1. PeriAcetabular Osteotomy 28 y/o lady with severe left hip pain. 28 y/o lady with severe left hip pain. Pain for 6 years, no clicking in hip. Pain for 6 years, no clicking in hip. Unable to exercise due to pain. Unable to exercise due to pain. On PE, positive Stinchfield and FADIR tests. On PE, positive Stinchfield and FADIR tests. On PE, hip flexion at 90 degrees with IR of 10 degrees., Right hip IR is 25 degrees. On PE, hip flexion at 90 degrees with IR of 10 degrees., Right hip IR is 25 degrees.

2. Pre-Op x-rays CEA= 28 degrees

3. Pre-op Abduction and Internal Rotation False Profile left Hip

5. 1 st Osteotomy Anterior Ischium

8. PAO

10. 2 nd Osteotomy Pubis

13. 3 rd Osteotomy Anterior Ilium to 1 cm from pelvic Brim

14. Osteotomy #3

15. Osteotomy #4 Intrapelvic from Ilium towards Ischial spine parallel to greater sciatic notch

19. Osteotomy #5 Complete Ischial osteotomy from intra-pelvic area and anterior to posterior column.

22. Mobilizing the Fragment

25. PAO

30. Fragment in final Position No crossover Sign

31. PAO

32. Fixation from anterior ilium to posterior column with a 3.5 mm cortical bone screw

33. PAO

35. Final Fixation 2 more 3.5 cortical bone screws from iliac crest into fragment!!

36. PAO

42. CEA 28 degrees CEA 43 degrees PAO