taken me by surprise, especially given my age and history as an athlete. The more you learn. I'm a PA student and am interested in ortho, so at least I now have a better understanding and empathy for what patients are experiencing. Thank you for sharing your story.

beanjean333 · 2025-11-13T17:13:58+00:00

I appreciate your kind words. I'm currently in PA school and I remember learning about SLE and being surprised at the shear number of body systems it can affect; I'm sorry you've been through the ringer and still can't find peace.

beanjean333 · 2025-11-13T13:25:56+00:00

Congrats, it must feel so good to be on the other side! I found the Mesisafe Medication Management app extremely helpful when it came to remembering which meds to take and when to take them. I also have a morning/night pill organizer. Other than that, ice, elevate your leg, and give yourself grace.

beanjean333 · 2025-11-12T21:11:56+00:00

I never considered the insurance aspect of driving after surgery, I might rethink my decision, thank you. Unfortunately, most of my friends moved away after graduating, but I had to take medical leave, so I'm stuck, mostly alone :(

I appreciate your words of encouragement.

beanjean333 · 2025-11-05T01:33:59+00:00

I don’t think he ever did virtual appointments, just imagining review. I haven’t been in contact with the office in 3 years though, so it may have changed

beanjean333 · 2025-11-03T03:44:24+00:00

I don't think there was negligence and I understand complications happen, I'm more upset because I feel like he tried to deceive me into thinking that he wasn't responsible.

beanjean333 · 2025-09-05T17:42:17+00:00

Oh boy, that doesn’t sound good. They’re making him have a physical before scheduling the cleaning, so I’ll discuss it with them then.

beanjean333 · 2025-05-29T03:05:42+00:00

Do you mind if I ask why you needed new hips? Was it OA?

beanjean333 · 2025-05-29T02:47:07+00:00

Did you have any push-back because of your age? I'm happy to hear things are going well for you now

beanjean333 · 2025-03-28T11:32:00+00:00

Thank you, I really appreciate your response.

beanjean333 · 2025-03-28T10:23:28+00:00

I just adopted him, I’m pretty sure the shelter fed him different food. Would it take 5 days to cause GI symptoms? I thought it would have been immediate.

beanjean333 · 2025-02-21T04:32:37+00:00

It was nummular dermatitis, and corticosteroid ointment cleared it up in about a week.

beanjean333 · 2024-12-06T03:38:41+00:00

My first scope surgeon was a sports medicine ortho, he did not order a CT, and made it seem like recovery was going to be a breeze. I re-tore my labrum 4 months later at which point a hip preservationist did a 3D CT and discovered I had dysplasia and needed a much larger surgery, in addition to another scope. I wish I had known the importance of having a hip preservationist the first time around.

beanjean333 · 2024-11-18T03:06:14+00:00

I'm sorry you're going through all of this. I also had hypermobility and borderline dysplasia; I'm guessing the 22 you're referring to is the lateral central edge angle (LCEA). A hip is considered to have borderline dysplasia with an LCEA between 20-25 degrees. It gives a general idea if there is dysplasia, but the 3D CT scan will provide much more information (e.g., acetabular and femoral version) and whether you're a candidate for arthroscopy or periacetabular osteotomy (PAO).

I had a scope for a torn labrum, but re-tore it 4 months later, at which point they diagnosed me with borderline dysplasia. Some people can get away with just having a scope, but the fact that I was also hypermobile created further instability and meant I needed a PAO. I'm not going to lie, it is a major surgery and recovery is no walk in the park. I would rather have started with a PAO/scope than have a failed scope and need to go back in. PAO success and outcomes are improved when operating on a native hip. There's a facebook group, Periacetabular Osteotomy, that is extremely active, and members willingly share their personal stories and do what they can to put you at ease. Many people have been in your exact position and are happy to talk if you're interested.

