feline simultaneous bilateral femoral head and neck ostectomy
This documents the time after my two year old cat, Reiver, had a simultaneous bilateral femoral head
and neck ostectomy (FHO). I put this page together because I found it very
difficult to find information on the internet about feline FHOs, and personal
experiences were particularly lacking.
Since putting up this page, I have heard from a couple of people whose cats have undergone FHO. I am encouraging people to send in their experiences with this procedure in order to build up a more complete base of information about dealing with the surgery, so far, in addition to Reiver, I have:
Reiver's Story:
Previous to Surgery:
Reiver was an extremely active, interactive and sociable young cat (born Spring 2004). I caught him
as a feral kitten and he has been an indoor cat since. He is FIP positive but has shown no signs
of active infection and has thrived since he came to us. He was fit and lean at 12 pounds.
Reiver began to favour his right hind leg early in March 2006. He was able to jump onto counters
and such but he seemed a little tender. He had pulled a muscle in the same leg a year previously
so I assumed it was a similar injury. When he did not improve, I took him to the vets' and he had
hip and knee x-rays done along with a thorough physical exam. (11.8 pounds). He was extremely
uncooperative but we got reasonable views and his hips appeared normal. The last time he had hurt
himself he had responded very well to a round of ketoprofen, so my vet prescribed the same treatment.
He initially improved, but I was watching him closely at this point and it was apparent that he was unable
to flex his right knee comfortably and this was preventing him from sitting, crouching and jumping.
Instead of sitting or meat-loafing, he started to slouch
up against things with his legs still extended. Otherwise he was able to weight bear well, could jump down, and run and play with the other cat and
the dog. He stopped jumping up onto things but would come and stand on his hind legs and ask to
be picked up. After a few days it was obvious he was in a lot of discomfort, and my vet switched him
to meloxicam. It seemed to help his comfort level but he did not improve otherwise.
At this point, I took him back to the vet and she thought he may have a more serious knee injury, and
we decided to have him anesthetised the next day so she could do a thorough manipulation to determine
where the problem lay. He was down to 10.9 pounds, apparently due to difficulty eating from his
inability to bend his leg. That night, I was watching him closely and he seemed to be having problems
with both hind legs.
Monday, April 17, 2006:
Reiver was given a general anaesthetic, but upon exam it became evident that his knees weren't the
problem. The vet decided to repeat the hip x-rays and was able to do good views of
both hips. It
was immediately apparent that he had bilateral Legg-Calves-Perthes disease (avascular
or aseptic necrosis of the femoral neck). She phoned me and I
told her to go ahead with the corrective surgery. She did a simultaneous bilateral femoral head and
neck ostectomy that afternoon.
Day 1 Post-Op:
Reiver stayed at the vet's overnight. He was given subcutaneous fluids twice and had a
Duragesic patch put on for pain control. He was not eating and was very grouchy, but his kidneys and bowels
were both working, so I picked him up the next day. He had a large incision on each hip but was able
to stand.
When we got home, he crawled out of the cat carrier and walked several steps. He seemed somewhat
anxious and disoriented but would interact with people and other animals. His walking was very
unsteady. He took a long time to settle down but eventually found a comfortable spot. That night
I put him in a large dog kennel with food, water and a shallow pan for a litter box.
Day 2:
Reiver was still not eating very well, but he would eat a bit, so I did not attempt to force feed.
He was able to climb up one stair to get to one of his favourite basking spots, but did not do any
other activity. That evening he used the litter box for the first time. He had a hard time because
he was unable to squat comfortably, but he eventually managed to urinate and defecate.
Day 3:
I took off the Duragesic patch, and a couple of hours later he was interacting more, changing position
and occasionally walking around a little bit.
Day 4:
His eating improved markedly, probably as a result of the patch removal, so I was able to start giving
him some meloxicam for discomfort. I had to put a soft collar on him as he had started to worry his
incisions. The collar interfered with his mobility for a bit, but he seemed to adjust fairly quickly.
This is a picture of the soft
collar, modelled by Skeezix.
