What is the femoral head and neck ostectomy (FHO) procedure?

Femoral head and neck ostectomy is removal or excision of the ball portion of the hip joint. After
removal, the bone is smoothed so there is no bone to bone contact occurring between the pelvis and the
remaining portion of the femur. Removal of the portion of the femur that articulates with the hip joint
then causes formation of a false fibrous joint.

What are the indications for FHO surgery?

Femoral head and neck excision or ostectomy is a salvage procedure used in the treatment and
management of hip dysplasia, trauma, or other diseases of the hip. Hip dysplasia means malformation
of the hip joints. It is the most common orthopedic disease in dogs, and a similar problem occurs in
cats but much less often. The malformed hip will eventually develop some degree of arthritis and in
some patients, pain. With trauma, patients can have fractures of the femoral head and often FHO
surgery is indicated. There are other diseases of the hip, such as Legg Perthes’ Disease, where the
blood supply to the femoral head is abnormal and causes aseptic necrosis of the femoral head. In
instances like these, FHO surgery is indicated to remove the diseased portion of the bone.

How long will my pet be in the hospital?

Hospitalization of patients for FHO surgery typically ranges from 1-3 days including the day of the
surgery and recovery. In general, most patients are discharged 1-2 days after their surgical procedure
but extended hospitalization may be required if there are complications.

What is the prognosis following surgery?

In general, femoral head and neck ostectomy is highly successful in cats and small dogs (under 40
pounds). However, because this type of fibrous pseudo-joint is an unstable joint, clinical function is
more unpredictable in larger dogs, however utilizing power equipment that smoothes the cut bone
ends very well, pets as large as 120 pounds have done very well. Also, if your pet has severe arthritis
versus an acute fracture or luxation, the recovery is generally slower.

Alternatives to consider if you are unsure about having the procedure done on your pet include:

1. Acetabular denervation procedure – this procedure is performed to decrease the pain nerve
response from the nerves that innervate the hip by scraping the covering of the bone in the region
and promoting scar tissue. It is minimally invasive surgery that can be performed prior to an FHO
to see its response in the patient.
2. Hip replacement – this procedure provides an artificial hip that will replace your pet’s current hip
bones. It is generally performed in the larger patients and estimates generally in the past have run
5-6K.

What post-operative care is required after FHO surgery?

Post-operative care following FHO surgery is very different compared to most surgical procedures.
Physical therapy is crucial to the success of the procedure.  Swimming, running, playing with other
dogs, retrieving, etc is all encouraged starting 7
that will replace the hip joint will heal with a greater range of motion.

What are the complications or risks associated with FHO surgery?

Overall, complication rate associated with elective procedures is approximately 10 to 15%.
Complications may range from mild and easily resolved, to more severe complications requiring
further treatments or diagnostic testing.

Are any follow-up appointments required during the post-operative period?

In general, recommendations for suture removal are 10 to 14 days after surgery. Monthly evaluations
are then done to assess progression of healing and encourage physical therapy to increase the range of
motion within the hip joint. If your pet is using his/her leg normally, then no further appointments are
necessary.

Remember, due to the “false” joint that is created, the leg will be slightly shorter than the other leg
and your pet may have a “mechanical” limp which is very different from a “painful” limp and of no
concern other than cosmetic. Our goal is to give your pet good range of motion with a pain free hip
and it is hard to achieve a completely normal gait with this “salvage” procedure.

fho

 

 

 

 

 

 

 

 

 

 

 

 

The figure illustrates the portion of bone that is removed during FHO