FEMORAL HEAD AND NECK OSTECTOMY (FHO)
Femoral head and neck ostectomy (fho) is performed to relieve pain and restore function to a hip that cannot otherwise be surgically corrected and for which medical therapy (time, pain control) is insufficient. Problems that can be relieved by fho include hip fractures, hip dysplasia, hip dislocations, and degenerative conditions such as Legg-Calves-Perthes disease.
PROCEDURE FHO involves cutting off the femoral head (the ball of the ball-and-socket hip) and removing it. A scar forms in the remaining space, effectively creating a false hip. This procedure allows an improved range of motion of the hip, and relieves the often-severe pain due to bone-on-bone contact.
RECOVERY Unlike most other orthopedic surgeries, the patient is encouraged to use the operated leg as much as possible as soon as possible. This enhances the quality of the scar that forms the false joint. We use pain relieving medications and medical procedures, nutritional management, and physical rehabilitation to enhance the recovery process.
Pain relieving medications commonly include a prolonged course of antiiflammatory medicine and a short course of a pure pain reliever. Medical procedures can include cryotherapy (cold compresses) for 10 to 15 minutes per day beginning on day one after surgery and continuing for three weeks, longer if needed, and laser therapy. We provide each patient with a recommended schedule of laser therapy.
Nutritional management typically includes weight loss down to an ideal lean weight (do not underestimate the value of maintenance of an ideal lean body weight - we have found it is tremendous!) and fatty acid (fish oil) supplementation for antiinflammatory effect.
Physical rehabilitation includes both passive range of motion exercises and active therapeutic exercise. Passive range of motion exercises are performed by holding the patients leg below the ankle and slowly and steadily flexing and extending the leg to the fullest extent that the patient will allow. The exercises begin on the day after surgery and continue for 15 minutes a day until the patient has returned to normal function.
We have found that most patients who are provided with the analgesic medications and nutritional support previously described perform their own therapeutic exercise. That is, they make steadily increasing use of the operated leg as the first several weeks post-op pass by. For the occasional patient that is persistently reluctant to use their leg, we recommend: 5 to 10 minutes of walking and swimming starting on day 1 after surgery, 5 to 10 minutes of balancing, obstacles and weaving starting on day one, 5 to 10 minutes of circles and hills added in starting on day 15, and 5 to 10 minutes of stairs, jogging, and running added in starting on day 21. All therapeutic exercises are continued until the patient has reached their individual peak performance.
Routine progress exams at two weeks and two months post-operatively are included with the surgery cost. We are glad to do a recheck exam at any other time you think your pet needs one.
COMPLICATIONS Complications are very uncommon with FHO. Complications can include: dehiscence (opening of the surgical incision), nerve damage, infection, bleeding, and failure to significantly relieve pain and improve range of motion.
We have infrequently encountered patients who seem to develop excessive contracture and stiffness of the muscles and soft tissues around the operated hip, and we have found that we can often help these patients with the following procedure: we anesthetize the patient, firmly move the hip through it's full range of motion repetitively until it does so easily, and then we increase the patient's pain relieving medication for two weeks.
PROGNOSIS / EXPECTIONS Most pets will carry the operated leg for 2 weeks or less after surgery.
The majority (to attach a number, just for perspective, we would say 90%) of dogs and cats that have FHO ultimately make a good to excellent recovery. Pets vary in how long they take to achieve this recovery; we have had patients that are walking and running on the operated leg within two weeks of surgery, and other patients that took more than a year to become maximally comfortable.
In our opinion, how well a pet ultimately recovers ultimately depends on two factors, weight and energy level. Pets that are maintained at a lean body weight recover more quickly and thoroughly. Pets that have a high energy level are pets that are more interested in being active when they have the opportunity to do so, or are more easily encouraged to be active. These pets will walk and run on the operated leg without hesitation, and their activity will allow them to build and maintain strength and flexibility, which in turn allows them be more active, and so on.
Small dogs and cats will sometimes not use their operated leg because they are very agile on three legs, presenting a different challenge. This challenge can usually be met with a combination of medication and physical therapy.
FHOs ON BOTH HIPS IN ONE SURGERY We sometimes have patients that require an FHO on both hips. It is generally very reasonable to have both FHOs done as one surgery. Dogs that have this procedure typically need 1 week or less before they are walking without assistance. After this time their recovery progresses in much the same way as that of pets that have had one leg operated on.
A 2005 veterinary study evaluated the recovery of dogs that had both FHOs done as one surgery. Twelve dogs were followed for 6 to 48 months after surgery, and the recovery of all twelve was rated as good to excellent.
At YVC, up to one week of hospitalization is included in the cost of the surgery for patients that have both hips operated on as one surgery.