Post-FHO Homework Suggestions for Cats (Cut Femur Head)

Homework Suggestions After Cat FHO, Femoral Head Ostectomy (Removing the Ball off the Femur at the Hip Joint)

Lulu M in Dubai-a real cat that had an FHO
Lulu M in Dubai…a real cat 🙂 that had an FHO and problems recovering. Lulu also has a great “Mom” who looked for progressive solutions.

First and Foremost –

Pay attention to the discharge instructions your veterinarian has given you. Really try to follow them.

These instructions usually include keeping your cat as subdued, quiet, and inactive as possible for at least two weeks, preferably with only controlled activity for 8-12 weeks.

I highly recommend that you do not allow your cat to play; 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. It will probably immediately occur to your cat to promptly and speedily dash to some hiding place. The best hiding place is one where you cannot reach them. You know.

It is better to keep your cat in their crate, and when you arrive home from the clinic, keep kitty in a place of your choosing to oversee them during this time of healing. I’m pretty sure controlled restriction from the beginning will work out best versus pulling your cat by the armpits or hind feet out from under the bed.

I do recommend that you shut the doors to the bedroom, closet, and bathroom, if your cat does escape. That way 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.

Surgical Cuts and Recovery –

During this surgery, there was cutting of muscle and other body parts that will need care and time to heal.

The muscle that was cut into during the FHO requires a little over six (6) weeks to make a normal collagen ratio and will take even more time to heal fully. You should consider that info 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 results from the surgery.

Use the E-Collar –

A hard e-collar will almost always work the best.

A soft e-collar will not work if the pet can get around it to lick their surgery site.

Calvin Cat Wearing Flexible Elizabethan Collar
Calvin Cat Wearing Flexible Elizabethan Collar to Keep Him From Biting or Licking His Surgery Site

Scar Tissue –

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 after surgery. This scar tissue only forms correctly under the right circumstances and over a couple of months of doing the right activities.

Too little of the correct activity allows the scar tissue to bind and tighten tissue in the hip area. Too much activity, especially dynamic or rambunctious activity, tears the scar tissue that is forming and causes extra bulky scarring.

Sometimes scar tissue 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 scar tissue. I do meet cats with lots of problems moving their leg after FHO due to excessive scar tissue. There are other reasons why they may have trouble moving the operated leg, too.

On the other hand, the bone that was cut, the femur, does not need 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.

Ice?

You do not need to wrestle with your cat to apply ice to the surgery site; I no longer recommend icing across the board after most surgeries or injuries. Advanced research findings over the past 10+ years support this. I do recommend using ice if your cat is in pain and therefore probably isn’t getting enough of the right kinds of pain medications. There are many reasons for pain after surgery, and dosing the right medicine(s) for your pet should encourage body use, whatever the problem. 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. The false joint is the pocket area of proper scar tissue that forms by slow, repetitive weight-bearing movement. The best way is to promote 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 lack of use of the operated limb.

Range of Motion? NO.

Since the cat will move on their own when they are comfortable and become even 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 (ROM). 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?

For comfortable and progressive results after surgery, I recommend working on some of the rehab activities noted below:

Some cats like going on leash walks with their peeps, and if your cat is one of them, then you may follow the standard foundation-building homework I write for canines. You may want to try to carry out that homework even if you have not previously “walked” your cat on a leash, either inside or outside. 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. It’s up to you; play around with it, but again, don’t get into a wrestling match with your post-surgical cat.

Vashi loves to walk outside in his harness

During the first two weeks especially, we want your cat to walk and stretch and use their operated leg in a natural, yet controlled way and with moderate to slow movements. Any walking is fine, i.e., to the litter box, to food and water, but avoid pouncing, jumping and dashing altogether or as much as possible.

Structured Walks and Movement Drills –

If your cat is using the leg pretty well a day or two after surgery, then I urge 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 outlined and as described 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.

You may also use this same treat method while another person holds the cat on a leash and a harness to introduce the concept of leash walking. If you can accomplish the leash walks, the kitty rehab work should be easier on you.

Some cats will follow a string or feather, etc…pulled slowly across the floor, and you may only use this method if your cat will walk sluggishly. Again, slow, progressive, tissue-building exercise…no pouncing now. Many cats will wait for distance between themselves and the item and then pounce on the string or feather, so use your knowledge of your cat to make good choices. No pouncing until after six weeks or more, depending on rate of recovery. Never less time.

