A femoral head ostectomy is a surgical operation to remove the

head A head is the part of an organism which usually includes the ears, brain, forehead, cheeks, chin, eyes, nose, and mouth, each of which aid in various sensory functions such as sight, hearing, smell, and taste. Some very simple animals may ...

and

neck The neck is the part of the body on many vertebrates that connects the head with the torso. The neck supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In ...

from the

femur The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with ...

. 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 Arthroplasty (literally " e-orming of joint") 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 i ...

of the femoral head and neck, Girdlestone's operation, Girdlestone procedure, and femoral head and neck ostectomy.

History

The operation was first described by

Gathorne Robert Girdlestone 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. Life Gat ...

(1881–1950) in 1945. He originally designed it for treatment of

tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in ...

and other disorders of the hips. It may thus be known as a "Girdlestone operation". Other surgeons have added various modifications.

In veterinary science

Use of the operation in veterinary science was first described in 1961 by J. S. A. Spreull. 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 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 doe ...

, an extremely painful

congenital A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...

condition found in many dog breeds and some cats. 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 The acetabulum (), also called the cotyloid cavity, is a concave surface of the pelvis. The head of the femur meets with the pelvis at the acetabulum, forming the hip joint. Structure There are three bones of the ''os coxae'' (hip bone) that c ...

(socket of the pelvis). Small horses and ponies can have an ostectomy without an

osteotomy 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 ...

of the

greater trochanter The greater trochanter of the femur is a large, irregular, quadrilateral eminence and a part of the skeletal system. It is directed lateral and medially and slightly posterior. In the adult it is about 2–4 cm lower than the femoral head.Stan ...

. 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. This procedure can also be successfully performed in pigs.Smith, J.S., Chigerwe, M., Kanipe, C. and Gray, S. (2017), Femoral head ostectomy for the treatment of acetabular fracture and coxofemoral joint luxation in a Potbelly pig. Veterinary Surgery, 46: 316-321. doi:10.1111/vsu.12604

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, most times one side is done and allowed to heal before the other side is done. 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". 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.

References

{{DEFAULTSORT:Femoral Head Ostectomy Dog health Orthopedic surgical procedures Surgical removal procedures Veterinary procedures

History

In veterinary science

Procedure

See also

References