Case: Femoral head and neck excision
29th December 2013
Femoral head and neck excision (FHNE) involves removing the ball of the hip ball-and socket joint, usually with an oscillating saw. As healing progresses, a fibrous tissue articulation develops to replace the joint. Diligent physiotherapy and/or hydrotherapy is needed in the following two months to keep this pseudoarthrosis (“false joint”) articulation flexible to achieve a decent range of long-term extension. One major benefit of FHNE over almost every other orthopaedic procedure is that there is no need to restrict activity in the post-op period. Activity, including stair climbing etc, is very much encouraged. See our post-op aftercare sheet for FHNE for more detail.
This surgery is vastly cheaper, less technically demanding and less complication-prone than total hip replacement. Indeed, when THRs do get serious complications, they often get revised to FHNEs. The function that is achieved with FHNE is usually more than adequate in cats and small dogs. FHNE is generally less adequately functional the larger the patient gets. That having been said, good outcomes can still be achieved in larger dogs.
Common indications for FHNE include:
* Luxation of the hip joint(s) secondary to hip dysplasia where hip replacement is not an option.
* Chronic degenerative joint disease failing to respond to medical management where other surgical options have been ruled out.
* Fractures involving the joint where fracture fixation is not possible /desirable or is ruled out by economic considerations.
* Legg Perthe’s disease, typically seen in young terriers. One or both femoral heads lose their blood supply and disintegrate. This condition is painful.
This 6 month old pug had a fracture of the femoral head that could not be reconstructed so FHNE was the best option.