What is femoral head ostectomy (FHO)?

JointQ&AMeongsiljang Veterinary Advisory Board

Femoral head ostectomy (FHO) is a surgical procedure that removes the damaged femoral head to alleviate pain and create a false joint. Here’s an overview of the surgical process, recovery period, and prognosis.

What is femoral head ostectomy (FHO)?

A veterinarian reviewing a dog’s hip X-ray

Femoral head ostectomy (FHO) is an orthopedic procedure that removes the damaged head and neck of the femur to eliminate pain and encourage the surrounding muscles to form a functional false joint. The primary goal is pain relief. Rather than restoring the joint itself, this surgery fundamentally prevents pain caused by bone-on-bone contact, making postoperative rehabilitation half of the recovery process.

When is FHO chosen?

FHO is chosen when the hip joint is severely damaged and recovery through conservative treatment is unlikely. Typical indications include: - Hip dislocation: When dislocations recur or cannot be reduced - Avascular necrosis of the femoral head (Legg-Calvé-Perthes disease): Commonly seen in small-breed dogs - Hip dysplasia: In cases of end-stage osteoarthritis with severe pain - Fractures of the femoral head or neck: Complex fractures that cannot be reduced - Other salvage indications: FHO serves as a salvage procedure when other surgical treatments are difficult or unlikely to be effective

FHO vs. total hip replacement (THR) comparison

Item	FHO	THR (artificial joint)
Suitable body weight	Mainly small and medium breeds (poor prognosis reported in large breeds)	Regardless of weight (preferred for large breeds)
Surgical difficulty	Relatively low	Very high (specialist required)
Recovery period	6–12 weeks	3–6 months
Joint function restoration	Pseudarthrosis formation (limited function)	Nearly normal joint function
Complication risk	Low	High (dislocation, infection, etc.)
Cost burden	Relatively low	Very high

Consultation with a veterinarian is needed, taking into account body weight, breed, and the owner's ability to provide rehabilitation.

How is the surgery performed?

FHO is performed under general anesthesia, and the duration may vary depending on the patient’s condition and the complexity of the surgery. The surgical procedure is as follows: 1. Anesthesia and preoperative preparation: Blood tests and an electrocardiogram (ECG) are conducted to confirm anesthesia safety, followed by the administration of sedatives and analgesics. 2. Skin incision and joint exposure: An incision is made on the lateral side of the hip joint, muscles are retracted, and the joint capsule is opened to expose the femoral head and neck. 3. Removal of the femoral head and neck: After performing an osteotomy, the attachments of the joint capsule and ligaments are severed to remove the femoral head and neck. 4. Smoothing of the cut surface: A rasp is used to smooth any sharp edges or protrusions on the remaining bone, minimizing irritation to surrounding soft tissues. 5. Interposition of soft tissue: Soft tissues, such as muscle, are placed between the resection surface and the acetabulum to facilitate limb use and comfort. 6. Suturing: The joint capsule, muscles, subcutaneous tissue, and skin are sutured layer by layer.

A puppy preparing for orthopedic surgery

What to check before surgery

FHO is an irreversible surgical procedure. Because the femoral head cannot be restored to its original joint once removed, it is essential to carefully consider the following points before surgery: - Have conservative treatments (pain relievers, physical therapy, weight management) been adequately attempted? - Is the owner able to actively participate in the 8–12 week rehabilitation process? - Do preoperative blood tests and cardiac evaluations show no risk factors for anesthesia? - If both hips are affected, is the owner prepared for sequential surgeries, one hip at a time?

Recovery period and rehabilitation are the keys to success

The success of FHO surgery depends less on the procedure itself and more on rehabilitation. Consistent muscle use is essential for the formation of a functional false joint. - Immediately post-op to 2 weeks: Administer pain relievers and anti-inflammatory medications, care for the incision site, and limit activity to short walks. - 2 to 6 weeks: Begin passive range of motion (PROM) exercises, use an underwater treadmill, and gradually increase the duration of short walks. - 6 to 12 weeks: Start strengthening exercises such as hill walking and swimming. - After 3 months: Most daily activities can typically be resumed.

