PAO vs THR – What to do and when to do it?

PAO vs THR – What to do and when to do it?

A staggering number of adults are suffering with chronic hip pain due to undiagnosed hip dysplasia. These adults, on average, see more than 3 physicians during the span of 5 years before receiving a diagnosis of hip dysplasia. Once diagnosed, they are faced with a tough decision, hip preservation surgery, such as a Periacetabular Osteotomy (PAO), or joint replacement surgery or a total hip replacement surgery.

If the adult is under the age of 45 and in overall good health then a PAO tends to be the preferred treatment option except when the joint deterioration is beyond repair. The PAO was first introduced in 1988 and has since become the most common hip preservation surgery worldwide. The PAO is considered a challenging surgical technique due to its complicated positioning and it is often referred to an orthopedic specialist who has experience treating patients with hip dysplasia.



Joint replacement or total hip replacement (THR) surgery is becoming far more common as our baby boomer generation begin to enter their later years of life. It is estimated that THR will increase by 174% by the year 2030. Scientific studies have also shown that 5% of all THR surgeries are due to hip dysplasia, and as many as 20% of all THR performed on an adult under the age of 50 are due to hip dysplasia. To complicate the matter even more, when hip dysplasia is present a THR surgery becomes more complex and should be performed by an experience orthopedic surgeon who has specific training and knowledge in the field of hip dysplasia.

A challenge comes when it’s time to make a decision. If the patient is eligible for a PAO then a PAO tends to be preferred. But, a question we often hear is “if I am not eligible for a PAO, how long should I live with chronic pain before I get a THR surgery?”. This is not a simple black or white answer. A person’s age, overall physical condition, pain level and the condition of the hip joint are just a few of the variables that complicate this problem. It’s generally best to preserve your own hip when possible instead of inserting artificial components that wear out or break with use. That’s especially true for younger people because the artificial parts need to last longer, and younger patients tend to be more active and that puts more stress on artificial hips.


To learn more about hip preservation surgery such as a PAO, click here.

To learn more about hip joint replacement surgery such as a THR, click here.


Luo, Dian-Zhong, et al. “Efficiency and Accuracy of Bernese Periacetabular Osteotomy for Adult Hip Dysplasia.” Orthopaedic Surgery, vol. 7, no. 4, 2015, pp. 375–377., doi:10.1111/os.12202.

Kurtz, Steven M., et al. “Future Young Patient Demand for Primary and Revision Joint Replacement: National Projections from 2010 to 2030.” SpringerLink, Springer-Verlag, 10 Apr. 2009,