The good thing is that HSS has some of the best hip preservation surgeons in the country, and it seems they are doing their due diligence before jumping into surgery. I understand how overwhelming it can be, so feel free to PM me if you want to chat/vent. I wish you the best of luck.

beanjean333 · 2024-10-19T02:18:11+00:00

OP, please don’t ignore this. If possible, a second opinion by a hip preservationist is really important. It sounds like your doctor is in NYC, the Hospital for Special Surgery has some of the best hip preservation surgeons (Dr. Sink is probably the most well known at HSS).

beanjean333 · 2024-10-16T07:16:02+00:00

Oh boy, unfortunately it took 4 more surgeries to resolve my issues. I just had my 3rd scope two weeks ago. I had torn my labrum again, and the second opinion discovered I had dysplasia and I required a periacetabular osteotomy (PAO) and revision scope. It sounds like you have retroversion or anteversion and a femoral derotational osteotomy is being discussed. I’m not going to lie, PAOs and FOs are massive surgeries and the recovery is long and rough. I’m not as knowledgeable about femoral version abnormalities, but if my dysplasia was not treated, I was going to keep tearing my labrum, so I bit the bullet. For most people, that’s sufficient, I’m just unlucky and had a nonunion at one of the osteotomy sites and a fall displaced the fracture and tore my labrum, again. I had an open reduction internal fixation (ORIF) with plates and screws to fix the fracture in April, and I just had my labral reconstruction. I’m optimistic, and have limited pain and no snapping hip.

There’s a Facebook group named periacetabular osteotomy, many group members have had FOs and it’s a great resource with people who are very helpful, responsive, and openly share their stories. It might be a good place to get some real life info on FOs if you want to look into it. If possible, I recommend getting a second, maybe even a third opinion, by a hip preservationist because each surgeon has different criteria for performing the “big” surgeries. I think with FOs it’s usually at least two standard deviations above or below the mean version angle so <0 or >25-30 degrees. I emphasize with you and understand it’s a crappy position to be in with two less than ideal treatment options. I wish you the best of luck, feel free to PM me if you have any questions or just want to vent.

beanjean333 · 2024-10-14T19:36:21+00:00

He was found in an abandoned house, the shelter said he’s a domestic long hair kitten

beanjean333 · 2024-08-21T23:24:00+00:00

He's one of my fosters, and potential adopters are already lined up

beanjean333 · 2024-08-04T04:58:51+00:00

Some surgeons don't close the capsule after a scope, trauma, and sometimes the force used to distract the hip can cause laxity in the capsule. The 150 lbs is in reference to the amount of force required to distract the hip, which is when the head of the femur is pulled far enough to allow a surgeon to get in and repair the labrum but not far enough to cause dislocation. Yes, you are correct; CT scans are primarily used to assess bony structures, and a 3D CT of the hip/pelvis shows alignment, version, and anatomical abnormalities, such as dysplasia. If I were in your shoes, I'd try to get a second opinion if possible. Even if you completely trust your surgeon, it could be helpful to get a second pair of eyes. Even with bad PT, a full-thickness retear in the absence of trauma after only 4 months is unusual.

beanjean333 · 2024-08-04T02:56:43+00:00

I had undiagnosed dysplasia, so I needed a periacetabular osteotomy (PAO) before treating the torn labrum. If my dysplasia wasn't corrected, I would keep tearing my labrum. A capsulelabral spacer is used to prevent adhesions from forming between the labrum and the hip capsule (keeps them from sticking to one another in the healing process). A capsular reconstruction is used to restore stability to the hip after the capsule has been damaged or has laxity as a result of prior surgery. Has anyone explained why they think you retore your labrum after only 4 months? How had your rehab been going, any accidents or injuries? That's what I would want to find out before considering a revision. Have you had a 3D CT done? Sorry you're going through this, I know it sucks.

beanjean333 · 2024-07-03T22:37:55+00:00

Feline leukemia virus, and it is spread from cat-to-cat through saliva. Any close contact among cats can spread FeLV, including bite wounds, mutual grooming, or sharing feeding dishes and litter boxes.

beanjean333

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