FHO Surgery, 6 Days Post-Op

Well, our very own Tucker is now 6 days post-op, and doing great. For the original story of his surgery, click here.

Tucker received Femoral Head Ostectomy (FHO) surgery last Wednesday, May 27th. Post operatively, he received cold laser therapy that day, and twice since. Normally, this surgery takes a long time to recover from, and typically the pet doesn’t even touch their toe to the ground for at least two weeks post-op.

Here is a video of Tucker that we shot today. He’s already close to 50% weight bearing on the leg, and is moving comfortably, and with minimal pain.

The reason for the rapid improvement in this case is probably due to two things:
1.) He’s a small breed dog, and not carrying any extra weight. Overweight dogs do much worse with any orthopedic surgery, and more so with advanced, reconstructive surgery like Tucker received; and
2.) The K-Laser cold therapy laser. Laser therapy, and in particular the high-powered K-Laser Cube 4 that we have – the most powerful laser on the market today – has changed the landscape of veterinary care when it comes to orthopedic and other injuries. What used to take 2 months to heal now takes 2 weeks, and the progress we used to hope for in 2 weeks we’re now seeing in 4-5 days.

Tucker is doing great, and we expect him to continue to improve to full recovery. We’ll post more video in the future as his condition warrants.

Tucker Gets Major Orthopedic Surgery

Many of you know our two mascots – Tucker and Tess. They’re our receptionist, Diane’s, two little shih tzus. Recently, Tucker injured himself jumping off the sofa.

At first he carried his right rear leg completely up as he walked. He was what we term three-legged lame. However, by the next day he was almost completely normal on the leg. He put up to 95% of his normal pressure on it, and he didn’t seem unduly sore.

At that time, I performed an orthopedic exam to try to localize the problem. In an ortho exam, we place the pet on his side with the effected leg up. I start at the toes and move up to the hip, feeling every bone and every joint for any area that is swollen, moves in the wrong direction, feels out of place, or where he gives me a pain sign.

For Tucker’s ortho exam, everything felt relatively normal. Nothing was out of place or swollen, and he wouldn’t give me a pain sign anywhere. However, we all know Tucker pretty well, and know that he’s a very stoic dog. He hates to complain. So I figured that he was simply masking whatever was going on. I put him on a general anti-inflammatory and ordered exercise restriction, and waited to see how things went.

Dislocated Hip
Dislocated hip in Tucker

Two days later we found out when he again started carrying the same leg, and was once again three-legged lame. This time I got to perform my orthopedic exam while he had an active problem, so the problem was a lot easier to find. In short, his hip was out of the socket. This was confirmed with x-rays, as you see to the right.

Dislocated hips are relatively common after any form of blunt trauma to the pelvis. We tend to see them after hit-by-cars, falls from elevation, and occasionally after dog fights. However, it’s relatively rare to see them from something as simple as jumping up and down off the sofa.

A lot of things have to go wrong for the hip to dislocate. There is a very thick, tough ligament that goes from the very end of the femoral head (that’s the ball in the ball-and-socket hip joint) to the acetabulum (that’s the socket part of this same joint). This ligament has to tear for the hip to dislocate. Also, the joint capsule that envelopes the entire joint has to tear as well. And finally, the combined muscular tendons of the area have to fail to some degree. So for a hip to pop out of place, a lot of tough structures have to give way.

Because of the tearing and failing of all these tissues, repairing a dislocated hip is not as simple as TV would have you believe. It’s not a matter of simply “popping it back in place” and everything’s fine. Getting it placed back in the socket is a simple matter, but getting it to stay there is very difficult. The vast majority of cases pop out again with the first challenge to the joint. And so was the case with Tucker. Irrespective our efforts to save the joint we couldn’t get the hip to stay in.

FHO on Tucker
Tucker’s post-op film after his successful FHO surgery.

So that meant the next step was a major orthopedic surgery called a Femoral Head Ostectomy, or FHO for short. In an FHO we remove the femoral head and neck completely, so that there is no hip joint. Instead of the normally function hip joint, the pet instead forms a muscular attachment of the rear leg to the pelvis.

This sounds like it might be unstable, but in fact it actually works very, very well. The way I explain it to clients is that after an FHO the back leg works similar to the front leg. If you study the anatomy of a dog’s front leg you’ll realize that there is no joint between it and the body. The front leg forms the shoulder joint through its attachment to the scapula (shoulder blade), but that entire apparatus is attached to the body by muscles only. There is no bone-to-bone joint that attaches the shoulder/shoulder blade to the rib cage. Instead, it’s all held in place by the muscles of the shoulder.

After an FHO the rear leg functions much the same way. The gluteals and other large pelvic muscles hold the femur in place. Because there is no bone-to-bone contact the pet feels no discomfort and walks relatively normally.

Tucker resting comfortably post-op
Tucker resting comfortably post-op

Theoretically, FHOs work best in small to medium sized dogs. However, I’ve used the procedure in dogs up to 130 pounds, and almost universally they do very well.

We performed an FHO on Tucker earlier this week, and so far everything is fine. Of course, we’re treating him with the K-Laser to increase his recovery rate and decrease his post-op pain, but I have no doubt that long-term he’s going to do very well.

Tucker laser post op
Laser treatment on Tucker 2 days post-op