The ventral approach to the hip for femoral head and neck ostectomy is gaining popularity among surgeons due to perceived improved patient recovery compared with the craniolateral approach. Key aspects of patient selection, technical execution, and postoperative management are highlighted in this article.<\/p>\n
Take-Home Points<\/strong><\/p>\n <\/div><\/div><\/p>\n Femoral head and neck ostectomy (FHO) is commonly performed for treatment of Legg-Calve-Perthes disease, coxofemoral joint trauma, advanced hip dysplasia, and feline slipped capital femoral epiphysis. Surgical removal of the femoral head and neck eliminates pain related to irregular bone-on-bone contact and allows formation of a pseudoarthrosis made up of dense fibrous tissue.1<\/sup><\/span><\/p>\n The traditional FHO method involves a craniolateral approach to the joint. The alternative ventral approach has gained popularity due to perceived benefits for the patient and has become the author\u2019s first choice in most clinical cases. The ventral FHO spares the gluteal muscles and dorsal joint capsule, which may add stability and reduce postoperative pain and subsequent time to comfortable limb function. Additionally, visualization of the lesser trochanter is improved, and bilateral simultaneous ventral FHO can be performed without patient repositioning.<\/span><\/p>\n Challenges of the ventral approach FHO include decreased visual guidance or a \u201cblinded\u201d orientation of the proximal osteotomy margin and difficulty associated with removal of additional bone following the initial ostectomy.2<\/sup> Protection and retraction of the proximal femoral vasculature and iliopsoas muscle during ventral FHO can also be challenging, especially in dogs with advanced hip dysplasia.<\/span><\/p>\n Although the ventral approach to the coxofemoral joint is well documented,3<\/sup> description of the ventral FHO surgical technique is limited.2,4,5<\/sup> This article provides insight into surgical indications for, and important technical aspects of, this alternative approach to FHO.<\/span><\/p>\n Although FHO is frequently referred to as a \u201csalvage\u201d procedure, the author does not agree with considering FHO only as a last resort, as this may encourage waiting until the patient has significant muscle atrophy and obesity, making postoperative rehabilitation and recovery less successful.<\/span><\/p>\n Historically, outcomes for patients weighing more than 20 kg (44 lb) were considered inconsistent and FHO was not recommended for larger breeds.6,7<\/sup> More recent literature has reported similar outcomes regardless of patient size,8<\/sup> although larger patients with higher athletic goals likely require more dedicated postoperative rehabilitation. Owners should be aware that over the long term, the FHO limb may have muscle atrophy and decreased hip extension and weightbearing, which may affect athletic performance.8,9<\/sup> However, overall owner-reported satisfaction with the procedure has historically been good to excellent.6,8,9<\/sup><\/span><\/p>\n The decision to choose the ventral versus the traditional craniolateral approach for FHO is most often based on individual surgeon preference. Patients for which the author would not recommend ventral FHO include most patients with craniodorsal coxofemoral luxation, as well as those with advanced hip dysplasia with severe craniodorsal subluxation and limited hip abduction. Additionally, chondrodystrophic conformation and obesity may make identification and retraction of regional anatomy difficult and can pose significant challenges even to surgeons with extensive experience and familiarity with the technique.<\/span><\/p>\n Due to variation in individual patient anatomy and the blinded nature of the osteotomy, measurement of a preoperative ideal FHO angle is recommended. This angle can be measured on standard ventrodorsal (VD) hip\u2013extended radiographs of the pelvis positioned in accordance with the Orthopedic Foundation for Animals (OFA) technique.<\/span><\/p>\n To determine the ideal FHO angle, an ideal FHO line is drawn from the proximal aspect of the lesser trochanter to the medial aspect of the greater trochanter. The long axis of the femur (LAF) is then drawn as a line connecting the \u201ccenter points\u201d of the bones\u2019 diameter at the levels of the lesser trochanter and fabellae. The intersection of the ideal FHO and LAF lines determines the ideal FHO angle (<\/span>FIGURE 1<\/b><\/span>) and acts as an intraoperative guide for orientation of the osteotomy.<\/span><\/p>\n\n
Patient Selection<\/h2>\n
Radiographic Planning<\/h2>\n
![\"\"](\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2024\/04\/Goh_TVPMayJune24_VentralFHO_Fig1A.png\")