Great (Or Not So Great) Expectations with Femoral Head Osteotomy (FHO) Part (I)

by Susan E. Davis, PT

Femoral head osteotomy (FHO) is the surgical excision (removal) of the ball and neck of the femur, at the hip joint.

It is used in cases of advanced hip dysplasia where the hip joint has also become arthritic, in complex fractures and for cases of avascular necrosis (lack of blood supply to the bone). A genetic condition called Legg Calve-Perthes, seen mostly in toy breeds, is an example of avascular necrosis.  

When I get a new referral to see a canine patient post-FHO, two immediate questions come to mind: 

1. How long ago was the surgery and 
2. Are the dog parents realistic in their expectations of the outcome?  

From experience I know that if the parents have waited a month or 2 (or longer) after the procedure to call me and/or are expecting their dog to walk as well or better than before the surgery, I am about to face some heat!

FHO is not the only option for these conditions, but it is probably the most commonly chosen.

If you think I don’t sound like a fan of the FHO, you are right.

Nobody, even the surgeon, is a fan of FHO. 

This is because it is a non-reversible “salvage” procedure and not a truly corrective one. Given the other options available, however, it is usually a very practical choice!
       
Other options include:

• Triple pelvic osteotomy (TPO) available for young dogs up to 1 year of age and involves cutting and re-positioning the bone and re- angulation of the joint
• Total hip replacement (THR) inserts an artificial hip (endoprosthesis), and is used in dogs over 1 year of age.  

Both options have a high success rate, but involve longer recovery and are much higher in terms of cost. 
The FHO becomes, if not the optimal treatment of choice, an economical solution with a shorter recovery period.  

It is performed more on smaller dogs, less than 40 pounds and it is not as highly recommended for large dogs.

The key is to understand why it is being done and what to expect afterward. 

When the hip joint is damaged by one of the conditions described above and conservative measures have not been effective, the hip will continue to worsen without surgery.  By “worsen”, I refer to degenerative changes as arthritis, fragmentations and bone spurs which will become painful and debilitating for your dog.

When the FHO is performed, the removal of the head and neck (the” ball” portion of the hip) allows a false joint to form in place of the normal ball and socket. 

Photo OrthoVet Super Site

From that point on the “hip” is biomechanically altered and the leg becomes shortened. Even with physical therapy and rehab, there can be some recurring deviations and lameness in gait with less weight borne on the leg than before the surgery.

Many times I have heard a dog owner state “My dog seemed to walk just like this or better before, so why did I have this done?

My response is “Your dog is now free from pain and secured from future crippling” arthritis and degeneration”.  

Though, with FHO, the return to full function is guarded, the quality of life is enhanced, and the owner still has his/her retirement savings intact.

***
Susan E. Davis (Sue) is a licensed Physical Therapist with over 30 years of practice in the human field, who transitioned into the animal world after taking courses at the UT Canine Rehabilitation program.  She is located in Red Bank, New Jersey.

She has been providing PT services to dogs and other animals through her entity Joycare Onsite, LLC in pet’s homes and in vet clinics since 2008.

She also provides pro bono services each week to a shelter and sanctuary for neglected and abused animals.  Sue is the proud “dog mommy” to Penelope, a miniature Dachshund with “attitude”.  For more information see her website www.joycareonsite.com , or follow on Twitter @animalPTsue.

Further reading: 
Femoral Head and Neck Excision


Related articles:
You Say Hip Dysplasia, I Say Knee Injury ... Forrest Gumbo's Story
From The Case Files: Hunter's Hip Dysplasia Was Nearly A Death Sentence 
Hip Dysplasia Prevention And Treatment Options 
Hip And Elbow Dysplasia: Are They The Same Thing?
Just When You Thought You Knew Everything About Hip Dysplasia
Indy’s Struggle with Dysplasia

Articles by Susan E. Davis:
Functional Strengthening Exercises: the What, Why and How
One Thing Leads To Another: Why The Second ACL Often Goes Too
Compensation: An Attempt To Restore Harmony
Paring Down to the Canine Core
Canine Massage: Every Dog ‘Kneads’ It”
Photon Power: Can Laser Therapy Help Your Dog?  
Physical Therapy in the Veterinary World  
Reiki: Is it real? 
Dog Lessons: Cooper  
The Essentials Of Canine Injury Prevention: 7 Tips For Keeping Your Dog Safer 

The Challenge Of Degenerative Myelopathy (DM): Knowledge Is Power (Part I)
Degenerative Myelopathy (DM): Top 10 Management Suggestions (Part II)