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From: Marie M.
Date: 05 Oct 2001
Remote Name: 18.104.22.168
I chose to have a periacetabular osteotomy (PAO). I am 6 months post-op and my screws are ready to come out. The joint pain is gone and I am walking on my own. I still have some very minor discomfort due to the surgery itself that is not common. The very main reason I, at age 37, chose PAO over THR is that the materials used in THR can wear out and let loose debris from wear that can cause complications (osteolysis, need to review that myself but I think it leads to bone loss). You hear a lot of wonderful things about these new ceramic on ceramic artificial hips (I do not know if they are FDA approved yet).However, the stem used still has to adhere to the femur and that union there between artificial stem and bone, and the length of time it would last is still questionable. The ceramic parts may last forever, as some promise, but that union between artificial stem and natural bone is still uncertain in terms of duration. Perhaps I will need a THR later, true, but the earlier in life you have THR the more likely you are to need revision surgery because of modern life expectancy, we simply live longer. You might think a THR after a PAO is yet another surgery as if you had had THR first and now needed a revision. Isn't it the same amount of surgeries anyway? Yes, but their nature is very different. In THR, if something happens to the components and you need a revision, the likelihood of success becomes less and less each time the surgeon goes in to fix something. If you are going from a PAO to a THR, the PAO would have given you some years before needing an artificial joint. Hence, you would be starting with a brand new THR, with less revision surgery necessary because you gained some years with your own bones after an osteotomy. I do not think the number of surgeries is the issue, it seems to be how long will artificial components last, what other complications they might present and how many revisions you will need. You do not have that issue with natural bone which is what is worked with in osteotomies. Hence, the later you have THR the better. However, osteotomies are more likely to give a hip many years of use without the need for THR only if the level of arthritis is caught before it damages things beyond repair. That only an expert can determine. Hope I was clear in my opinion on the subject. But it is only an opinion. Only you can decide what chances you want to take and what kind of recovery you are willing to put up with. If you have any other wuestions feel free to post. Good luck.