My Dog or My Cat Needs A Hip Salvation Procedure: Femoral Head and Neck Excision Versus Total Hip Replacement: Which One To Choose?

OUTCOME

Femoral head and neck excision is considered a salvage option that has been traditionally used for the treatment of painful hip joints. Femoral head and neck excision is usually not recommended in large breed dogs unless all the aspects of conservative management have been attempted and total hip replacement is not an option. (1).  

When performed in small breed dogs or cats femoral head and neck excision surgery can provide satisfactory outcomes from an owner’s perspective, particularly if an appropriate post-operative physiotherapy regime is employed. However, the results are less predictable (and can include persistent lameness) and the hip function will not be normal (having a decreased range of motion, proximal displacement etc..). The difference in outcome between femoral head and neck excision and total hip replacement is less obvious in small breeds and cats. The current literature still tends to demonstrate a better outcome in small dogs and cats operated with hip replacement versus femoral head and neck excision (1, 2, 3).  

After total hip replacement, your animal is expected to recover a near full function, pain-free, for the rest of their life. It is becoming increasingly recognised as offering improved outcomes and should therefore be considered the gold standard (1).  

RECOVERY 

After a femoral head and neck excision, your animal will require an intensive physiotherapy treatment to limit the decrease in hip range of motion and muscle wastage secondary to the procedure. Not performing post-operative treatment will increase the risk of disappointing or poor functional outcomes. The restriction will be limited to room rest over the first week with a gradual increase level of controlled activity over 3 to 6 weeks. 

Post-operative total hip replacement recovery requires more commitment as your animal must be strictly rested (not free to walk in the house/apartment) for 6 weeks with activity limited to a few on-lead daily walks for their needs. After 6 weeks, if radiographic or CT assessment confirms the implants have not moved, activity can be gradually increased over 3 to 6 weeks 

COST 

Because of the cost of the implants, the level of expertise and experience required to perform that procedure, a total hip replacement is more expensive than femoral head and neck excision. 

1. W. Off, U. Matis.Excision arthroplasty of the hip joint in dogs and cats. Clinical, radiographic, and gait analysis findings from the Department of Surgery, Veterinary Faculty of the Ludwig-Maximilians-University of Munich, Germany. Vet Comp Orthop Traumatol 2010; 23: 297–305. 

1. Witte PG, Scott HW, Tonzing MA. Preliminary results of five feline total hip replacements. J Small Anim Pract. 2010;51(7): 397-402 

1. Liska WD, Doyle N, Marcellin-Little DJ, Osborne JA. Total hip replacement in three cats: surgical technique, short-term outcome and comparison to femoral head ostectomy. VCOT. 2009