Femoral Head Ostectomy (FHO)

Femoral head ostectomy (FHO), also known as femoral head and neck excision (FHNE), was developed over 50 years ago as a salvage procedure to treat hip problems including hip OA from hip dysplasia. The human counterpart procedure is called a Girdlestone procedure which has largely been rejected as a viable procedure except in extreme circumstances and in third world countries. 

The FHO procedure involves surgical removal of the femoral head and neck. Removal of the femoral head is supposed to eliminate pain by creating a space between the pelvis and the femur. During the post-operative recovery period, a “false-joint” develops as scar tissue matures between the femur and acetabulum thereby reducing bone-on-bone contact and rubbing during motion. The procedure can be perform either unilaterally or bilaterally (staged or at the same time).

Dogs that have received FHOs walk and run with an abnormal gait because the biomechanics of the “ball-in-socket” joint are totally destroyed. Although dogs can function with FHO, FHO is functionally inferior to total hip replacement (THR). Literature reports with objective data conclude that about 40% of dogs with an FHO function satisfactorily, about 20% are functionally unchanged, and about 40% function poorly with continued problems or are worse than before surgery.

FHO is functionally inferior to total hip replacement.

The long-term success depends largely on early and sustained postoperative physical therapy. Rehabilitation exercises are initiated within days after surgery for continue for months. Rehabilitation techniques include passive range of motion (PROM), underwater treadmill exercise, swimming, weight shifting exercises, and other joint and muscle exercises to ensure adequate range of motion, muscle mass development, and improved function.

FHO is a low risk procedure. The trade-off is the high risk of dysfunction. With this understood, this is occasionally the choice for some animal owners who are highly risk averse. With that in mind, a risk with FHO is whether or not the procedure will actually improve the overall circumstance of hip dysplasia. Each condition, such as hip luxation, Legg-Perthes Disease, fractures, arthritis, and so forth should be considered individually on whether or not an FHO will be helpful. THR is usually a much better option.

• Complications from FHO surgery include:
• Leg length discrepancy (always)
• Persistent lameness
• Prolonged recovery
• Abnormal gait
• Muscle atrophy
• Reduced range of motion of the hip
• Infection
• Painful femoral neck / acetabulum rim contact

All of these complications can occur in young, middle age, or old dogs – small, medium, and large breeds - and even in cats. Due to the fact that the FHO procedure involves the complete excision of the head and neck, it should only be performed when owners are well informed about other surgical options as well as the advantages and disadvantages of all treatment options. Reversing a FHO to a THR is possible in some instances, but this option should never be relied upon during the initial surgery decision making for dogs with hip dysplasia.

FHO involves the complete excision of the head and neck. It should only be performed

when owners are well informed about other surgical options as well as

 the advantages and disadvantages of all treatment options.