Femoral Head Ostectomy in Dogs and Cats: How It’s Done, Prep, and Recovery

For dogs and cat with painful hip disease, a femoral head ostectomy (FHO) procedure offers an opportunity to bring them comfort.  

While FHO surgery isn’t the only option for pets with hip disease, it’s the most common and affordable.  

Here, learn what an FHO procedure is and what you need to know if you’re considering an FHO for your dog or cat.  

What Is Femoral Head Ostectomy in Dogs and Cats?

A femoral head ostectomy (FHO) is a common surgical procedure that tries to improve movement and reduce pain in a diseased hip joint by removing the femoral head and neck.  

The femur is the thigh bone. The hip joint is where the femur meets the pelvis and is called a ball-and-socket joint. The head of the femur is the ball, and the acetabulum of the pelvis is the socket. The head of the femur normally sits in the acetabulum. 

During an FHO, the head and neck of the femur are removed. By removing the femoral head and neck, bone-on-bone pain within the hip joint is reduced or eliminated. The dog or cat will form a false joint (pseudarthrosis) out of fibrous tissue, which allows them to continue walking. 

One thing to note is that you may hear the procedure called a femoral head and neck ostectomy (FHNO). When vets say “FHO” or “FHNO,” they generally mean the same thing. 

How Do Femoral Head Ostectomies Work?

FHO surgery in dogs and cats is done by some general practitioners and by specialty centers. 

The pet is anesthetized for the procedure to keep them pain-free and motionless. 

A cut is made on the side of the pet’s thigh over the hip joint. The muscles in the area are pulled back and the surgeon enters the hip joint capsule. The attachment between the head of the femur and the hip socket will be cut, and the hip is purposefully dislocated from the socket. Using either a saw or osteotome (a chisel for bone) and mallet, the femoral head and neck are removed. The edges of the bone are smoothed. The muscles and skin are closed over the hip joint.  

X-rays are usually taken after the procedure to ensure the results are acceptable. 

Why Would a Pet Need a Femoral Head Ostectomy?

FHOs are considered if the animal has pain or limping from a hip condition, especially if the condition isn’t improved by pain medications, weight loss, and other non-surgical treatments.  

FHO surgery may also be considered in pets who need a surgical treatment but cannot have a more specialized procedure, either due to patient factors or the pet parent’s finances. 

A pet might need an FHO if they have any of the following hip conditions: 

1. Hip dysplasia: Hip dysplasia is an inherited condition in which the hip joint doesn’t form properly, leading to looseness and instability in the joint. Over time, arthritis develops. This condition is more common in medium- to large-breed dogs. Cats are rarely diagnosed with hip dysplasia, though their numbers may be underestimated. 

2. Hip fracture: If there is a break of the femoral head, femoral neck, or acetabulum (hip socket), an FHO might be recommended to prevent pain from bone-on-bone movement and the resulting arthritis. 

3. Dislocated hip: FHO may be considered for an animal with a dislocated hip that will not reduce (realign) or if dislocation is recurrent. 

4. Avascular necrosis of the femoral head: Also called Legg-Calve-Perthes disease, this condition develops when the blood supply to the femoral head is cut off, causing the femoral head to necrose (have tissue death). This condition is most common in cats and small-breed dogs. 

5. Osteoarthritis: Osteoarthritis could develop from any of the conditions listed above, as well as other causes of joint inflammation (swelling). If arthritis pain is severe for the pet, the veterinarian may recommend an FHO.  

Side Effects and Risks of Femoral Head Ostectomy in Dogs and Cats

FHO procedures are likely to cause the following side effects: 

• Permanent limb shortening of the leg: This happens because the femoral head and neck are taken out. 

• Muscle atrophy on the affected limb: The pet is likely to bear less weight on this limb, causing muscle atrophy. Any damage to nerves can also cause muscle atrophy. 

Pets who undergo FHO may also have long-term lameness or gait abnormalities (changes to the way they walk).  

With dog FHO surgery, these abnormalities are usually more severe in large-breed dogs. Animals can also have reduced range of motion in the limb, which could affect their ability to jump and climb.  

Uncommonly, a pet will continue to be in pain after recovering from an FHO procedure. Some pets will also get stiffness because of scar tissue development. One way to avoid this is to follow the exact instructions for rehabilitation after surgery. 

Other risks include infection of the surgical site and damage to the sciatic nerve, which runs near the hip joint. 

Keep in mind that an FHO is a procedure done under general anesthesia. Anesthesia always comes with risks, such as anesthetic drug reactions or aspiration pneumonia. Anesthetic deaths are rare in dogs and cats and occur in fewer than 1% of cases, according to this study. Animals who are older, obese, or have co-existing health conditions may have a higher risk. 

Benefits of Femoral Head Ostectomy in Dogs and Cats

The FHO procedure helps dogs and cats in many ways. 

1. Reduces chronic pain by ending bone-on-bone contact 

2. Enhances mobility by reducing pain 

3. Improves quality of life for patients with hip conditions 

4. Is usually more affordable and more widely available than other surgical options for hip conditions 

5. No surgical implants needed (unlike total hip replacement) 

Effectiveness of Femoral Head Ostectomy in Dogs and Cats

FHO is considered effective, with more than 90% of dog and cat owners reporting satisfactory results, according to this article.  

Changes to a patient’s way of walking may be more noticeable in large-breed dogs who have had an FHO. Despite long-term gait changes, these large dogs often still have improved limb function and reduced pain after the procedure. 

Patients who are active and lean and have good muscle tone tend to recover better regardless of size.  

FHO is less effective in obese animals and sedentary animals. Cats and small dogs are generally considered better candidates than large dogs.  

