Thursday, September 27, 2012

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 at the Monmouth County SPCA in Eatontown, NJ.  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.


Sue is also the author of a fantastic book on physical therapy, Physical Therapy And Rehabilitation For Animals: A Guide For The Consumer.  

Physical therapy can do so many great things for your dog. Understanding all the possibilities physical therapy can offer will change your dog's life. This book definitely belongs on the shelf of every dog lover.



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 
It's Not Just Walking, It's Therapy! 
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part I)
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part II Physical Therapy)
Range Of Motion: It’s A Matter Of Degree…
The Weight Of Water And How It Helps Dogs 
By Land or By Sea? A Comparison of Canine Treadmills 
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part I)
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part II) 
Scar Tissue: Is it Too Much of a Good Thing? 
Physical Therapy Tip Of The Month: Ramps! 
Physical Therapy Tip Of The Month: Indoor Duo Dog Exercises!
Physical Therapy Tip Of The Month: Best Practices After Your Dog’s Surgery

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

8 comments

  1. This was a terrific post! Right now we are facing such a difficult time with our basset and going through our options for Fred as his hips are soooo bad and the vet explained FHO the less costly but no going back option. I think this post is so great at explaining exactly what FHO is and what it entails. Thanks for a great post!

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  2. It was so nice seeing blogs about other cats and dogs with FHO surgery, so I started my own blog about my cat Mo's FHO.

    He is doing sooo well about 3 months post-op and I would recommend this surgery to absolutely everyone! My cat is definitely pain free.

    To read about our journey post femoral head ostectomy, go to mofhosurgery.blogspot.com!

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    1. Glad to hear your baby is doing well after the surgery. Thank you for sharing your link.

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  3. Thank you for this post. I am just starting the research as my dog had his first appt at UC Davis for his hip dysplasia (now called Degenerative Something or Other).

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  4. I am beginning my research on this surgery as my 8-month old lab, who is about 62 lbs., got hit by a car yesterday and we found what looks like a pea-sized fracture near the growth plate near the top of the femur bone on his back left leg. The surgeon says we may want to wait on the surgery, perhaps not do it all, and crate rest my dog for 6 to 8 weeks. There is a possibility he may heal o his own if he doesn't move his leg too much. This is going to be tough and sad as this is a very hyper lab. My husband thinks this may affect his personality in a negative way, by confining him to a small place for so long. He even said it may be abusive? Obviously, I'd try and make the crate as comfortable as possible and would be with him and care for him like a baby, but it is totally against the dog's personality. The ortho. surgeon, though, said the operation is not a guarantee. She admitted we are in a tough spot.

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    1. Hi Aimee,

      sorry about your dog. Crate rest is often used with injuries or with post-op and it is very hard on everybody indeed. With some conditions, such as heartworm treatment, such approach is a must and question of life and death.

      The main things to consider is to have the crate in such place so he can still be close to everybody and not feel excluded.

      When Jasmine was recovering from knee surgeries, I slept on the main floor with her so she was never alone at any time.

      Now, Cookie has been recovering from iliopsoas injury and was ordered strict rest as well. Though we did not crate with that. However, she is an extremely active girl and I KNEW that such drastic reduction of activity was not going to work and she'd end up depressed or jumping out of her skin.

      We voiced our concerns right there and Cookie has been on Trazodone to facilitate what needed to be done. It's been working well keeping her calm and undepressed. You might want to ask about this and look into it. Many behaviorist use it by also many surgeons use it to facilitate post-op.

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  5. We are looking at rescuing a dog. The group we are working with has suggested an 8 month old mixed breed dog of about 35 pounds. They said she recently had femoral head resection due to a hip defect at birth. Thoughts? This is our first dog and we are concerns about taking on too much...

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    1. A first dog, particularly a young one is always a steep learning curve. Learn all you can about the surgery; there is a FB group called Orthodogs and I'm sure there are a number of people who's dogs had this done and would be happy to talk to you.

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