Femoral Head Ostectomy Vs Total Hip Replacement
Do Kieu
To help make decisions, Total Hip Replacement (THR) results must be compared to published reports of the Femoral Head Ostectomy (FHO) option. The following is detailed referenced information about Femoral Head Ostectomy in the veterinary literature to support the conclusions above.
Off and Matis published the only reference that could be found that based results on objective data. 132 dogs and 51 cats were examined using computerized gait analysis, kinematic measurements, radiographs, limb measurements, orthopedic examination, and owner questionnaire. They concluded that functional results were rated at good in 38% of the animals, satisfactory in 20%, and poor in 42%. Functional deficits in small, as well as large, breed dogs resulted from the FHO procedure.
1. Brinker states that an FHO is a nonreversible salvage procedure that is used to improve quality of life. A fibrous false joint forms and thus it does not maintain biomechanical function. There is a tendency of overuse the procedure for conditions that are repairable. Results vary considerably. A limp may remain because the leg is shortened by removal of the femoral head and neck, some loss of range of motion and a gait abnormality persists, and the thigh and hip muscles remain somewhat atrophied.
The FHO is suitable if it is acceptable to have compromised hip joint integrity, if lack of total pain relief is acceptable, or if there are financial constraints. The text continues stating that active use of the limb may take over 1 month and rehabilitation time of 6 months or more are not uncommon.
2. Berzon et.al. reported on the efficacy of FHO in 94 dogs and cats. The five most common indications for a FHO included degenerative joint disease, avascular necrosis of the femoral head, capital epiphyseal and femoral neck fracture, comminuted acetabular or pelvic fracture, and non-reducible or chronic coxofemoral luxation. All of these indications, with the possible exception of some acetabular fractures, are also indications for a THR. Acetabular fractures and pelvic fractures are generally repairable injuries.
5. Montgomery et. al. compared 3 different FHO surgical techniques. They concluded the specific techniques compared did not improve results between any of the groups for the percentage of leg use during normal activity, mean postoperative time until leg use, use of the leg or hopping while running, or lameness with exercise. The results were similar for large and small dogs, although the lameness tended to be milder in small dogs. Most of the small dogs were lap dogs with little opportunity for extreme exercise. The incidence of postoperative problems did not vary with increased body weight. Dogs (hunting dogs) whose intended use included vigorous exercise had a higher frequency of moderate to severe lameness.
6. Vasseur states in his publication that in mature dogs with severe degenerative joint disease involving the hip joints, total hip replacement restores hip function more consistently, and much more rapidly, than FHO. He recommends a vigorous rehabilitation program and maintenance of normal body weight to help restore function. Complications include shortening of the operated limb, with prominence of the greater trochanter, decreased range of motion in the pseudoarthrosis as compared to the normal hip, muscle atrophy, and impaired function. Occasional lameness is not unusual in larger dogs, and they may have difficulty jumping and climbing stairs. In addition, hunting dogs or dogs expected to perform other challenging physical tasks should not anticipate a complete return to normal function. Vasseur also states that it may take as long as 6 to 12 months for the animal to achieve an optimal result after FHO, with only fair return of function.
7. Lewis also evaluated different surgical techniques for performing the FHO surgery. An overview of the FHO procedure shortcomings was presented. He concluded that previously reported improved results with new techniques provided inconsistent results.
8. Grisneaux et.al. obtained objective data using force plate computerized gait analysis on limb function 3, 15, and 120 days after FHO with (for 21 days) and without the use of postoperative anti-inflammatory medication. The results show that operated dogs had significantly lower peak vertical, peak propulsive, and impulse propulsive forces on the limb and lower angles of hip joint abduction and extension than did normal dogs. Most of the limbs treated by FHO were unable to regain normal function and muscle mass after surgery. Body weight did not appear to be associated with the outcome of the FHO. The extent of muscle atrophy at the time of surgery correlated with prolonged recovery time. Dogs with the lesser trochanter preserved functioned better than those where it was partially or completely removed. Although all owners subjectively expressed complete satisfaction with results of surgery at the end of the study, operated dogs still had objectively significantly lower peak vertical, peak propulsive, and impulse propulsive forces and lower angles of hip joint abduction and extension than did control dogs at day 120. Owners noticed worsening of the lameness following cessation of anti-inflammatory medication. A conclusion states that active physical therapy may be a life-long necessity of dogs undergoing FHO. The hypothesis of the study was that promotion of active physical therapy during the first postoperative weeks combined with administration of an NSAID would minimize the reduction of mobility and, therefore, result in treated dogs having greater impulse propulsive forces and hip joint abduction and extension angles than dogs receiving a placebo. The hypothesis could not be demonstrated.
