Homework Suggestions for Cats After FHO, Femoral Head Ostectomy (Removing the Ball off the Femur at the Hip Joint)
First and foremost:
pay attention to the discharge instructions your veterinarian has given you and really try to follow them. These instructions usually include keeping your cat as subdued as possible for at least two weeks, preferably subdued with only controlled activity for 8-12 weeks.
I highly recommend that you not allow playing, no cat rugby, no toys to pounce, no “I’m still the bossiest kitty” smack-downs from the surgery kitty to the other kitties, no smack downs from other kitties to the “wounded” kitty, etc…and definitely no jumping onto things for 8-12 weeks.
Escape Artists –
Given the opportunity, it is highly likely your cat will escape from you upon arriving home from the hospital and will promptly and speedily dash to some hiding place.
It is better to keep your cat in their crate, and upon arriving home from the clinic, keep them in a place of your choosing to govern them during this time of healing. I’m pretty sure controlled restriction will work out better than if you end up pulling your cat by the armpits or hind feet out from under the bed.
Surgical Cuts and Recovery –
During this surgery, there was cutting of muscle and other tissue that will require care and time to heal.
The muscle that was cut into during the FHO requires a little over six (6) weeks to achieve a normal collagen ratio and will take longer to heal more fully. This should be considered when you think your cat is ready to jump onto high places at two (2) weeks after surgery. Don’t let them if you hope for the best outcome from the surgery.
Just as in recovery from canine FHO, we count on the right amount of the right kind of scar tissue to help stabilize the joint over time after surgery. Too little of the correct activity allows the scar tissue to bind and tighten the hip area. Too much activity, especially dynamic or rambunctious activity, tears the scar tissue that is forming and causes too much of the wrong type of scar tissue.
Sometimes the bulking is removed in over-active dogs. I do not personally know of anyone who has paid for a 2nd surgery to de-bulk their cat’s hip area. I do run into cats with lots of problems moving the leg that had an FHO, however.
On the other hand, the bone that was cut, the femur, does not require the same care that a fracture repair would; the head of the femur was cut off completely. There is no bone healing from bone to bone, as there is after a fracture.
You do not need to wrestle with your cat in order to apply ice to the surgery site; I no longer recommend icing across the board after most surgeries or injuries in keeping with the advanced research findings over the past 5+ years. I have more info on icing if you click here.
In physical rehabilitation after FHO we should aim at keeping the “false” joint comfortable after surgery. This is the pocket area of proper scar tissue that forms by slow, weight-bearing movement. This happens by promoting hip flexion (bending) and extension (stretching out) through natural therapeutic exercises that stimulate leg use, not range of motion exercises. Natural leg use drills lead to muscle strengthening and avoid chronic disuse of the operated limb.
Range of Motion? NO.
Since the cat will move as they are comfortable and are made more comfortable with the right amount of the right pain medicines and restrictions, I DO NOT recommend pet owners try to do range of motion. I have a paper discussing that here.
I know it is popular for veterinarians to recommend ROM after surgery or injury. Please read the papers I referenced ^^. And thank you 🙂
So What Do I Do?
In light of this information I recommend working on some of the rehab activities noted below:
Some cats are accustomed to going on walks, even leash walks, with owners, and if your cat is one of them, then the standard foundation-building homework I write for canines may be followed for cats as well. You may want to try to implement that homework even if you have not previously “walked” your cat. Please use a harness to introduce this walking activity. If your cat is one of those “paralyzed” cats in a harness, then perhaps regular walking won’t work as soon as I’d like it to. Up to you; play around with it, but again, don’t get into a wrestling match with your post-surgical cat.
During the first two weeks especially, we want your cat to walk and stretch and use their operated leg in a natural, yet controlled manner and with moderate to slow movements. Any walking is fine, i.e., to the litter box, to food and water, but pouncing, jumping and dashing are to be avoided altogether or as much as possible.
Structured Walks –
If your cat is using the leg fairly well a day or two after surgery, then I encourage you to slowly increase the time of consistent leg use and otherwise start some structured walking at five days after surgery.
If your cat will not go for structured walks with you, as described further above, then another possibility is to use a favorite treat to coax them to walk slowly across the floor. You could hold up the treat at head height and crawl along with your cat to get them to walk along in a continual gait pattern as best possible, trying to get to the treat. Two to five minutes of this walking a couple of times a day for the first week will be beneficial for the cat and possibly hard on you. Because…crawling on the floor.
This same treat method may be used in conjunction with another person holding a leash on a harness on the cat to introduce the concept of leash walking, which would be easier on you.
Some cats will follow a string or feather, etc…pulled slowly across the floor, and this method may be used if your cat will walk sluggishly. However, many cats will wait for distance and then pounce on the string or feather, so use your knowledge of your cat to act as wisely as possible. No pouncing until after six weeks or more, depending on rate of recovery.
The Goal –
The goal is to encourage enough continual, weight-bearing leg use so as to create a callous of scar tissue within the compartment where the top of the femur now rides. This is very much like the callous that forms on your own sit bones as you become accustomed to riding a bicycle or sitting in a horse’s saddle. This is much like the callous that forms after someone has a mastectomy and receives implants. Get the idea?
Too much activity and/or abrupt, jumping movements could tear up the scar tissue we want to form and instead create more “bad” scarring from the new damage. Eventually, with too much activity, there could be a bulk of scar tissue and increased pain from that.
Bulking doesn’t seem to happen as often in cats as it does in dogs, primarily because they may not weigh as much, and therefore do not put as much pressure on the surgery leg when doing the wrong activities. Cats are also in theory easier for people to control after surgery, in contrast to the large Labrador that has an FHO and caretakers that let it run amok.