Day 5:
Reiver climbed up the stairs to my bedroom when I wasn't watching him. He then climbed up the pet
stairs onto my bed (I have had them for a long time, to help my dog get up). He was able to go
down them very easily, so I stopped locking him the dog kennel at night and brought him upstairs
where he would normally sleep and eat. He remained in the dog kennel during the day when we weren't
able to keep an eye on him.
Day 6-9:
Reiver continued to improve at a fairly steady rate. His appetite was good and he would play if he
was able to do it lying down. He needed heat all the time, he seemed to feel the cold, and I was
glad for the SnuggleSafe. The
following pictures were taken a week post surgery. I picked him up and put
him on one of his formerly favourite spots, the top of the scratching
post, but he was perfectly happy to sit up there for a time. This is a
shot of his left hip,
and this is a shot of his right,
as you can see, he's interested in the world around him. The incisions are
not the same shape, as the vet modified them to allow her to access his hip
joints with a minimum of trauma to his surrounding musculature. This sitting
shot is one of the first times I saw him bend his back legs since he started
having problems. The bare spot on his left shoulder is from the Duragesic
patch.
Day 10:
I took out Reiver's stitches late afternoon, and it perked him up noticeably.
Day 11:
I took his soft collar off, and his mobility and eating improved a great deal. He shows little
interest in the incisions now that the stitches are out, though otherwise he grooms his shaved parts
obsessively. Now that the soft collar is off I have given him the run of the house, even when we
are away.
Day 12:
Reiver climbed onto the couch by himself.
Day 13:
I took Reiver in to the vet's for a follow-up appointment. He walked all over the back office and
explored quite a bit, and spent quite some time avoiding the staff. He has a little swelling around
his incisions, and they are a bit hot, but there is no discomfort and he appears to be perfectly
at ease. He doesn't like having his hips poked at, and he weighs 9.8 pounds. The vet said that he
had lost quite a bit of muscle mass on his hips, but his body weight seemed acceptable otherwise.
At this point I am extremely happy that I went ahead with the surgery rather than making the decision
to euthanise. (It wasn't an easy decision to make.) He is comfortable and reasonably mobile, and
seems to be much his old self with the exception that he's not jumping onto everything. If there is
no further improvement I would still consider the procedure to have been a great success, and I expect
him to improve gradually over the next several months.
Day 14:
At suppertime Reiver climbed onto the couch again by himself and then climbed onto the top of the
couch. This enabled him to make the short jump from there onto the dining room table.
Life is getting back to normal.
3-4 weeks:
Reiver has started to make playful overtures to the other cat and our dog. He was always a very enthusiastic wrestler and chaser, and though he's just taking wild swipes at them with his front paws while lying down, it's the first time I've seen him interact with them in a really playful manner.
I took down the dog kennel and removed the shallow cat box. He's using a covered cat box upstairs now that has about an 8" rim on it. It's still not deep or long enough for either of the cats to be happy with it (they are used to a 14" deep, 30" long box), but he hasn't any trouble getting in and out of this one so I'll use this for a month and then see if he can get back to their old one.
4-5 weeks:
Reiver is acting more like himself - following us around all the time, getting into things, etc. He doesn't seem to be able to jump much, but he's learned that he can climb onto a lot of things that he used to jump to, such as the shelving in the closets. Tonight he followed me up the stairs and actually went up them using a 'bunny hop', pushing with his back legs in unison rather than climbing up stair by stair, for most of the way up. He seemed to be very comfortable doing it, so I suspect that he'd done it before but this was the first time I'd seen him do it. He has always played a lot with the other cat, and they would be on the stairs a lot at night, so I'm wondering if he's been doing physiotherapy with Skeezix in the wee hours of the morning.
Other than the jumping, the main behavioural difference is that he remains really clingy. He was always a very affectionate and interactive cat, but I think he's still cold and when there is someone being still he thinks it's very important that he's on top of them. He has started waiting for me to fall asleep and then climbing onto me and curling up, the SnuggleSafe is a poor alternative these days.
