What is FHO (Femoral Head Ostectomy) in dogs?

Femoral Head Ostectomy (FHO) is a surgical procedure commonly performed in dogs to alleviate pain associated with hip disorders, especially when other treatments are not effective or feasible.

The surgery involves the removal of the femoral head and neck, which eliminates the bone-on-bone contact within the hip joint. This might sound drastic, but in many cases, it offers a remarkable improvement in quality of life—particularly in small to medium-sized dogs, or in larger dogs that are less active or have limited surgical options due to financial constraints or other health conditions.

FHO is typically indicated in cases where the hip joint is severely damaged, such as advanced hip dysplasia, fractures of the femoral head or neck, chronic joint luxation, Legg-Calvé-Perthes disease, or degenerative joint disease that hasn't responded well to medical management.

In some dogs, hip replacement might be a more biomechanically ideal solution, but not all patients are good candidates for that procedure, which is significantly more expensive and technically demanding. FHO, by contrast, is a relatively straightforward surgery and doesn’t require implants.

After the femoral head is removed, a false joint made of fibrous tissue develops in its place. While this pseudarthrosis does not restore a completely normal range of motion, it often results in substantial pain relief and improved function. Dogs usually rely on their surrounding muscles and soft tissue to stabilize the limb. Post-operative physical therapy is crucial in ensuring a successful outcome.

Early use of the limb is encouraged, and controlled exercises can help strengthen the muscles and prevent stiffness. Most dogs start walking again within a few days to weeks, with gradual improvement over several months.

Smaller dogs and cats tend to adapt very well after FHO, sometimes returning to near-normal activity levels. Larger dogs may have a more variable outcome, and their recovery often depends heavily on weight management, rehabilitation, and muscle conditioning.

While the leg may appear slightly shorter after surgery, this typically does not impair the pet’s ability to walk, run, or even play. The prognosis is generally good, especially when surgery is followed by proper aftercare and physical rehabilitation.

FHO is considered a salvage procedure, meaning it's not designed to restore perfect anatomy, but rather to relieve pain and improve function. In many cases, it allows dogs who would otherwise suffer chronic pain to lead active and happy lives.

References:

• Johnson, K. A. (2014). Piermattei’s Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. Saunders Elsevier.
  

• Fitzpatrick, N., & Yeadon, R. (2009). Complications of femoral head and neck excision in the dog and cat. Veterinary and Comparative Orthopaedics and Traumatology, 22(4), 282–288.

About the autor

Felipe Garofallo is a veterinarian in Brazil, specialized in orthopedic and neurosurgical care for dogs and cats.

He is also the founder of Ortho for Pets – Veterinary Orthopedics and Specialties.