Femoral head ostectomy

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Femoral head ostectomy
Femur head.png
The femoral head and neck
Specialty orthopaedics

A femoral head ostectomy is a surgical operation to remove the head and neck from the femur. It is performed to alleviate pain, and is a salvage procedure, reserved for condition where pain can not be alleviated in any other way. It is common in veterinary surgery. Other names are excision arthroplasty of the femoral head and neck, Girdlestone's operation, Girdlestone procedure, and femoral head and neck ostectomy.[ citation needed ]

Contents

History

The operation was first described by Gathorne Robert Girdlestone (1881–1950) in 1945. [1] He originally designed it for treatment of tuberculosis and other disorders of the hips. [2] It may thus be known as a "Girdlestone operation". Other surgeons have added various modifications.[ citation needed ]

In veterinary science

Use of the operation in veterinary science was first described in 1961 by J. S. A. Spreull. [3] Dogs, cats and small horses, donkeys and ponies have all had the procedure performed successfully. It may be used in some cases of hip dysplasia, an extremely painful congenital condition found in many dog breeds and some cats. [4] It is also performed in cases of trauma where the head of the femur is badly broken or severed, or in response to other diseases of the hip bone, such as Legg-Calve-Perthes' disease. It is sometimes the procedure of last resort when other methods have failed or sepsis of the joint has occurred, but it can be indicated when the hip joint is severely affected or if arthritis In the joint is serious enough. It can also be indicated in small animals with pelvic fractures, particularly fractures of the acetabulum (socket of the pelvis). [5]

Small horses and ponies can have an ostectomy without an osteotomy of the greater trochanter. As a salvage procedure, this is usually performed in those animals which have the specific injury of a fracture of the capital physis. These animals would not return to function as riding horses and the procedure may be performed for those animals involved in breeding, milking, and being kept as companion animals. [6] This procedure can also be successfully performed in pigs. [7]

Procedure

The procedure exposes the head section of the femur bone (the ball of the ball and socket joint), and then the head is removed using a small saw or a bone hammer and chisel. Rarely both sides are done in one operation, [4] most times one side is done and allowed to heal before the other side is done.[ citation needed ]

Unlike in most other hip joint operations, the head of the femur is not replaced, but is allowed to heal and develop its own fibrous scar tissue so that the joint is no longer bone-to-bone, a pseudoarthrosis (also called a "false joint"). The neck of the femur is usually removed at the same time as the head. This prevents the post operative complication of bone rubbing on bone and continued pain. This has led to the procedure often also called "Femoral head and neck ostectomy".[ citation needed ]

Animals who have had the operation are required to maintain a lower weight to compensate for the loss of skeletal integrity, and typically have excellent functional outcomes with appropriate physical therapy. [8]

See also

Related Research Articles

<span class="mw-page-title-main">Legg–Calvé–Perthes disease</span> Osteochondrosis that results in death and fracture located in hip joint

Legg–Calvé–Perthes disease (LCPD) is a childhood hip disorder initiated by a disruption of blood flow to the head of the femur. Due to the lack of blood flow, the bone dies and stops growing. Over time, healing occurs by new blood vessels infiltrating the dead bone and removing the necrotic bone which leads to a loss of bone mass and a weakening of the femoral head.

<span class="mw-page-title-main">Hip dysplasia (canine)</span> Joint abnormality in dogs

In dogs, hip dysplasia is an abnormal formation of the hip socket that, in its more severe form, can eventually cause lameness and arthritis of the joints. It is a genetic (polygenic) trait that is affected by environmental factors. It is common in many dog breeds, particularly the larger breeds, and is the most common single cause of arthritis of the hips.

<span class="mw-page-title-main">Orthopedic surgery</span> Branch of surgery concerned with the musculoskeletal and bones system

Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is also used to correct a coxa vara, genu valgum, and genu varum. The operation is done under a general anaesthetic.

<span class="mw-page-title-main">Hip replacement</span> Surgery replacing hip joint with prosthetic implant

Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is one of the most common orthopaedic operations, though patient satisfaction varies widely. Approximately 58% of total hip replacements are estimated to last 25 years. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.