9. Plante et.al. reported force plate objective data comparing conservative management, FHO, and triple pelvic osteotomy treatment of hip dysplasia in immature dogs. The dogs in the FHO group showed ground reaction force abnormalities, most likely due to the absence of a coxofemoral joint. The FHO group had decreased peak propulsive and impulsive force compared to the triple pelvic osteotomy and control group.
10. Budsberg et.al. reported a study that compared the results of treating 16 dogs with bilateral coxofemoral osteoarthritis using total hip replacement on one side versus not on the other side. The ground reaction forces (weight bearing) indicated that dogs had significantly increased loading function of the treated side after unilateral total hip replacement. The data also indicated that force was transferred from the untreated side to the treated side during the study period. Loading rates increased indicating an increased willingness to load the treated hip over time. The study data provided substantial evidence of improvement in dogs after total hip replacement.
There are few things more heartbreaking than seeing our dogs in pain, especially when that pain impacts their mobility. Mobility-impacting conditions like injuries, arthritis, or hip dysplasia can become debilitating. Fortunately, these days, animal medicine has advanced to the point where we can do something to help our limping dogs heal.
Both a total hip replacement and a femoral head ostectomy (FHO) focus their attention on the femur. In a total hip replacement, doctors remove the ball and socket of the femur and replace it with an implant. These implants are made of different types of materials, namely metal alloys like metal and plastic.
Thanks for helping me understand that total hip replacement would be replacing the ball and socket of the femur with an implant. I just needed to know about this because my uncle apparently might need to undergo an anterior hip joint replacement procedure surgery. It's because of the accident he was in earlier which has affected that part of his body, especially when he is already at his 50s.
Holep Ameliyatının
Maliyeti Nedir?
Holep ameliyatının maliyeti nedir? Bu konuda kullanılan teknikler zerine genel bir kıyaslama yaptık. HoLEP tekniği gnmzde iyi huylu prostat bymesine bağlı mesane ıkım tıkanıklığında kendini kanıtlamış altın standart olmaya aday bir tekniktir. zelikle byk hacimli prostatlarda aık prostatektomiye benzer başarısının yanında, kesi yapmadan uygulanması ve daha kısa hastanede kalış en byk avantajlarıdır.
-implant
Dogs older than 12 months that have osteoarthritis or dislocation of the hip joint secondary to severe hip dysplasia can be treated with either a total hip replacement (THR) or femoral head ostectomy (FHO). The advantage of total hip replacement is that it eliminates pain and lameness and provides normal range of motion and gait (how your pet walks) by removing the affected joint and replacing it with a prosthetic (artificial) joint that is biomechanically similar to the original joint. Total hip replacements are usually very successful for the lifetime of your pet, and active dogs are able to resume a high level of activity for the remainder of their lives.
Radiographs (X-rays) of a juvenile dog with subluxation of both hip joints secondary to hip dysplasia. The head of the femur (arrow) is poorly seated within the acetabulum, indicating poor hip joint congruity. There is no evidence of degenerative joint disease (arthritis).
Radiographs (X-rays) of a mature dog with degenerative joint disease secondary to chronic hip dysplasia. The head of the femur (arrow) and acetabulum are severely arthritic, as evidenced by the flattened femoral head, thickened femoral neck, numerous osteophytes, and shallow, sclerotic acetabulum.
Appointments can be scheduled with the Orthopedic Surgery Service by contacting the Veterinary Medical Teaching Hospital Monday through Friday at 979-845-2351. Either you or your veterinarian can make the initial phone call, but we will need to speak with your veterinarian prior to confirming the final appointment.
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