A dog undergoing rehabilitation on an underwater treadmill

Essential home care after surgery

The first 4 to 6 weeks after surgery are critical, as home care directly impacts the speed of recovery. - Non-slip mats: Place carpets or yoga mats on hardwood floors to prevent slipping. - No jumping or stairs: Completely restrict access to sofas and beds (install stair gates if necessary). - Short, frequent walks: Walk your dog 2–3 times a day for 5–10 minutes each, keeping them on a leash for control. - Weight management: Even a 1 kg weight gain can significantly stress the joints, so carefully regulate food portions. - Monitor the incision site: Visit the clinic immediately if you notice swelling, discharge, or redness. You may also want to check out our Puppy Glucosamine Guide for supporting joint health.

Visit the vet immediately if you notice these symptoms

Most dogs recover smoothly after FHO surgery, but if you notice any of the following symptoms, it may indicate a complication, and you should visit the vet immediately: - Discharge, pus, or a foul odor from the surgical site - Complete refusal to put weight on the operated leg even after 3 days post-surgery - High fever (above 39.5°C) lasting more than 24 hours - Persistent whimpering due to pain even after 2 weeks post-surgery - The incision opening up or stitches coming out

Reviewed by a veterinarian

Dr. Tony — Punnawat Phongkittirak

Veterinarian

A veterinarian who majored in veterinary medicine at Khon Kaen University, Thailand, and completed the IVSA program at North Carolina State University in the United States. Drawing on clinical experience at animal hospitals, he works in the pet healthcare field and is dedicated to building a digital care environment that connects pet parents with veterinarians.

Frequently asked questions

Will my dog be able to walk completely normally after FHO surgery?

In most cases, dogs can resume their daily activities without pain. However, since the surgery doesn't fully restore the joint, some mild gait abnormalities—such as a slight difference in leg length or a light limp—may persist. There may also be minor discomfort during running or sudden changes in direction. That said, small-breed dogs often experience a significant improvement in their quality of life after surgery.

Is FHO surgery an option for large-breed dogs as well?

It is possible, but the prognosis may be less favorable than in small-breed dogs. The heavier the dog, the longer it takes for the false joint to stabilize, and the more intensive the rehabilitation becomes. For large-breed dogs, total hip replacement (THR) is generally recommended as the first choice, with femoral head ostectomy (FHO) considered a secondary option when cost or surgical constraints make THR difficult.

If both hips need surgery, are they operated on at the same time?

Typically, surgeries are performed sequentially, one leg at a time. After the first surgery, the pet undergoes 6 to 12 weeks of rehabilitation to ensure proper recovery before proceeding with the second surgery on the opposite leg. Performing both surgeries simultaneously is not recommended because the pet would lack a weight-bearing leg during recovery, making rehabilitation impossible.

How much does the surgery cost?

Surgical costs vary significantly depending on the hospital, location, and your dog's condition. For the most accurate estimate, consult with an orthopedic specialist. Be sure to request a detailed quote that includes all expenses, such as pre-surgical tests, hospitalization, and post-operative rehabilitation.

What happens if rehabilitation isn’t done?

Without rehabilitation, the surrounding muscles can atrophy and a false joint may fail to form properly, leading to persistent lameness. With FHO surgery, rehabilitation is just as critical as the procedure itself in determining the outcome. In fact, if you’re unable to actively participate in your pet’s rehab, it’s important to carefully reconsider whether surgery is the right choice.

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References

[1] Fossum TW, Small Animal Surgery, 5th Edition, Chapter on Hip Joint, Elsevier, 2019

[2] Piermattei DL, Flo GL, DeCamp CE, Brinker, Piermattei and Flo's Handbook of Small Animal Orthopedics and Fracture Repair, 5th Edition, Saunders, 2016

[3] Tobias KM, Johnston SA, Veterinary Surgery: Small Animal, 2nd Edition, Elsevier, 2018

[4] Off W, Matis U, Excision arthroplasty of the hip joint in dogs and cats. Clinical, radiographic, and gait analysis findings, Vet Comp Orthop Traumatol, 2010

What is femoral head ostectomy (FHO)?

What is femoral head ostectomy (FHO)?

When is FHO chosen?

FHO vs. total hip replacement (THR) comparison

How is the surgery performed?

Recovery period and rehabilitation are the keys to success

Essential home care after surgery

Reviewed by a veterinarian

Dr. Tony — Punnawat Phongkittirak

Frequently asked questions

Related Guides

References