<span class="mw-page-title-main">Hip fracture</span> Broken bone in hip joint region

A hip fracture is a break that occurs in the upper part of the femur, at the femoral neck or (rarely) the femoral head. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk.

Arthroplasty is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure. It is an elective procedure that is done to relieve pain and restore function to the joint after damage by arthritis or some other type of trauma.

<span class="mw-page-title-main">Hip</span> Anatomical region between the torso and the legs, holding the buttocks and genital region

In vertebrate anatomy, hip refers to either an anatomical region or a joint.

<span class="mw-page-title-main">Joint replacement</span> Orthopedic surgery to replace a joint

Joint replacement is a procedure of orthopedic surgery known also as arthroplasty, in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. Joint replacement surgery is often indicated from various joint diseases, including osteoarthritis and rheumatoid arthritis.

<span class="mw-page-title-main">Hip dislocation</span> Orthopedic injury

A hip dislocation is when the thighbone (femur) separates from the hip bone (pelvis). Specifically it is when the ball–shaped head of the femur separates from its cup–shaped socket in the hip bone, known as the acetabulum. The joint of the femur and pelvis is very stable, secured by both bony and soft-tissue constraints. With that, dislocation would require significant force which typically results from significant trauma such as from a motor vehicle collision or from a fall from elevation. Hip dislocations can also occur following a hip replacement or from a developmental abnormality known as hip dysplasia.

<span class="mw-page-title-main">Hip replacement (animal)</span>

Hip replacement is a surgical procedure performed in dogs and cats as a salvage procedure, to alleviate severe pain in the hip due to, for example, hip dysplasia or irreparable bone fracture. The procedure replaces the head of the femur and the acetabulum with prosthetic implants. Because animals under about 40 pounds (18 kg) carry their own weight with little strain on each leg, hip modification surgeries are often sufficient to restore hip function in many cases. As a result, while hip replacement on animals can be seen in any animal of any size, from cats upwards, it is most often performed in the medium-large breeds of dogs.

<span class="mw-page-title-main">Veterinary surgery</span> Surgery performed on animals

Veterinary surgery is surgery performed on animals by veterinarians, whereby the procedures fall into three broad categories: orthopaedics, soft tissue surgery, and neurosurgery. Advanced surgical procedures such as joint replacement, fracture repair, stabilization of cranial cruciate ligament deficiency, oncologic (cancer) surgery, herniated disc treatment, complicated gastrointestinal or urogenital procedures, kidney transplant, skin grafts, complicated wound management, and minimally invasive procedures are performed by veterinary surgeons. Most general practice veterinarians perform routine surgeries such as neuters and minor mass excisions; some also perform additional procedures.

<span class="mw-page-title-main">Transient synovitis</span> Medical condition

Transient synovitis of hip is a self-limiting condition in which there is an inflammation of the inner lining of the capsule of the hip joint. The term irritable hip refers to the syndrome of acute hip pain, joint stiffness, limp or non-weightbearing, indicative of an underlying condition such as transient synovitis or orthopedic infections. In everyday clinical practice however, irritable hip is commonly used as a synonym for transient synovitis. It should not be confused with sciatica, a condition describing hip and lower back pain much more common to adults than transient synovitis but with similar signs and symptoms.

Protrusio acetabuli is an uncommon defect of the acetabulum, the socket that receives the femoral head to make the hip joint. The hip bone of the pelvic bone/girdle is composed of three bones, the ilium, the ischium and the pubis. In protrusio deformity, there is medial displacement of the femoral head in that the medial aspect of the femoral cortex is medial to the ilioischial line. The socket is too deep and may protrude into the pelvis.

<span class="mw-page-title-main">Hip resurfacing</span>

Hip resurfacing has been developed as a surgical alternative to total hip replacement (THR). The procedure consists of placing a cap, which is hollow and shaped like a mushroom, over the head of the femur while a matching metal cup is placed in the acetabulum, replacing the articulating surfaces of the person's hip joint and removing very little bone compared to a THR. When the person moves the hip, the movement of the joint induces synovial fluid to flow between the hard metal bearing surfaces lubricating them when the components are placed in the correct position. The surgeon's level of experience with hip resurfacing is most important; therefore, the selection of the right surgeon is crucial for a successful outcome. Health-related quality of life measures are markedly improved and the person's satisfaction is favorable after hip resurfacing arthroplasty.

