Femoral Head Ostectomy (FHO) versus Total Hip Replacement (THR)
The debate about doing FHO or THR is often endless. When speaking to most board certified surgeons, the THR wins; but in my opinion it is very much case dependent. As board certified surgeons we are trained to recreate the normal anatomy, which makes sense as the normal anatomy usually gives a pretty good outcome! However, just because we can, does not mean we always should. The more technically challenging and precise a surgical procedure is, the more diﬃcult it is to do in smaller patients.
Small dogs and cats tend to have an excellent outcome with an FHO so why put them through a technically challenging surgery and the owners through an expensive procedure if both can achieve a positive outcome. I understand that the cat with the totally hip will now have an anatomically normal hip, that might have a more complete range of motion than an FHO hip, well providing the surgeon managed to get the angles correct of course. I guess it depends what we are striving for: to rebuild the patient? Or to create patient with a pain-free near-normal gait? I leave you with some facts below and then some patient selection ideas below.
- Technically simpler procedure, not as much expertise required
- Minimal training and instrumentation required
- High success rate with good case selection and proper post-operative exercise
- Aﬀordable for most people
- Requires a longer rehabilitation period (in general), especially in chronic cases and if looking to a near normal recovery.
- Because minimal training is required to do the surgery; the need for good post operative exercise program is often overlooked, unappreciated
- Complications requiring a second surgery are
- Faster post-op recovery
- Technically a recreation of the normal anatomy
- High success rate with excellent outcomes in the hands of an experienced
- More costly
- Much more diﬃcult technically
- Diﬃcult to find a properly trained/skilled surgeon with experience
- Complications tend to be complex often requiring more than 1 surgery and often result in removal of the implants.
Suggestion on case selection:
FHO: Small to medium sized patients; conditions that are not very chronic. In this situation, very chronic means years in the making like severe OA due to hip dysplasia. Avoid: large breed dogs, maybe about 60 lbs or greater but note that size should not be the only consideration).
THR: Large (like golden retrievers and the heavier style Labradors) and giant breed dogs. Patients with very chronic conditions like the dog with chronic OA secondary to hip dysplasia.
Avoid: having this surgery done by a non-boarded surgeon; when you find a boarded surgeon trained to do THR ask how many cases they have done, how frequently. Even if you are trained to do this surgery, doing it once every 3 years does not let you get good at it. Beware!
I may come across like I’m a bit down on the THR. I am not, I REALLY like the procedure. I just don’t think that it’s the “be all and end all” and that anything other than a THR is a “lesser procedure”.