Femoral Head and Neck Excision Arthroplasty refers to the removal of the articulating, ball at the top of the thigh bone (femur). This procedure has been used for the management of a range of conditions involving the hip joint. The most common reasons for this are untreatable hip joint fractures, chronic dislocations, osteoarthritis, hip dysplasia and hip pain, in cases where total hip replacement is not considered viable. The reason for the procedure is to remove the direct contact of the thigh and hips bones to remove the pain associated with this bony contact.

The outcomes following surgery are generally good in smaller patients, but may be variable in larger patients where there is more weight being transferred through the joint. The “ball” part of the ball and socket joint is removed, so the bone and joint pain is generally relieved, and the load of the joint is then taken up by the muscles to carry the body weight in the standing patient. Total hip replacement may be the preferred option to restore anatomical joint function, but should that procedure not be an option for patients, then a femoral head excision arthroplasty, combined with good, proactive, rehabilitation, physiotherapy and hydrotherapy will often return patients to very good function.

Mechanical lameness, or an observable rise of the hip muscles, on the side of the surgery may occur long-term following removal of the joint, however with extensive physiotherapy, rehabilitation and exercise this instability will improve and the patient’s recovery in the short and longer-terms should be good. Physiotherapy may begin immediately following surgery, with ice and heat therapy, massage, gentle hip range of motion exercises and lead controlled walks. Consultation with a physiotherapist would be advised following this surgery.

Complications rates are low, with the most common complications being in

Hip Dysplasia refers to the development of poorly conformed hips commonly seen in young, large breed, dogs. There is a combination of factors which influence the development of Hip Dysplasia, such as genetics and breed predisposition, environment and exercise, diet and speed of growth. The poor conformation refers to the ball and socket joint of the hip, where the socket is very shallow, and the ball is very flattened, and does not sit within the socket allowing excessive movement between the two. The excessive movement within the hip joint causes the early wearing of the articular cartilage, and pain as a result of the impact of bone rubbing against bone. The management of hip dysplasia is aimed at control of pain and stability of the hip joint.

Total Hip Replacement or Femoral Head and Neck Excision Arthroplasty are used for the management of severe hip pain, whilst Physiotherapy, Exercise moderation, Dietary, Anti-inflammatory and Joint Supplementation (fish oils, glucosamine/ chondroitin, pentosan polysulphate injections) are used for conservative management of Hip Dysplasia.

Juvenile Pubic Symphysiodesis (JPS) surgery is a technique used in young, large breed, dogs who are at risk of developing Hip Dysplasia. JPS surgery is performed on dogs ideally less than 24 weeks of age, with patients of 16-20 weeks having better results. JPS surgery is a relatively minor, low risk, surgery which is performed on the pubic bone, on the underside between the patient’s legs. The surgery aims to fuse the growth area of the pubis in the young, growing patient, which then allows the hip conformation to improve by forming a better ball and socket. The recovery following JPS surgery is quick, with little notable effects. X-rays may be performed 3-4 months following surgery to assess the outcome and hip conformation. Consultation with a physiotherapist would be advised following this surgery to aid further muscular hip stability and the developing hip conformation.

Because the procedure is minimally invasive the complications rates are low, with the most common complications being infection (2-4%). Other complications may be due to injury of structures of the pelvic canal, but these are avoidable with good surgical technique.

fection (2-4%).

Other complications may be tem

Elbow dysplasia is the most common cause of forelimb lameness in large breed dogs. The term refers to the abnormal development of the 3 bones which make up the elbow joint, causing abnormal wear of the articular cartilage, and formation of fragments of bone or cartilage within the joint. The condition occurs in young, rapidly growing dogs, with most patients being diagnosed under 2 years of age, with a second group of patients being diagnosed later in life. The most common underlying cause of elbow pain is a small fragment of bone called the medial coronoid process which displaces and constantly irritates the elbow joint. The abnormal wear of cartilage and formation of fragments within the joint lead to the progression of debilitating osteoarthritis and ongoing joint pain. There is a progression of medial compartment syndrome, where the articular cartilage is lost from the inside aspect of the elbow, and bone rubs against bone.

The diagnosis of elbow dysplasia and fragmented medial coronoid process is based on clinical examination and early osteoarthritic changes seen on x-rays. Should changes not been seen on x-rays then either CT scan or arthroscopy may be required. CT scan gives a 3-D view of the bones of the elbow joint allowing the bony fragments to be seen, whilst arthroscopy uses a camera to look inside the joint and treat the condition in a single step.

The gold-standard for diagnosis and management of elbow dysplasia and fragmented medial coronoid process is arthroscopy, with any further management of the joint based on the changes identified. Occasionally cutting of the bone at the back of the forearm (bi-oblique proximal ulnar osteotomy, proximal abducting ulnar osteotomy) will ease the tension across the joint and alter the weight bearing through the joint onto healthy cartilage.

The prognosis for return to function is good, with 60-70% of patients having resolution of the lameness, despite the inevitable progression of osteoarthritis. The outcome however will be largely dependent upon the degree of damage within the joint at the time of surgery.

Complications following arthroscopy are very low, with an expected quick post-operative recovery, and improvement of function in the weeks following the procedure. The joint will have some swelling following the surgery, but this should resolve without issue in 2-5 days. Infection is the most common complication (usually less than 2%) which should be monitored for following surgery, and is generally easily treated with antibiotics, but in serious infections, washing of the joint with sterile saline may be required.

Long-term options for the management of elbow dysplasia are based on the maintenance of lean body condition, physiotherapy, joint supplementation (fish oils, glucosamine, chondroitin, pentosan polysulphate injection), joint anti-inflammatories and exercise moderation.

porary paresis of the large nerve running at the back of the hip joint (sciatic nerve), which may be related to the initial injury or the traction applied during surgery itself, however this paresis will generally resolve in the days to weeks following surgery. In a small number of cases this paralysis may be permanent.