Big D's femoral head ostectomy

October 28, 2011

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Like - Share - October 27 at 11:16pm

Bright Eyes & Bushy Tails Veterinary Hospital
Trivia question: what is the white thing that the awesome Big D Bengal cat gave us at surgery? Look here for the answer Friday...
October 27 at 11:19pm - Like

Allan Berger
Margo got it in 10 minutes. :-) That is the femoral head: the ball of the hip joint. If you look at the ventrodorsal radiograph (the one that shows the broken tail), you'll see that Big D's hip joint is dislocated. More in a minute...
October 27 at 11:30pm - Like

Bright Eyes & Bushy Tails Veterinary Hospital
Big D had a dislocated hip joint. There are three ways to fix that:
1) Closed reduction. "Pop it back into joint." If there's not much damage to the joint, this can work great. If the muscles, ligaments, etc are substantially damaged, this doesn't work as well you might think it should.
2) Open reduction. Surgery, and place some fancy stitches to hold it in place, then "pop it back into joint followed by tightening those stitches. (Dr. Allan does some toggle pinning, but usually reserved for dogs not cats.) Sometimes some fancy additional sutures beyond the toggle to hold it in place beyond the toggle.
3) Femoral Head Osteotomy (FHO); more accurately but lest often called FHNE (Femoral Head and Neck Excision). That's what we did to Big D.
October 27 at 11:40pm - Like

Bright Eyes & Bushy Tails Veterinary Hospital
The soft tissue supports for Big D's hip were all messed up. While we were easily able to "pop it back into joint," it just as quickly popped back out. That left options 2 and 3. In small critters (and even some larger ones), it is surprising but they don't really need their hip joint. If we cut off the femoral head, the muscles of the leg are strong enough to support the leg without the joint. The two biggest risks are if you leave too much bone, they rub when really you just want the muscles supporting the leg. And if there's a huge amount of soft tissue injury, occasionally there's not enough muscle strength to support the leg.
October 27 at 11:44pm - Like

Bright Eyes & Bushy Tails Veterinary Hospital
I think last part of the explanation: check out the last X-ray image in the series, which is the post-op view. See how the ball-shaped head of the femur has been cut off? Compare to the good right leg where the ball of the femur seats into the acetabulum socket of the pelvis. The "neck" of the femur has also been (intentionally) removed to prevent any bone-on-bone contact.
October 27 at 11:46pm - Like

Allan Berger
Probably TMI, but IMEX surgical supply has some nice illustrations of the toggle pin technique to hold the joint back together with stitches. We usually reserve this for larger dogs, or if there are injuries on both hips:
outside link

Stabilization of Coxofemoral Luxation Using the Toggle Pin Method
www.imexvet.com
IMEX Veterinary Inc. is the leading manufacturer of veterinary orthopedic produc...

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October 27 at 11:50pm - Like

Lynn Young
Great info, thanks!
October 27 at 11:58pm - Like

Kathy Flynn
Our Stryker, a 9 year old BC, had a FHO when he was 1 1/2 years old for a dislocated hip that the toggle pin didn't work for. He went 6 months with the toggle pin before it was broken and he required the FHO. Good job on this cat, Allan.
October 28 at 8:17am - Like

Paula Kelly
Never TMI...love this stuff.
October 28 at 9:38am - Like



Bright Eyes & Bushy Tails Veterinary Hospital
Our trivia question: what is this? Answer here tomorrow (Friday).
Like - Share - Edit - October 27

Christian Miller Cartilage
October 27 at 11:22pm - Like

Bobbi Chipman Hip joint
October 27 at 11:25pm - Like

Celeste Hussli-Poole Lumbar disc?
October 27 at 11:26pm - Like

Margo Cline Femoral head
October 27 at 11:27pm - Like

Destinee J. Fusaro A thingy
October 27 at 11:28pm - Unlike - 2

Allan Berger
Margo got it! (Hip joint is pretty close). Check out the left hip joint (which is actually on the right side of the image) and notice that the ball of the femur is not in the hip joint socket (acetabulum of the pelvis). In a moment I'll post the radiograph from after the surgery.
October 27 at 11:29pm - Like

Maddie Boyle
Big d is doing great! He is starting to walk around and get a feel for his "new" leg. Thank you guys for everything!!!
November 3 at 9:52pm - Unlike - 1



Bright Eyes & Bushy Tails Veterinary Hospital
This lateral radiograph from when we were looking to define the problem contains a hint to the answer to our trivia question.


Bright Eyes & Bushy Tails Veterinary Hospital
Other than posting the post-operative radiograph this is the biggest hint I can give. (I will display that post-operative radiograph as soon as someone gives the answer.)
Like - Share - Edit - October 27

Allan Berger (But the broken tail is not the answer.)
October 27 at 11:24pm - Like

Renee Wenzel I would say that there is something wrong with a hip.
October 29 at 11:07am - Like

Allan Berger Yes! The left one is dislocated.
October 29 at 2:11pm - Like


Bright Eyes & Bushy Tails Veterinary Hospital
Big D with owner Madisen: Big D looking non-plussed on his way home, but actually feeling OK.
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Madisen with Big D: Madisen looking non-plussed on her way home, but actually feeling OK.
Like - Share - Edit - October 27


This is the post-operative X-ray image. Look at the hip joint of the left leg (left leg is on the right side of the image: the leg that is not labeled 'R'). By comparing that left leg with the normal right one, see how Dr. Deb Conant cut off the ball of his femur? Explanation for why on the primary discussion.
Like - Share - Edit - October 27

Allan Berger
(Notice we solved the tail fracture with also an 'amputational strategy.' Sometimes the simplistic theory of 'if it's not there, it can't cause a problem' truly works better than careful reconstruction.)
October 27 at 11:56pm - Like

Donnie Morlan Do animals have phantom pain?
October 28 at 9:39am - Like

Allan Berger Good question about the phantom pain. Occasionally pets will chew at the stump after an amputation - and I always associate that with pain. But if it's pure phantom pain I don't think there's a good way to know.
October 28 at 2:50pm - Like