Understanding Femoral Head Ostectomy (FHO): A Guide for Pet Owners

A common orthopedic procedure that we perform in dogs and cats is the Femoral Head Ostectomy (FHO), also known as a Femoral Head and Neck Excision. This surgical option is commonly used to treat various hip problems in both dogs and cats, offering relief from hip pain and improved mobility. FHO involves removing the head and neck of the femur (the ball part of the ball-and-socket hip joint), allowing the body to create a "false joint" made of scar tissue. While it may sound drastic, FHO can be a life-changing solution for pets suffering from conditions like hip dysplasia, Legg-Calvé-Perthes disease, or traumatic injuries.

What is a femoral head ostectomy (FHO)?

Femoral head ostectomy (FHO) is a hip surgery in dogs and cats used to treat various hip joint issues. To understand this, let's break it down:

• Femoral: Refers to the femur, which is the long bone in the upper leg (thigh) of your pet.
• Head: The "ball" part of the ball-and-socket hip joint, located at the top of the femur.
• Ostectomy: A surgical procedure to remove bone.

In simple terms, FHO involves removing the ball part of your pet's hip joint. This might sound alarming, but it's actually a well-established and effective treatment for many hip conditions.

The goal of FHO is not to recreate a normal hip joint, but to remove the source of pain and allow your pet to have a functional, pain-free hip.

After recovery, most pets can run, play, and enjoy a good quality of life, even though their hip anatomy is different.

I always tell people that once the hair grows back, the general onlooker would not know surgery was done.

When is the FHO surgery recommended for pets?

FHO surgery is often considered a viable option when your pet is affected by specific hip conditions that cause pain and affect mobility. These include:

• Hip dysplasia: This genetic condition causes the hip joint to develop abnormally, leading to looseness in the joint and eventual arthritis. It's more common in dogs, especially large breeds, but can also occur in cats.
• Severe arthritis: When the hip joint is severely damaged by arthritis, removing the source of bone-on-bone contact can significantly reduce pain. Only in severe cases, where the pet is not responded to medical management, would be recommend this option.
• Legg-Calve-Perthes disease: This condition, also known as avascular necrosis, which primarily affects small dog breeds, causes the femoral head to deteriorate, leading to significant pain.
• Traumatic injuries: Fractures of the femoral head or neck, or dislocations of the hip that can't be successfully repaired, may necessitate an FHO.
• Hip dislocation: Hip dislocations that can't be replaced or managed with other treatments might require an FHO.

FHO is often considered when:

• Other treatments (like medication, weight management, or physical therapy) haven't provided sufficient pain relief
• The pet is not a good candidate for total hip replacement due to age, size, health status, or financial constraints
• The hip problem is severely impacting the pet's quality of life

It's important to note that while FHO can be an excellent solution for many pets, it's not always the first choice. Your veterinarian will consider factors such as your pet's age, size, activity level, and overall health when recommending this procedure.

For smaller dogs and cats, FHO often produces excellent results. Larger, more athletic dogs might have better outcomes with other procedures, but FHO can still be a good option if other treatments aren't feasible.

Ultimately, the goal of FHO is to relieve pain and improve your pet's quality of life, allowing them to return to normal activities without the constant discomfort of a problematic hip joint.

How is the FHO procedure performed in pets?

The FHO surgery itself is a well-established and relatively straightforward procedure.

With that being said, although some experienced veterinarians can perform, most will refer to a board-certified veterinary surgeon to perform the FHO procedure.

The surgeon will begin by making an incision over the hip joint and carefully removing the femoral head. This eliminates the bone-on-bone contact that was causing pain and discomfort.

Afterward, the surrounding muscles and tissues will adapt to create a false joint, allowing for reduced pain and discomfort.

Post-surgery, your pet will require a period of rest and physiotherapy to ensure a successful recovery.

What to expect after your pet's FHO surgery

After surgery, your pet's comfort is our top priority. We'll create a tailored pain management plan to ensure they're comfortable enough to participate in important daily physical therapy sessions.

These therapy sessions are designed to restore your pet's full range of motion in the hip joint, especially focusing on extension movements. We'll encourage weight-bearing on the operated limb as early as possible, gradually rebuilding strength in the surrounding muscles.

Most pets begin using the leg within days or weeks following surgery, a testament to FHO's effectiveness in pain relief. However, full recovery and a return to normal activity levels can take several weeks to a few months.

This healing period is crucial for the formation of the false joint and the strengthening of the surrounding muscles.

Even after your pet seems fully recovered, maintaining a healthy weight and incorporating regular, low-impact exercise into their routine will ensure the long-term success of the surgery and prevent future joint issues.

What are the benefits of the FHO in dogs and cats?

FHO surgery in pets offers numerous benefits for pets suffering from chronic hip pain and mobility issues:

• Pain relief: The most significant advantage of FHO is its effectiveness in alleviating pain. By removing the damaged bone, the source of pain is eliminated, allowing your pet to move more comfortably.
• Improved mobility: With reduced pain, most pets experience a dramatic improvement in their ability to walk, run, and play. This enhanced mobility can significantly improve their quality of life.
• Faster recovery: Compared to other hip surgeries like total hip replacement, FHO recovery is generally faster. Many pets are up and moving within days of surgery, and full recovery is typically achieved within weeks to a few months.
• Lower cost: FHO is a more cost-effective option compared to total hip replacement, making it accessible to a wider range of pet owners.
• Lower risk of complications: Because FHO doesn't involve artificial implants, there's a lower risk of implant-related complications like loosening or infection.
• Long-term success: With proper post-operative care and rehabilitation, the results of FHO surgery can be long-lasting, providing your pet with comfortable, pain-free movement.
• Applicable to various conditions: FHO isn't just for hip dysplasia or avascular necrosis. It's a versatile procedure that can address pain and dysfunction caused by other hip conditions as well.

What are the potential complications of FHO surgery in dogs and cats?

While FHO is generally a safe and effective procedure, like any surgery, it carries some potential risks and complications.

One of the most common issues is related to inadequate rehabilitation. If your pet isn't provided with sufficient pain management and physical therapy, they may not regain the full range of motion in the hip joint. This can lead to muscle contracture, where the muscles around the hip become tight and limit movement.

In rare cases, there may be technical complications during the surgery itself. For example, if a portion of the femoral neck is inadvertently left behind, it can impede the formation of a smooth false joint. This can usually be corrected during surgery if detected.

Other potential, though less common, complications include infection, nerve damage, and luxation (dislocation) of the pseudoarthrosis (false joint). These are rare but can be addressed with additional treatment if they occur.

In conclusion, femoral head ostectomy (FHO) surgery presents a valuable solution for pets grappling with debilitating hip conditions. By removing the source of pain and promoting the formation of a false joint, FHO can significantly enhance your pet's quality of life. While not without potential complications, the benefits of pain relief, improved mobility, and a relatively swift recovery make it a valid option for many pet owners.

If you have any questions or are thinking about this particular surgery for your pet, please get in touch with your veterinarian.