Ambulatory Veterinary Surgery

FEMORAL HEAD AND NECK OSTECTOMY

Femoral head and neck ostectomy (FHO) is a nonreversible surgical procedure performed on the hip joint for a variety of conditions.   Its primary purpose is to relieve pain associated with abnormal joint anatomy or function. Pain is relieved by elimination of bony contact between the femur and the pelvis through the formation of a fibrous false joint.   Because of slight limb shortening and some loss of range of motion, some gait abnormality persists.   Although it is classified a salvage procedure, it is a valuable method for improving the quality of life for many pets by elimination of pain.

Activity:    Early, active use of the limb is necessary to maintain range of motion and promote formation of a false joint.   Passive range-of-motion exercises should be performed four times daily - with 20 to 30 repetitions per session.   This is started immediately and continued until the dog or cat can weight bear at a run, in which case it is doing its own physical therapy.   Leash walking and freedom for the animal to move about a confined area are encouraged until suture removal.   After 2 weeks postoperatively, active exercise such as running and swimming is encouraged.   Animals will ordinarily be toe touching by 10 to 14 days, partially weight bearing in 3 weeks, and using the leg by 4 weeks.

Prognosis:    Return to active and pain free use of the limb depends on the duration of the condition, and the severity.   Animals receiving operations for acute trauma, such as head and neck fractures, may be functional within 30 days. Those having chronic dysplasia with long‑standing pain and muscle atrophy may require 6-10 months or more. These animals benefit particularly from swimming as an exercise.  Patients with markedly displaced joint fractures and some with chronic dysplasia may never again regain good function.

• Analgesics ( such as NSAIDs and Narcotics ): Used judiciously, they allow for early and more comfortable rehabilitation

• Cryotherapy (Cold Pack ): To decrease pain and inflammation, PROM is followed by an application of ice packs to the operated hip( s)  for 5 to 10 minutes per session
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• Standing and controlled leash walking: Have the patient stand and bear weight on the affected limb(s) to encourage weight bearing.  Perform a controlled walk for 1 to 3 minutes  2 to 4 times per day as tolerated.  Use a sling if needed.

• Warm pack: Apply to the hip joint(s) prior to massage and PROM ( 5 to 10 minutes).  Wet towels placed iln the microwave can provide moist heat for a short time period.  Adequate care must be provided to prevent burns.
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• Massage: Following warm packs and prior to exercises, 5 minutes at each session.
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• PROM: Gently flex and extend each joint, 5 repetitions 2 to 3 times per day after warm pack and massage.
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• Leash walking: Walk in a controlled walk ( at heel position ) 5-10 minutes 2 to 4 times per day BEFORE warm packs and PROM
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• Swim therapy: 3 times per week for 10 to 15 minutes.  Underwater treadmill to encourage weight bearing.
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• Cryotherapy: After exercise for 5-10 minutes to decrease pain / inflammation.
  

• Warm packs / range of motion exercises: Use to begin each therapy session.
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• Contralateral limb lift exercises: Hold one limb off the ground for 30 seconds to 1 minute so the patient will stand on the opposite limb.  10-15 repetitions per leg  2 times per day. 
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• Sit to stand exercises: Using food as incentive, ask the patient to sit and then stand without walking forward,       10    repetitions 2 times per day
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• Walking in reverse: With food as a treat, stand in front of the patient and ask him to step / walk in reverse by moving the food treat toward his mouth.  5 to 10 steps back, 2 to 3 times per day. An alternative to this is reverse dancing exercises, where the dog is held up on its’ hindlimbs and the forelimbs are supported by the therapist as the dog dances backwards.
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• Cavaietti: Set three to four 2X4’s or poles on the ground approximately 1 to 2 dog lengths apart and no higher than 4 inches.  At a very controlled speed, walk the patient over the poles 3 times as part of his daily walking,
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• Circles: Using food as a treat, ask the patient to circle  ( nose to tail ) several times.  Do this in both directions 2 to 3 times per day.
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• Foam walking: Using a long piece of foam, or a material that is unstable such as an air mattress of trampoline, have the patient walk across the material, 3 to 10 times twice daily.
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• Cryotherapy: After exercise sessions, apply cold packs to the affected hip(s) for 5 to 10 minutes