Front Matter

Chapter 14 Disorders of the Pelvic Limb: Diagnosis and Treatment 367

during this time. For most cases, the authors
recommend limiting rehabilitation therapy to
cryotherapy, laser therapy, and massage dur­
ing the initial convalescent period. Stretching,
manual work, strengthening (land‐based and
hydrotherapy) can be initiated 1  month fol­
lowing surgery. Off‐leash activity is not recom­
mended until 12 weeks following surgery.

Femoral head and neck ostectomy

Femoral head and neck ostectomy is a salvage
procedure in which the head and neck of the
femur are removed, eliminating the bone‐on‐
bone contact of the worn femoral head and
acetabulum (Figure 14.16). This procedure
relies on peri‐articular fibrosis and muscle to
support the body‐weight of the patient. There
are few perioperative complications, as no
implants are present (Dueland et al., 1977).
Patients may have a residual gait abnormality,

but are usually perceived as pain‐free by their

clients, and can maintain an acceptable level of

activity (Off & Matis, 2010).

Postoperative management. Functional shorten­

ing of the limb associated with dorsal dis­

placement of the femur, failure to recover

normal muscle mass, and decreased range of

hip motion are likely causes of poor outcome

with FHO. Most patients will not bear weight

on the limb for 3–5 days following surgery.

Rehabilitation therapy is imperative for a

functional outcome. Long‐term administra­

tion of analgesic medication and early ther­

apy (5–14 days following surgery) aim to

improve comfort and preserve range of motion

of the hip (Grisneaux et al., 2003). Once the

patient is adequately bearing weight, strength

training is initiated. Underwater treadmill

therapy can be extremely beneficial and is

recommended starting 2–3 weeks following

surgery. Swimming tends to be less beneficial

in these cases, as patients are often hesitant

to fully engage the surgical limb. Recovery is

usually longer than that experienced with a

THR, typically 16–20 weeks until optimal

function is achieved. The most predictable

outcome with this procedure is with a thin,

well‐conditioned patient.

Coxofemoral luxation

Anatomy

The coxofemoral joint derives most of its stability

from the round ligament of the femoral head,

the joint capsule, and the dorsal acetabular

rim. The joint also receives ancillary stabilization

from the ventral labrum, surrounding muscu­

lature, and the adhesion–cohesion relationship

of the joint surfaces and synovial fluid.

Disruption of two or more primary stabilizers

results in luxation of the hip (Holsworth &

DeCamp, 2003).

Pathophysiology

Hip luxation is most often due to a traumatic

event, such as vehicular trauma (Bone et al.,

1984; Basher et al., 1986; Demko et al., 2006).

Figure 14.16 Femoral head and neck ostectomy is a
salvage procedure in which the head and neck of the
femur are removed, eliminating the bone‐on‐bone
contact of the worn femoral head and acetabulum.