Femoral head and neck ostectomy (FHO) is a commonly performed procedure for surgical treatment of traumatic and chronic conditions affecting the hip.
The option to do an FHO is typically presented along with other surgical alternatives. Some surgeons see it as a last resort or a “salvage” procedure, whereas others believe it to be a primary recommendation for many orthopedic diseases of the hip.
Common indications for an FHO include:
- Femoral head and neck fractures
- Catastrophic acetabular fractures
- Coxofemoral hip luxations
- Failed total hip replacements
- Chronic pain associated with hip degenerative joint disease (including traumatically induced disease, Legg-Perthes disease, and canine hip dysplasia)
Excision of the femoral head and neck palliates pain by eliminating bony contact between the pelvis and femur, allowing formation of a pseudoarthosis. The pseudoarthrosis that forms comprises dense fibrous tissue lined by a synovial membrane.
A thorough review and understanding of the craniolateral approach to the hip is recommended. Preservation and reconstruction of the supportive soft tissues are keys to a quick return to ambulation and long-term function. Recognition of the origin and insertions of the hip musculature is especially important if the FHO is performed on a hip that is luxated or traumatized.
FHO = femoral head and neck ostectomy
The procedure has the best outcome and is typically recommended for mature pets and dogs weighing < 17 kg; however, physically fit dogs of all sizes tend to rehabilitate and respond favorably regardless of their weight. In addition, muscle mass has been found to be one of the most important variables in determining outcomes of the procedure.
Postsurgical FHO patients have some degree of limb shortening and gait abnormality; however, with aggressive rehabilitation, these animals have been reported to respond well to the procedure and return to an active lifestyle.
The animal should be routinely anesthetized using a premedication, an induction agent, and gas anesthesia; then placed in lateral recumbency with the affected limb hung and aseptically prepared for surgery (A).