Is the FHO really a salvage procedure?
The FHO is often referred to in the textbooks as a salvage procedure. This means that it is a last ditch eﬀort to save limb or life; a lesser choice procedure. If you take the standpoint that the FHO does not anatomically rebuild the hip joint, then it is a lesser procedure. Understand that as surgeons, we are trained to recreate the normal anatomy, after all, that is the original blueprint! However, as a clinician what’s more important is that our patients are able to enjoy an active life while being pain-free and drug-free.
The FHO does not anatomically rebuild the hip but it does provide a well functioning, pain-free repair option for many patients.
One of the KEY FACTORS for having a successful outcome with the FHO is ensuring that the patient gets the APPROPRIATE post-operative exercise. When I was doing my residency (although the dinosaurs were extinct by then, it was still a long time ago), we did FHOs mostly when all else failed (fracture repair failed or total hip was not an option for the client). It was truly employed as a salvage procedure. Although we encouraged motion and exercise post-operatively, we did not define it or pay much attention to it. So of course the FHO received a bad reputation: we did the procedure on “loser cases” and did not really pay attention to establishing a functioning hip post- operatively. Rehabilitation can make up for the anatomical deficiencies created by the FHO. Think of the FHO as a two part the treatment plan:
- Part 1: the FHO surgery removes the painful, fractured, diseased portion of the hip joint.
- Part 2: the post-operative exercises focus on rebuilding the soft tissues which support the hip joint so that it can function properly.
As a side note, according to Wikipedia: “Specialization in physical therapy (we’re talking human medicine now) in the US occurred in 1974”. It is not a very old discipline. The first talk on rehabilitation at the ACVS annual forum was in 1998 (that talk totally changed my approach to orthopedics!)
I now consider the FHO as a primary method of treatment for many coxofemoral conditions. Anatomically rebuilding a fractured femoral neck or head can be very challenging, especially in the smaller patients. If a procedure is challenging, then the complication rate is bound to be high and likelihood of a successful outcome lower. The FHO is technically less challenging and we know how to make it work well.
As with any surgery, selecting the appropriate cases on which to perform the procedure will also aﬀect the success rate.