The surgery may not give adequate results for dogs who enjoy high-impact competitive sports or athletic outdoor activities that require a full range of motion. 

Femoral Head Ostectomy Cost

Lemonade Pet Insurance reports that the cost of FHO per hip is around $1,200 to $3,000, while CareCredit reports that the average cost for dog FHO surgery is around $2,600 per hip.  

The cost for FHO surgery in cats is reportedly in the same range, with costs expected to be on the lower end of the range, about the same as for a small dog. 

Costs will be higher if the dog is large or if the procedure is done by a specialty clinic. Some non-profit or low-cost clinics may have veterinarians willing to do this surgery for a lower cost. 

Depending on the reason the pet needs an FHO, pet insurance may help to cover the cost. Policies commonly exclude pre-existing or breed-related conditions, so hip dysplasia may fall into this category for some policies. Hip fractures or dislocations are more likely to be covered. 

CareCredit, which is a credit card that can help with budgeting for your pet’s care, may also help. Check with your veterinarian to see if they accept CareCredit. 

Preparation for Femoral Head Ostectomy in Dogs and Cats

Your veterinarian will ask you to fast your dog before the procedure to reduce anesthetic risk. This generally means no food after midnight and no water a few hours before the procedure. Your veterinarian will give you precise instructions—be sure to follow those! 

You’ll also want to check with your veterinarian about any medications your pet is taking. Some medications, like blood pressure or nonsteroidal anti-inflammatory drugs (NSAIDs), may be skipped the morning of the procedure. Other drugs, such as thyroid medications or anti-anxiety medications, are generally still given the day of surgery. Follow your veterinarian’s instructions. 

You’ll want to be prepared for your pet’s return home and the recovery rules that follow. Ensure you have a comfortable bed for your pet to recover in, such as the FurHaven Velvet Waves or NonoPets Corduroy Fleece beds. 

For large dogs, you might consider buying a sling, like the Labra plush sling or Walkabout Walkabelly sling, in case you need to help support them as they recover.  

Block off access to stairs, cat trees, and other fall/jumping risks before your pet returns home. The Unipaws free standing gate could help. 

Post-Op Care and Recovery for Femoral Head Ostectomy in Dogs and Cats

While it generally takes only 10 to 14 days for the incision to heal, your pet’s recovery period will usually last for several months.  

Your pet’s recovery and the results of their surgery depend heavily on how well you follow your veterinarian’s instructions. 

Consider the following: 

1. Pain medications: Your veterinarian will prescribe pain medications, usually for at least a week after surgery. Examples of commonly prescribed pain medications include NSAIDs (such as carprofen or Galliprant) and gabapentin. Pain relief should be your primary concern for the first few days after surgery. Give medications as prescribed. 

2. Thermotherapy: Your veterinarian may recommend using an ice pack over the joint for a few days before switching to moist heat packs. General recommendations are to apply the pack over the incision for around 15 minutes two to three times daily. Always keep a protective layer between your pet’s skin and the cold or warm pack to avoid damage to the skin. 

3. Activity restriction: Strict activity restriction is usually recommended for several days after surgery. Your pet may need to stay in a crate or small room. If you have a dog that pees and poops outdoors, they should go on very brief leash walks for these tasks only. You may need to use a sling or other form of walking help, especially if you have a large dog. Your pet should not engage in rough play for at least a month. 

4. Passive range of motion: If your pet will allow it, you can try passive range-of-motion (PROM) exercises, gently moving the hip through its range of motion. Your veterinarian can give you instructions for doing PROM. You should not push your pet if they are in too much pain for PROM in the first few days after surgery. 

5. Return to activity: After the first healing phase, which is several days to a week, the veterinarian will recommend that you slowly start to reintroduce physical activity. The goal is to rebuild muscle while the false joint forms. If you don’t give enough activity, the scar tissue may form too tightly, resulting in reduced range of motion. Exercises your veterinarian may recommend including walking up and down stairs, walking on the hind limbs only, standing to sitting, and walking through water. Follow your veterinarian’s instructions and check with them before introducing any new activity. 

Recovery generally lasts about six weeks. If your pet is still struggling after that time, make sure to check in with your veterinarian.  

If you would prefer guided rehabilitation, ask your veterinarian for their recommendation about a certified rehabilitator for pets. 

Alternatives to Femoral Head Ostectomy in Dogs and Cats

While FHO is generally the most affordable surgical option for dogs and cats with hip joint disease, there are other surgical options a pet parent could consider: 

1. Total hip replacement (THR): THR is generally considered the gold standard for adult animals with severe hip dysplasia or arthritis. THR can also be used in pets with hip fractures. THR is also, however, the most complex and expensive choice, and it is generally done by surgery specialists. During the procedure, the hip joint is completely replaced with an implant. 

2. Triple pelvic osteotomy (TPO): This is a surgery done in young puppies (often 6 to 12 months) with hip dysplasia before they’ve gotten arthritis. Different parts of the pelvis are cut and rotated to improve the shape of the hip. Plates and screws are used to stabilize the pelvis. 

3. Juvenile pubic symphysiodesis (JPS): This is another surgery done in young puppies (usually younger than 5 months of age) who are at risk of getting hip dysplasia. A small part of the pubic bone is fused, and the rest of the pelvis grows in a way that results in tighter hip joints. 

4. Internal fixation: For pets with hip fractures, pins may be used to repair the break. This may be recommended in larger animals, while FHO is more often recommended in smaller animals. Some hip fractures are not suited to internal fixation, and other procedures, like FHO or THR, may be needed. 

While medical management is an option for dogs and cats with hip conditions, a procedure such as an FHO is generally recommended when medical management is either already failing or expected to fail.