The Goal –

The goal is to encourage enough continual, weight-bearing leg use to create a callous of scar tissue within the compartment where the top of the femur bone 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. Get the idea?

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. The 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 cut femur and the muscle, and while scar tissue is forming due to friction from consistent and proper 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.

Setbacks –

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 asked to review a 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, preferably the veterinarian who did the surgery. This can help confirm the situation I described above. It is standard procedure to take an x-ray after the surgery, so it shouldn’t cost you additional money to get that x-ray for your records.

Not Another Surgery!?

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 in some rehabilitation cases, but on the whole, rehab practitioners spend too much time on the same work volume when they rely on the water treadmill. It is also not very practical to work most animals at a clinic in a water treadmill, especially when you have these programs available to use at home and if you have dealt properly with causes of pain.

I frequently take over rehab 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. More on water treadmill.

If you are going to “fix” the extra femur piece problem without surgery, you will have to invest in a structured pain control protocol with your veterinarian. You also need exercise drills designed by a strength and conditioning specialist who understands sports medicine rehabilitation. I am definitely available for in-person or phone consults regarding this situation.

Or, get the second surgery.

Timing Medications & Drills –

You should also time medication dosing so that the pain medications are helping with the exercises. I recommend doing the drills or walks or other exercises between 45 minutes after giving the medications and up to 4 hours after dosing. Follow the recovery time I recommend in-between drills. If you have more questions about this, please see this book and these instructions for now.

Extending and Stretching the Surgery Leg –

There are a variety of easy and healing ways to get your cat to stretch out that operated hind leg. 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 well as ever, if not better, without anyone stretching it or forcing movement.

Crepitus –

If I meet a cat patient more than six weeks after surgery they should be using their leg well. If they aren’t using the surgery leg in extension, I will check to determine if there is crunchiness in the hip area. Crepitus at the hip after FHO often indicates that there is a piece of femur sticking out into the tissue. This is usually causing pain. See discussion about that several paragraphs above this one.

I check for crepitus or issues with the incision area, discussing with the veterinarian if need be, and clear the cat from other medical issues, so far as we are able. I then work on exercises and drills that encourage the cat to stretch their surgery leg on their own.

Continuing Work –

Sometimes I get a cat to extend from the floor to a couch, slowly, for a treat or toy. They leave their back paws on the floor and slowly reach up with the front. Then I draw them back to the floor again. During the first four weeks this method only works best if the cat does not end up jumping onto furniture. 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 recover at least two hours between exercise sessions.

After three weeks of base-building exercise then you may begin more structured play. This work should encourage stretching, leg use, and muscle strengthening. You can use a feather in the air that your cat will rise onto their hind legs and 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, start stair walking. Some cats will follow the owner for continual repetitions. Other cats will need a leash and harness. Some cats will walk away. Do what you can, and keep in mind that several easy repetitions of continuous movement are needed to encourage recovery. Sporadic activity will not build the base your cat needs to flourish.

After Building a Base –

Where and when possible, a set of 5 x 8-10 stairs once every other day could be a good workout. Any slow climbing is better than none, only after building a base first. More repetitions in a row are better for the muscles than only one or two stairs here and there.

By three to four weeks, your cat will be wanting to run around more. They will function as if they are ready for all the “usual” household activities. I recommend you avoid harsh movements during healing. This is so your cat doesn’t tear the good scar tissue that has already formed from following these instructions. Capillaries also need time to heal after any surgery.

If your pet is not using the operated leg after week one, then I recommend calling your vet for recheck and pain medications. You may also contact me for rehab intervention and to get them started on beneficial exercise. Of course you may show this plan to your veterinarian.

If you follow this exercise prescription well and would like advanced exercises, then contact me for a consult. There is a contact form at the bottom of this page if you would like to pursue further rehabilitation for your cat.