<span class="mw-page-title-main">Hip dysplasia</span> Joint abnormality

Hip dysplasia is an abnormality of the hip joint where the socket portion does not fully cover the ball portion, resulting in an increased risk for joint dislocation. Hip dysplasia may occur at birth or develop in early life. Regardless, it does not typically produce symptoms in babies less than a year old. Occasionally one leg may be shorter than the other. The left hip is more often affected than the right. Complications without treatment can include arthritis, limping, and low back pain. Females are affected more often than males. Risk factors for hip dysplasia include female sex, family history, certain swaddling practices, and breech presentation whether an infant is delivered vaginally or by cesarean section. If one identical twin is affected, there is a 40% risk the other will also be affected. Screening all babies for the condition by physical examination is recommended. Ultrasonography may also be useful.

<span class="mw-page-title-main">Gathorne Robert Girdlestone</span>

Gathorne Robert Girdlestone (1881–1950), often known as GRG, was a pioneering orthopaedic surgeon, the founder of the Nuffield Orthopaedic Centre, and the first Nuffield Professor of orthopaedic surgery at the University of Oxford.

X-rays of hip dysplasia are one of the two main methods of medical imaging to diagnose hip dysplasia, the other one being medical ultrasonography. Ultrasound imaging yields better results defining the anatomy until the cartilage is ossified. When the infant is around 3 months old a clear roentgenographic image can be achieved. Unfortunately the time the joint gives a good x-ray image is also the point at which nonsurgical treatment methods cease to give good results.

<span class="mw-page-title-main">Phemister graft</span>

A Phemister graft is a type of bone graft which uses bone tissue harvested from the patient to treat slow-healing, or delayed union bone fractures. Thus, it is a form of autotransplantation. Typically, the tissue used in the graft is cancellous bone harvested from the patient's Iliac crest and laid in strips across the fracture site. The use of the patient's living bone stimulates osteogenesis, the growth of bones.

References

  1. Girdlestone GR (1943). "Acute pyogenic arthritis of the hip: an operation giving free access and effective drainage". Lancet. 241: 419–421. doi:10.1016/s0140-6736(00)41922-7.
  2. Haw CS, Gray DH (February 1976). "Excision arthroplasty of the hip". J Bone Joint Surg Br. 58 (1): 44–7. doi: 10.1302/0301-620X.58B1.1270495 . PMID   1270495. Open Access logo PLoS transparent.svg
  3. Spreull, J. S. A. (1961). "Excision arthroplasty as a method of treatment for hip diseases in the dog". Veterinary Record. 73: 573.
  4. 1 2 Rawson EA, Aronsohn MG, Burk RL (2005). "Simultaneous bilateral femoral head and neck ostectomy for the treatment of canine hip dysplasia". J Am Anim Hosp Assoc. 41 (3): 166–70. doi:10.5326/0410166. PMID   15870250.
  5. Weir, Malcolm; Barnette, Catherine. "Femoral Head Ostectomy (FHO) in Dogs". VCA Animal Hospitals.
  6. Squire KR, Fessler JF, Toombs JP, Van Sickle DC, Blevins WE (1991). "Femoral head ostectomy in horses and cattle". Vet Surg. 20 (6): 453–8. doi:10.1111/j.1532-950X.1991.tb00354.x. PMID   1369530.
  7. Smith JS, Chigerwe M, Kanipe C, Gray S (February 2017). "Femoral head ostectomy for the treatment of acetabular fracture and coxofemoral joint luxation in a Potbelly pig". Veterinary Surgery. 46 (2): 316–321. doi:10.1111/vsu.12604. PMID   27990668.
  8. Berzon JL, Howard PE, Covell SJ (1980). "A retrospective study of the efficacy of femoral head and neck excisions in 94 dogs and cats". Vet Surg. 9 (3): 88–92. doi:10.1111/j.1532-950x.1980.tb01661.x.