That extra, harsh, impact pressure is what can cause the top of the cut femur to tear into the healing area where instead we’d like to have a callous of scar tissue form. Slow, steady, easy exercise encourages the best healing in most cases.
Deeper Problems –
After about five (5) days, and especially if your cat is not using the leg much by then, I recommend you speak to your veterinarian about finding some additional pain control medications that will suit your cat.
Recovery will improve if your pet feels less pain and is able to use their leg more “normally”, yet gently. Pain medicine helps achieve this, as do other pain “helps”. In my experience the medications are needed for an average of four (4) weeks for cats after this surgery, if not more.
No, as amusing as it might be, your cat does not need a water treadmill workout to start walking again!
Too Much Femur Remaining –
Another common problem after FHO is that not enough of the femur head was removed during surgery. This could mean that the remaining bone is too tall and continually cutting into surrounding tissue. This could also mean that one piece of the femur is jutting out into the surrounding tissue and cutting it. I have seen this occur many times in dogs.
If I am brought into case and I suspect that there is too much femur head remaining, I ask the client to get a post-surgical x-ray from their veterinarian. This can help confirm the situation I described above.
Many times people do not want to put their pet through another surgery. I have helped pets recover from the “too much femur” condition many times. The recovery in these cases (and in the cases I help recover without surgery) occurs by building out the thigh muscles, and that occurs with a lot of the right kinds of exercise drills. You will also need a lot of pain medicine.
Water treadmill work can take the place of pain medicine, but on the whole, rehab practitioners spend too much time on the same work volume when they rely on the water treadmill.
I frequently take over cases wherein the pet has been working on the treadmill three times per week for months and hasn’t improved past a very basic point.
If you are going to “fix” the extra femur piece problem without surgery, you will have to invest in a structured pain control protocol and exercise drills designed by a strength and conditioning specialist and sports medicine rehab practitioner. I am definitely available for in-person or phone consults regarding this situation.
Or, get the second surgery.
There are a variety of ways to get your cat to stretch out that operated hind leg, and any may be utilized as long as the end result is not further injury. I find that with careful restrictions and exercise, along with proper pain medication, cats will usually come around to using their leg as fully as ever, if not better, without anyone stretching it or forcing movement.
(Above updated February 22, 2018. Below will be updated when I have more time)
If I see a cat more than 6 weeks out from surgery, and they have plenty of pain medication yet aren’t using the leg in good extension, I will work on exercises and drills that encourage the cat to stretch on their own. Sometimes I get a cat to extend from the floor to a couch for a treat or toy and then I draw them back to the floor again. During the first four weeks this works best if the cat does not end up jumping onto the couch. A stretching drill like this should be done 2-4 times per day with 10 repetitions each time. Please allow your cat to rest and recovery at least 2 hours between exercise sessions.
After three weeks, then more structured play to encourage stretching, leg use and muscle strengthening may be implemented. One example of this is to use a feather or string in the air that your cat will rise onto their hind legs and reach to bat. Two to three minutes of this type of play or twenty repetitions at this time, twice per day is beneficial.
At four weeks, if your cat will walk with you up and down stairs without bounding, it is good to start this exercise (stair walking). Some cats will follow the owner for continual repetitions. Some cats will need a leash and harness. Some cats will walk away. Do what you can, and keep in mind that several repetitions of continuous movement are what is needed to encourage recovery. Sporadic activity will not build the base your cat needs to flourish.
Where and when possible, a set of five times eight to ten stairs once every other day could be a good workout. Any slow climbing is better than none, and more repetitions in a row serve the muscles better than only one or two stairs here and there.
By three to four weeks, your cat will be wanting to run around more and will function as if they are ready for all the “usual” household activities. I still prefer to avoid very harsh movements at this time so that cats don’t disrupt the good scar tissue that has formed. I tell people that the tissue we want is very much like what you get when you ride a bike a lot. If you have not ridden in a while and you go out for a longer ride, the bones at your seat will likely feel like they hurt the next day when you sit in a hard chair. People who frequently ride have scar tissue that operates as padding between bone and tissue. After a couple of riding sessions, the appropriate scar tissue forms and it is no longer painful to sit. Same applies to how much your seat hurts after riding a donkey to the bottom of the Grand Canyon for the first time ever. I’ve not done that, but I hear stories…
This is very similar to the type of tissue I want to see your cat form after an FHO; they need a slow build-up of scar tissue to cushion between the femur and the muscle, and while it is forming due to friction from consistent leg use, I don’t want to tear it or otherwise disrupt it with harsh movements. Excessive movement and subsequent tearing could lead to formation of more bulky scar tissue which makes it harder for the leg to move and sometimes causes nerve pain.
Similarly, we don’t want to allow the animal to not use the leg, because scar tissue will form that will bind the leg into a place of reduced function and it will always then hurt to do some favorite activities in the future.
Not too much, not too little.
If your pet is not using the operated leg after week 1, then I recommend calling your vet or me for rehab intervention and to get them started on beneficial exercise and pain medications. Of course you may show this plan to your veterinarian.
If you follow the exercise prescription well and after week 4 would like advanced exercises, then a rehab consult is necessary. I have some separate recommendations for canine FHO’s elsewhere on this site or in a book.
If your cat does end up hiding under the bed when you get home because you felt sorry for them and let them out of their crate, don’t pull them out from under the bed by the arms/front legs. I do recommend that you shut the doors to the bedroom, closet, and bathroom, though, so that when they do come out from under the bed, you will have a better chance of collecting them and getting them back into a crate.
©2007 Rehabilitation and Conditioning for Animals
Deborah Carroll CCRP, CSCS