©2007 Rehabilitation and Conditioning for Animals

Deborah Carroll CCRP, CSCS

Updated March 28, 2018

FHO for Westie Going Well Now…

Fall, 2013
I went last week out to a veterinary clinic at a vet’s request to see a Westie that had hip surgery and whose leg was just dangling after about 2 weeks. The young dog has been diagnosed with Legg-Calve’ Perthes disease, and he has had an FHO surgery on one hip.
This is the text I got from the owner Saturday, three days later:
Hi, Deborah-
We are seeing good improvement in JJ. He’s standing on his leg at each meal and he has started to use it during our slow walks. He appears to be much happier-caught him smiling today! We haven’t completed all the walks you prescribed yet. Only 2 five min walks today. He’s keeping still most of the day. If not in his crate, he sleeps on the floor in my office or in our family room. We look forward to seeing you next week.
That’s great news, and we had an hour and a half appointment, in person, to ensure that the caretaker really understood what was going on and my instructions.
It also really, really helps that we have full support from the veterinarian, a young man who does a lot of surgery and with whom I have only worked infrequently. He became familiar with the type of exercise physiology-based rehab I promote and practice through injury during his own life adventures, and he seems to understand and embrace the concepts I talk about with him. He successfully uses a lot of these guidelines without my intervention, and I’m really glad to have been brought in on this case. I think together we’ll make a huge difference!
I’m soon to publish the guidelines for post-FHO surgery, but in the meantime, you will do well to begin by using the same guidelines I have already published for post-knee surgery. Here is a link to the Amazon page with the booklet, currently available in paperback or on Kindle:
Blessings-
Deborah

LouDog FHO Almost a Year Ago – Still Lame

Ryan
Submitted on 2014/02/13 at 8:23 pm
My dog had FHO almost a year ago. He was slow to gain muscle tone but everything looks good now. The doctor said to make sure he wasn’t rough housing and not to run for a specified amount of time. On our walks I would go back and forth across the street so he would get a good distribution of inclines (not much is flat near me).

My worry is that the leg he had the surgery on has a slight rotation outward, sometimes as much as a 30 degrees outward. And it makes me cringe when he rotates on it. My question is, is it normal for that to happen, and if not how could I correct it?

Thank you!

P.S. His name is Lou Dog and he is a border collie/lab mix

2/20/14

Hey Ryan 🙂

From what you describe, your dog is still compensating for pain by rotating his knee laterally, outward. I suspect he hasn’t yet built up muscle equal to the other thigh either…? If he isn’t using the leg consistently and building up from a very basic plan, only increasing slow walk time by 5 minutes, up to 30 min, (so that would take several weeks), then working on more muscle-building exercise, he won’t be able to build muscle progressively and well and use the leg with less pain.
That may make total sense, or it may seem like a vague answer…depends on how you understand exercise physiology, I think.
Typically we all try to push things faster than they are naturally designed to comply…and people really push the animals because our pets, especially dogs, are eager to make us happy and get about “normal” lives.
So, they end up ahead of themselves with lingering injuries and pain.
It sounds like you did well with basic recovery parameters…when you feel the thighs, are they equal in size? Get behind him and cup your hands loosely over the femur/quads and slide them up and down, from flank to knee. Also, stand and cup your hands, thumbs down, over the hams and slide your hands up and down. Usually the quads develop faster and more equally than the hams.
It really sounds like LouDog could use some pain meds or you could start with ice and vibrational massage prior to each walk to see if that’s enough pain help. Then start back at 2-4×10 min super slow walks daily with no additional running around. To alleviate the pain rotation or the functional deficits, I suggest you start back closer to the beginning so he may achieve success and THEN if/when he gets to a sticking point, a point wherein he is rotating again, you will know what to address…
Hope that makes sense-

POSTED BY REHABDEB | FEBRUARY 20, 2014, 1:14 PM | EDIT

Gus, Great Pyrenees Knee Surgery, Hip Surgery, Complications

Hi Deborah,

Gus Maxwell Porch Swing Sling
Gus Maxwell Porch Swing Sling
Teri also commented on Rehabilitation and Conditioning for Animals’s link on Facebook

Teri wrote: “Hi Deborah Carroll…although you did a superb job working with our Great Pyrenees Gus post-surgery…I would also HIGHLY recommend to anyone considering surgery (especially on a large dog) to go to all lengths trying non-surgical resolutions. As you know, Gus had the knee surgery and had every possible complication including blowing out the opposite side hip joint. Although he doesn’t consider himself disabled….I wish I had done things differently when he first had symptoms. As always….you’re the best!

My note:

The above picture is from my (Deborah’s) files…Gus enjoying the day in his porch sling I made, using pulleys and my favorite cheap harnesses (Travelin’ Dog from Petsmart online-use in rear and sometimes front). Owner Mom could help him outside during the day and then get him upright using the pulleys without as much stress to her body. I think Gus weighs more than she does!