Reverse PAO Is a ‘Powerful Method’ for Treating Global Acetabular Retroversion

A 21-year-old male presented to Cleveland Clinic’s Center for Hip Preservation for treatment of symptomatic left hip pain, which developed over time in his occupation as a heavy manual laborer.

The patient’s physician, Atul Kamath, MD, who is also director of the center and staff surgeon in the Orthopaedic and Rheumatologic Institute, notes that anteroposterior imaging showed that the patient was skeletally mature. And while the cartilage on his left hip was preserved, Dr. Kamath also noticed a crossover sign, indicating acetabular retroversion, a posterior malorientation of the acetabulum. Acetabular retroversion can predispose patients to femoroacetabular impingement and is a risk factor for early-onset osteoarthritis of the hip.

Planning the right approach

Given the global acetabular retroversion, the procedure could not be accomplished by a simple rim trimming of the cranial aspect of the socket through an arthroscope. As Dr. Kamath explains, “This would cause insufficiency or a lower volume socket that might cause secondary or iatrogenic instability of the hip.”

The procedure and outcomes

Dr. Kamath chose to address the complex deformity with introverting, or reverse PAO (anteverting periacetabular osteotomy), where the shape of the socket is manipulated to create more effective anteversion and dramatically increase range of motion. “This offers a powerful method for treating the impingement within the hip, and then also affording more normal biomechanics given the anteverted socket,” he says.

Dr. Kamath notes that postoperative imaging demonstrates elimination of crossover sign and fixation through the PAO. The patient is doing well and was able to return to his work with great functional improvements and decreased pain.

Video case study

To learn more about the case and see preoperative images, watch the video below or visit Cleveland Clinic’s YouTube channel.