He seems to be perfectly comfortable when he's doing things at his own speed. He doesn't mind being picked up anymore, but we have to be careful moving him around, he occasionally complains if his back end gets moved in certain ways. His hips are no longer warmer to the touch than the surrounding tissue, and he has put on some muscle mass on the rear end. He's also gained back other weight, I haven't weighed him but he seems to be in much the previous condition he was in pre-surgery, other than some lack of muscle on his hindquarters.
~8 weeks:
Reiver jumped, actually jumped over me a couple of days ago. It was mostly a downwards trajectory to the floor, but he had to get up and over me in order to do that. He is also running around and chasing Skeezix periodically, although their long boxing bouts aren't in evidence as yet - it's not as fun when he can't stand on his back legs. When he is playing with me he will very occasionally thump me with one of his back legs, which I think is a good sign.
I am continuing to give him a low maintenance dose of Metacam (meloxicam) every day, I think it does help him be a little more comfortable, and that increases his activity. He is certainly still a little ginger about his back end and legs, but he's far closer to his old self.
August, 2006:
I had some problems this summer with the cat box. Reiver was able to use the old cat box comfortably, so I changed from the lower, smaller box and then started to have problems a couple of weeks later. I have ended up with two cat boxes in the house, the regular one upstairs and the lower one downstairs. He doesn't use the lower one exclusively, but it seems to have stopped the inappropriate urination. I don't know if this was related to his physical abilities or some behavioural issue.
November, 2006:
It's been a few months since I updated this, mostly because things have been so normal. Reiver is not as athletic as he was before the surgery (I don't find him peering down at me from the top of the kitchen cupboards), but overall he appears to be a completely normal cat (that is, it's a running battle to keep him off the kitchen counters). He tends to climb rather than jump, but is quite willing to jump onto something if climbing isn't an option. He occasionally complains when picked up, and still often sits with his legs straight rather than bent, but I see him curled up, meatloafing and such in perfect comfort. His gait is slightly off, the vet thinks that one leg is possibly slightly different in length than the other, but he doesn't limp and just appears a little 'slinky' when he's walking - there's no noticeable difference when he's trotting or running - something he does quite a lot. His muscle mass on his hips is very slightly less than before, but it's unnoticeable to a casual observer and he's fit and very lean at 11 pounds.
I think there were two reasons he had such a good result from his surgery. The first is that his personality is such that he's a busy, nosy and very interactive cat, and the second is that he has a very affectionate and physically playful relationship with the other cat. These two things provided a tremendous amount of physical stimulation post-surgery, I don't think that he would have regained his abilities in the way he did had things been different.
That said, I was just hoping for a comfortable, mobile, and content cat, and I think that result is attainable from this surgery without the intense physical therapy, but I am positive it made the difference between a satisfactory result and one that was better than I ever could have hoped for.
April 2007:
Reiver is now almost one year post-operative so I thought I would update this page once more. He has continued to improve since November. The improvements get smaller as the days go by, but then again Reiver gets closer and closer to his old self.
Essentially, Reiver is completely normal. There are a few small deficits, if one knows what to look for, but he is absolutely a nosy, mischievous, playful young cat. While he still hasn't managed the jump from the kitchen counter to the top of the cupboards, he can jump easily onto the counter (especially if you're cooking!), and can jump from the coffee table to his favourite window perch, a span of about five feet!
He is fit and lean at a bit over 11 pounds, and he has a normal amount of muscle mass on his hind legs. He can tear around the house at high speed in the wee hours of the morning without any complaints. I no longer give him the anti-inflammatories, and he doesn't complain at all when we pick him up, unless he's being prevented from getting into trouble.
The total cost of the surgery, including all work-up and post surgical visits, medications, etc, was a shade under $2000.00. This was at a small rural clinic in Eastern Ontario, Canada.
It remains to be seen how well he will cope when he ages, I will continue to do updates to track that.
Further, I have received a few e-mails from people thanking me for putting up these pages. Thank you all for your stories. I want to encourage anyone to write who wants to ask more specific questions, and I hope in the near future to put up some more stories about cats who have had this procedure - I think it is important to get multiple experiences up, particularly about cats of varying ages and temperments, even if the procedure wasn't the rousing success that Reiver's was - that information is vital when one is trying to make such a difficult decision!
Monday, April 23, 2007
