Email kcmidway@tampabay.rr.com

Mission Statement:
To provide quality referral orthopedic and soft tissue surgical services to patients at a reasonable cost to clients in Citrus County Florida and surrounding counties, as well as an alternative referral site for their veterinarians.

The Femoral Head Ostectomy (FHO)

The femoral head ostectomy surgery is strictly a salvage procedure that most often is done as a last resort. It involves removing the ball or head and neck of the femur from the socket joint or acetabulum. The result is to create a non-painful false joint called a pseudoarthrosis.

Indications for this surgery may include chronic hip luxation, fractures of the femoral head or neck, fractures of the pelvis in the acetabulum, and severely arthritic hip joints. It is commonly used as a treatment for aseptic necrosis of the femoral head (Legg –Perthes Disease) which is a disease where the blood supply is lost to that area by an unknown cause in small breed dogs.

Our procedure involves entering the hip joint through a side and forward incision called the cranio-lateral approach.  We expose the femoral head and neck. We carefully dissect the fibrous joint capsule from this area to allow visualization of the area to cut. Many orthopedic surgeons use a chisel and hammer to remove the bone. At Midway we use an air driven oscillating saw. This allows us to make a much smoother cut and eliminates the risk of the bone cracking and chipping in an unwanted fashion when using the chisel. The saw also allows us to cut the bone again if we feel we have not removed enough of the femoral neck. We try to preserve a structure where muscles attach called the lesser trochanter. This is thought to provide extra support to the joint following surgery. At times we remove the rim of the socket to help avoid any painful bone to bone contact post operatively that would greatly reduce the chances of success.

After surgery the patients are encouraged to use the leg and help form the false joint. Just following the post surgical pain period of the first few days we have the owners begin passive range of motion exercises ( PROMs).  We also prescribe pain relieving drugs such as a non-steroidal anti-inflammatory agent and a form of synthetic codeine.

The prognosis is very good for animals less than 40 lbs. The results may not be as good in the larger animals although dogs up to 150 lbs. have had successful FHO operations. Owners should be advised that this is a salvage procedure and last resort. Animals who are candidates for the surgery should have exhausted all other forms of treatment since occasionally an FHO may have an unfortunate outcome.

Dr. Nayfield has performed many of these procedures throughout his career. He feels that with the use of the oscillating saw, modern anti-pain medications and physical therapy techniques the success rates have improved greatly in the past few years. Still clients must be made aware of the potential complications that may follow this surgery and make the proper decision.