Post-Surgery Care Instructions Following Femoral Head & Neck Ostectomy
What to Expect
Your pet may have undergone a femoral head and neck osteotomy (FHNO) to manage his/her hip joint disease (e.g. hip dislocation, femoral head/neck fracture, Legg-Calve Perthes disease, end-stage osteoarthritis etc). The FHNO is a surgical procedure that involves the removal of the femoral head and neck (i.e. the “ball” part of the ball-and-socket hip joint). Fibrous scar tissue then gradually forms in the gap where the “ball” of the hip joint was removed, forming a pseudoarthrosis (known as a false joint).
The degree of limb usage after surgery varies between patients. In general, the lighter the patient, the better they tend to do after surgery. Regardless, the patient will generally function better and be relatively more pain-free after the FHNO surgery than prior to, even if they do not return to full normal use of the hindlimb. One study reported that up to 96% of patients had a favourable outcome after receiving the surgery as part of management of their hip joint disease1. Convalescent (recovery) periods for patients undergoing FHNO can be as long as 3-4 months – please do not be discouraged with their progress too early on.
General Post-Surgery Care
After coming home from the clinic, your pet should be kept in a warm, dry, quiet and ideally indoor location in the 24 hours following discharge. If your pet is discharged on the same day that he/she had surgery, they may still be a little bit drowsy after they go home with you. There may also be some irritability or incoordination during this initial 24-hour period immediately after the surgery.
The shaved area on your pet's front or back legs is the IV injection, IV catheter and IV fluid site(s). Some bruising to this area may be seen when they go home with you; however, if this persists beyond 72 hours, please give us a call at the clinic. You may also find that the underside of their paw may have been shaved - this allowed the placement of blood pressure monitoring equipment, so that we could monitor their progress under anaesthesia closely.
Surgical Site and Wound Care
The surgical site is located on the upper thigh, near the hip joint. Some pets may have a light bandage applied over their surgical wound after surgery, and this is usually removed at home about 24-48 hours after the surgery. Your veterinarian or veterinary nurse will advise you when is an appropriate time to remove the bandage at home. There are several sutures present on the surgical site - it is helpful to count the number of stitches present when your pet first goes home with you, so that you will know if any goes missing before the wound is fully healed.
The surgical site should be checked daily for swelling, discharge or loss of sutures. It is important that you keep your pet in a clean and dry environment so that the surgical wound remains clean. Pets should not get bathed or allowed to get their wound wet in any way, until all the stitches have been removed. For cats - please only use shredded paper or non clumping litter in the litter tray to prevent the litter material from sticking to the wound.
It is also imperative that your pet is not allowed to lick at the surgical site because this may lead to the wound splitting open before it is fully healed and/or wound infections and/or other more serious complications. If you notice your pet licking or chewing at the surgical site, he/she will need to wear an Elizabethan collar to prevent this. E-collars may be purchased from our clinic reception. Ensure that pets are not allowed to roam outdoors without close supervision when they are wearing an E-collar, as this poses a choking hazard if it gets caught in a fence or branch.
Exercise & Physiotherapy
In the first 48 hours, strict confinement to a small room or indoor area is required, to minimise swelling of the surgical site. Slow and lazy leash walks for toileting purposes during this first 48 hours is permitted. Thereafter, supervised activity is highly recommended, in order to help “organise” and gradually strengthen the fibrous tissue forming in the false joint. Return to supervised activity shortly after the surgery also perserve and encourage a good range of joint motion during and after recovery.
After the first 48 hours, your pet can resume light activity. Starting walking your dog for 5 minutes, twice daily for 5 days. If he/she is tolerating this well, gradually increase this by 5 minutes each week to help build up muscle strength. Walks should be done at a slow and lazy pace initially on flat ground only – your pet should avoid excessive physical and boisterous activity (rough play / jumping) until the surrounding muscles are sufficiently strong enough for such high level activity. With passing time and increasing limb strength, more vigorous exercise, stairs and uphill exercise may be introduced. Cats should remain indoors until the surgical wound is fully healed. As every pet is different, so please keep in close contact with your veterinarian who will be able to advise when more vigorous activities can be introduced.
At the time of discharge, your veterinarian would have also demonstrated how to perform physiotherapy exercises on your pet at home. Besides the physiotherapy exercises that you can perform on your pet at home, you may also consider booking your pet in for professional physiotherapy sessions. Talk to your veterinarian about the physiotherapy and rehabilitation services offered for canine patients in Palmerston North.
Please do not hesitate to contact us at the clinic if you require further clarification or have any enquires regarding the post-surgery exercise regime of your pet.
Diet
Unless otherwise directed by your veterinarian or veterinary nurse at the time of discharge, no significant change is usually required to your pet's diet. However, it may be helpful to decrease their daily rations by 10-15% during the recovery period, so that they do not pile on excessive weight during the duration of reduced activity.
Post-Surgery Revisit
For some pets, your veterinarian may recommend that he/she comes back to the clinic in 3-5 days' after the visit for a recheck with one of our nurses. The nurses will check the surgical wound, your pet's temperature, and check that your pet is tolerating their oral medications well. Other aims of this visit is also to ensure that everything is going as planned at home, and that your pet's pain levels are well-managed. We can also address any concerns you may have with the post-surgical home care of your pet during this time.
Suture Removal
Sutures are typically removed 12 to 14 days after the surgery. Occasionally, your veterinarian may decide to "stage" the suture removal in that half of the stitches come out in 14 days', and the remainder comes out 5-7 days' later. Please phone for an appointment to book your pet in for suture removal.
Medications
Your pet would have received additional pain relief medications after their surgery, and most pets will also have oral medications to go home with. Please administer all medications as directed on the label; ensure that any antibiotics and all pain relief medications are given with a meal.
Should you have any enquiries or further concerns about the post-operative care of your pet, please do not hestitate to phone us at (06) 3588675 to discuss.
References
1Off W, Matis U. Excision arthroplasty of the hip joint in dogs and cats. Veterinary Comparative Orthopedics and Traumatology 23, 297-305, 2010.
Published by Cahill Animal Hospital on 30 July 2016