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 , 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


  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!

  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!

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

  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).

  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.

    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.

  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...

    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.

  6. Hello! We are at a loss here, Jana, you sound like the perfect person to ask! Our rescue pup was hit by a car as a pup, one hind leg is lame and the other hind leg has the dislocated hip. Would you recommend FHO? I'm so worried about stability as its her only good leg. I hear restorative surgeries though require good hip alignment and balance, which she doesnt have. Help! Forever grateful, Whitney

    1. Hi Whitney, sorry about your pup. Obviously, I cannot make any recommendations regarding whether or not to do surgery. I am not a vet and I wouldn't have nearly enough information.

      What I do recommend, though, is to find a great orthopedic specialist and have them evaluate the situation. Veterinary medicine can do close to miracles these days.

      What you need is somebody to thoroughly evaluate the pup and give a recommendation. With the situation being this complex, I'd likely want evaluation from two independent specialists and I'd want to discuss all potential options.

  7. Our GSD was about 11 months old when she had her first hip surgery (Femoral Head Osteotomy)/.... If all goes well the other will be done down the road. It was obvious at 6 months that she was going to have hip problems and a trip to the vet/x-rays proved it. She's just short of 3 months post-op. Tough to keep a young pup from wanting to play and rest is very important to the recovery for this surgery. She's had her good days and then some days of obvious discomfort.... even this far post-op. My guess is that she aggravates the hip when forced to correct her slipping on a tile floor and the weak joint/lack of structure leads to this discomfort. Praying for full recovery, but understand that we may have to settle for 80% or so normal function from the leg.

    1. Praying for full recovery as well. I'd definitely recommend taking steps to eliminate any slippery surfaces. After Jasmine's knee injury we plastered all floors with rugs. Or, you can look into ToeGrips. That would absolutely aid with smoother recovery.

      If having a hard time keeping her calm, which I imagine would be the case, could also discuss with your vet the use of Trazodone to calm her down. We used that for Cookie and worked great. It's been initially used by behaviorists but now more and more utilized by surgeons to facilitate post-op recovery.

      You also want to look into some physical therapy, cold laser therapy and things like that.

    2. How did your pup do with the second fho. We are faced with this decision currently. The first fho was about a year ago. Does your pup kinda of hop in the back now, and step in the front? Thank you

    3. I don't know if the comenter will respond but I have seen dogs with both hips done who were doing quite well.

  8. Hi Jana, Im waiting to take my kelpie to the vets (long travel) but looking for info in meantime. She is recovering after fho, she was pain free and bearing weight more and more and we were slowly upping the reps and walking distance all was going very well, shes been home from vets a week but surgery was approx four weeks ago.

    My worry is she has hurt it somehow and is now very reluctant to bear weight preferring to walk on three legs. with massage and ROM exercises seeming to give her pain. We continue to walk her, heat and massage. but with not much success on four legs, hence vet tomorrow.
    There is a lumpy spot behind her knee in her muscle, im hoping its a knot/trigger point/ stiffness issue but worried she has done damage around the surgery area due to how it feels under my hand during rom., is there much that can complicate after fmo? I notice at the top of the thigh there is a grinding when doing ROM, which doesn't feel good. Any ideas or info would be great.

    1. Every surgery has potential complications ... could well be a muscle or something else. Unfortunately, it's impossible to theorize - it needs hands-on.

      Complications of the surgery include loss of range of motion of the hip joint, continued lameness, muscle weakness, unwillingness to exercise and nerve damage.It can sometimes take 6-8 months before use of the operated leg appears normal, and some dogs never have a normal gait on the operated leg. However, this does not necessarily mean that they are painful. With removing the joint, there are a number of changes in the way that force is transmitted through the leg, but they are usually not painful on movement of the false joint.

      It is possible, though, that there is a injury in another area such as the knee. You need to see what the vet says.

      Wishing a good recovery.


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