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Femoral Head and Neck Excision Arthroplasty

Excision arthroplasty, femoral head and neck ostectomy, femoral head and neck excision, and femoral head and neck resection are all terms that refer to the removal of the head and neck of the femur for the relief of pain.

The procedure is modelled on that used for humans (Girdlestone arthroplasty). It is for salvage solely and is used when there is severe pain in the hip joint. The procedure makes the hip joint unstable, but dense scar formation at the level of the previous hip joint, maintains the function of a joint.

The limb will be shortened, and the range of motion diminished somewhat. Gait abnormalities are common following surgery, and if pre-existent not necessarily corrected by excision. However, as the procedure diminishes pain, it is certainly an effective means of eliminating joint related pain, and is a highly effective means for dogs which have a pronounced limp associated with pain. It is reported to be best suited for small dogs under 25kgs, but good results are often achieved in large dogs as well.

The indications are similar to those for total hip joint replacement. In fact, failed hip joint prostheses are revised to excision arthroplasties, and vice versa. The most inappropriate indication is in the older dog with painful hip disease with a superimposed neurological deficit of the hind limbs. Results of excision arthroplasty are variable, but improvement is seen for 6-18 months following surgery. Many small dogs will have an excellent result with hardly any perceived gait abnormality.

The femur (large bone of the thigh) and the pelvis meet to form the hip joint, one of the most important joints in the body. Articular cartilage covers the bony surfaces enclosed within the joint capsule or joint cavity. For optimal locomotion and function it is crucial that these surfaces are congruous (well fitted to each other). Several conditions can affect the hip joint in such a fashion that the joint does not move freely or in a pain free manner. This will result in lameness.

Postoperatively, the animal is restricted until the skin sutures are removed. At this time active exercise is begun and continued. Best results are consistent and associated with physiotherapy and higher levels of exercise at this time. Appropriate aftercare is the most important aspect of recovery, and actively adhering to physiotherapy advice will help ensure a successful outcome. Physiotherapy and rehabilitation should be pursued immediately after any orthopaedic surgery, to be of optimal benefit to the recovery of the patient.

Post-operative rehabilitation aims at maintaining and restoring;

▫ Weight bearing

▫ Joint range of movement

▫ Muscle mass and strength

▫ Proprioception

▫ Function

Upon discharge or first follow-up the physiotherapist will give instructions on the following;

▫ Restrictions

▫ Food allowance

▫ Home exercises and condition management

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