FHO case study; a journey using hydrotherapy and gait pattern retraining

The first time I ever heard about FHO surgery I was shocked to learn of the high success rates for doggo patients who have made the decision to undertake this somewhat radical approach to solving an all too common problem. As a hydrotherapist, planning a recovery program for a dog who has recently completed FHO surgery at first appeared daunting but when you have amazing patients and doggo owners who follow the plan step-by-step, what once appeared as daunting suddenly becomes one of the most rewarding rehabilitation cycles of my career. In this blog, we will dive into FHO surgery, what it entails and the plan towards a successful recovery using both hydrotherapy and physiotherapy as the main focal points on the journey to success.

What is FHO?

Canine femoral head and neck excision (FHO) surgery is a procedure that addresses hip joint issues in dogs, providing relief and improved mobility.

FHO is commonly performed to alleviate pain and discomfort associated with hip dysplasia, fractures, arthritis, or other conditions affecting the hip joint. It involves the removal of the femoral head and neck, allowing the formation of a "false joint" with surrounding muscles and tissues.

During FHO surgery, the surgery removes the femoral head (the ball part of the ball-and-socket joint) and sometimes the neck of the femur. This eliminates the bone-on-bone contact that causes pain, and the body adapts by forming a pseudo-joint, utilising surrounding muscles for stability.

The Road to Recovery

Every journey starts out best with a proper plan or road map in place so that all parties involved are aware of the recovery process and what steps to take next to ensure the best recovery and rehabilitation possible.

After FHO surgery, dogs will need rest and restricted activity. Pain medications and the beginning of some rehabilitation therapy will also be prescribed to manage discomfort and aid in the recovery process. Controlled exercise is crucial during the recovery phase. Short, on-leash/guided walks can help prevent muscle atrophy and promote joint mobility. Avoiding activities that place excessive strain on the hind legs, such as running or jumping is of the most importance at this early stage.

Most Vets will ask patients to seek a physiotherapist post-surgery to aid and assist in the recovery process. Joint mobilisation exercises, massage and the use of laser therapy will all go a long way to promote strength and flexibility to aid in the recovery process as this is also a crucial time to be aware of potential complications that could quickly derail the road to recovery. These complications, such as infection or persistent lameness, need to be addressed as soon as they are noted and the safest option if there is ever any doubt would be to return to the vet for further review.

As each patient progresses in recovery, the vet may gradually allow increased activity. However, it's essential to remain cautious and avoid pushing your dog too quickly, ensuring a steady and safe return to normal activities. This is the perfect time to add hydrotherapy to your recovery plan to not only continue in aiding the road to recovery but to also help build and manage muscles in the hind limbs and lower back.

X ray taken pre-FHO

Hydrotherapy Case Study

The recent FHO case we worked with in the clinic belonged to a patient who was hit by a minivan and left in a state that can only be described as life-threatening. The patient was a standard breed Chihuahua and he arrived in our care approximately 2 weeks after his FHO surgery. He was, as you can probably expect, cautious of anyone moving or touching his injured leg and due to the nature of his injury, his other hind leg had also been fractured in the accident. A slow and steady initial consultation in the clinic allowed him to gain the trust of not only me as his hydrotherapist, but also allowed him to feel safe and secure in the clinic space. The initial gate assessment and palpation were different to a normal review because again, understandably, the cautious and pain alarm/reaction within this little fighter was well and truly ringing for all to hear.

With some careful placement of his family and the lure of some of our very own hydrotherapy treats, we were able to fit him with a Help ‘Em Up Harness to better control him in the tank space and from there, the trust between the patient and myself as the hydrotherapist began to grow. Prior to the filling of the tank, his LHL was held up in flexion and his balance was poor due to all of the weight being distributed through his other HL. Once the water level reached his mid-thigh, he began to shift his weight laterally onto the operated side and began toe touching. The session began with a slow roll of the treadmill and I allowed him to feel the belt moving under him prior to engaging a cycling of the LHL. At first, again, he was unsure of what was happening. Still, within a matter of 20 seconds, he relaxed his LHL fully and allowed me to cycle further than previous which also included a technique whereby I placed my index fingers to the planter side of his paws and shortened each step by allowing my fingertips to make contact to the belt. From there, the balance of the 2-minute set was spent slowly cycling his legs and for the first time in 2 weeks, he was actually back to walking with an altered gate using all four limbs.

The second set saw a similar result to the first and I made the decision that for his third set I would fill the tank further and allow him to independently swim, whilst being managed using the Help ‘Em Up Harness, to better feel how his operated leg was functioning. Without any hesitation, he freely paddled both FL’s and HL’s together and as the set and session closed, he was well and truly sold on the magic in the water that is hydrotherapy.

We would see this patient twice a week for further sessions and also included laser modalities and home weight-transferring exercises as prescribed by Jo, our physiotherapy guru. This dual approach saw the road map to recovery become all that much clearer for our patient as with each session and week that went by, his gate consistency and strength grew to a point where he was able to freely walk using all 4 limbs with little to no issue. Our session structure began to change approximately 6 weeks after our initial meeting with the focus moving towards gate pattern retraining and also further strengthening to his HL and back by adjusting each session's set time and speed. Utilising a fixed FL stand, we were also able to directly target only the HL in each 2nd set of each session which again helped our patient to grow not only in strength but also in confidence with each visit. We managed him further by spacing out his treatments to weekly, and as of today, he is still on the road to recovery but is a lot further down the track than when we first met. His owner’s initial goal was to have him back to full function, and with this continued hydrotherapy approach, he just might come back better than he ever was before.

Where to from here?

It's impressive to see the positive progress in the Chihuahua's recovery through hydrotherapy after such a traumatic incident. The careful approach, use of the Help 'Em Up Harness, and the gradual introduction of exercises seem to have played a crucial role in building trust and improving mobility. The collaboration with the physiotherapy plan and the integration of laser modalities highlight a comprehensive approach to rehabilitation.

To conclude, canine femoral head and neck excision surgery can significantly improve the quality of life for dogs suffering from hip joint issues. A thoughtful approach to post-surgery care, including rest, controlled exercise, and proper veterinary guidance, is key to a successful recovery. By understanding the procedure and actively participating in your dog's rehabilitation, you can help them regain mobility and enjoy a more comfortable, active life. As always consult with your Vet and canine specialist therapist to tailor the best plan forward to aid in the full recovery of your beloved four-legged doggo!

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