Rising star editorial: Periacetabular osteotomy-Reliable outcome and expanding indications

Periacetabular osteotomy has evolved from a procedure limited to developmental dysplasia of the hip into a versatile joint-preserving surgery for a wide range of acetabular pathomorphologies. Large-scale studies have demonstrated its effectiveness in improving pain, function and quality of life, with long-term survival rates approaching 68% at 20 years, though modern refinements likely yield even better results. Apart from a precise technical execution, its success depends on patient selection: while patients over 40 years old were once considered contraindications, recent evidence shows that outcomes are more closely tied to the absence of preexisting arthritis than to age. Indications have expanded to acetabular retroversion and borderline dysplasia and advances in imaging and technique, such as limited soft-tissue dissection and refined pubic cuts, have improved safety and recovery. Furthermore, technical innovations like augmented reality promise to further enhance surgical precision in the future. Level of Evidence: Level V.