FHO Surgery for Dogs
Femoral Head and Neck Osteotomy — A Salvage Procedure for a Painful Hip
Antietam Valley Animal Hospital | Berks County, PA | Reading, PA
Understanding When an FHO Is Needed
The hip is a ball-and-socket joint: the “ball” (femoral head) sits inside the “socket” (acetabulum) of the pelvis. An FHO (Femoral Head Osteotomy, sometimes called Femoral Head and Neck Ostectomy, or FHNO) becomes an option when that joint is a persistent source of pain and normal function of the joint can't be restored. Rather than repairing the joint, the procedure removes the source of the bone-on-bone pain.
Common reasons an FHO is recommended include:
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Hip luxation (dislocation) that can't be stably reduced, or that repeatedly re-luxates
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Severe hip osteoarthritis, often secondary to hip dysplasia, that hasn't responded to medical management
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Legg-Calvé-Perthes disease (loss of blood supply to the femoral head, most common in small-breed puppies)
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Femoral head or neck fractures, particularly in cases where a fracture repair isn't a good option
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Chronic, unresolvable hip pain where a total hip replacement isn't pursued (due to cost, patient size, or other factors)
What Is an FHO?
During an FHO, the surgeon removes the head and neck of the femur, eliminating the bone-on-bone contact that was causing pain. The body then forms a “false joint” (pseudoarthrosis) out of scar tissue and muscle where the joint used to be. This false joint doesn't have the same anatomy as a normal hip, but with consistent early rehabilitation, most dogs — especially smaller and medium-sized dogs — regain comfortable, functional use of the leg.
Unlike TPLO or MPL surgery, an FHO is considered a salvage procedure: the goal is a pain-free leg through a different (not normal) joint mechanism, rather than restoring the original joint anatomy. Outcomes are generally very good, particularly in dogs under roughly 50lbs and in dogs with strong, well-conditioned hip muscles going into surgery.
Preparing for Surgery
Required Pre-Operative Workup
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Orthopedic and neurologic exam to confirm the hip (rather than the back or knee) is the source of pain
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Radiographs (X-rays) of the pelvis and both hips — needed to confirm the diagnosis, assess the extent of arthritis or fracture, and rule out other conditions; sedation is often required for well-positioned hip films
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Pre-anesthetic bloodwork (CBC and chemistry panel)
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Weight check and physical exam the morning of surgery
Preparing Your Home Before Surgery Day
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A confinement space — crate, gated room, or small area with minimal stairs
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Rubber-backed rugs or yoga mats over slick flooring, which is especially important for hip patients
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A sling or towel for supporting the hind end — this will be used heavily and early with FHO recovery
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An e-collar or recovery suit on hand
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A plan for frequent, short, assisted bathroom breaks
The Day Before Surgery
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No food after 8pm the night before; water is generally fine until the morning
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Bathe your dog if needed — the incision can't get wet for at least 10–14 days
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Confirm your confinement area and rugs are set up and ready
Surgery Day
Your dog is admitted in the morning for a pre-anesthetic exam, then placed under general anesthesia with continuous monitoring throughout the procedure. The surgeon places the stabilizing suture through small anchor points in the bone on either side of the joint and tightens it to the correct tension. The incision is closed in layers. Because no bone is cut, anesthesia and surgery time are typically shorter than with a TPLO.
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We use a layered ("multimodal") anesthesia and pain-control protocol for every orthopedic surgery, designed to keep your dog calm and comfortable at every stage and to stay ahead of pain rather than catching up to it. Before surgery, your dog receives a combination of a calming sedative and pain-relieving medications (dexmedetomidine, midazolam, and methadone) to ease anxiety and provide the first layer of pain relief before anesthesia even begins. Anesthesia is then induced gently with propofol and maintained during surgery with isoflurane gas -- a well-established, closely monitored combination used in veterinary and human hospitals alike. Throughout the procedure, a dedicated team member continuously monitors your dog's heart rate, blood pressure, oxygen levels, and body temperature. At the surgical site, we use Nocita, a long-acting local anesthetic that numbs the area for up to 72 hours after surgery -- similar to a nerve block a person might receive after their own orthopedic surgery -- which meaningfully reduces how much pain your dog feels as they wake up and in the days that follow. We also give an anti-inflammatory pain medication (carprofen) during surgery to start reducing pain and swelling right away, and send you home with carprofen, gabapentin (a nerve pain medication), and an antibiotic to keep your dog comfortable and support healing over the following days and weeks.
Anesthesia and Pain Management
The First 12 Hours: Going Home (Outpatient Recovery)
As a general practice, we don't have overnight staffing on-site, so all of our surgical patients — including amputations — go home with their owners the same day, once they're comfortable, stable, and recovered enough from anesthesia to travel. In our experience, most pets do just as well, and often better, resting overnight in the comfort of home with their own family rather than in a hospital kennel, as long as you follow the aftercare instructions below closely. In the rare case that a pet needs a higher level of overnight monitoring than we can provide, we'll coordinate a direct transfer to a 24-hour emergency/specialty hospital such as BluePearl Pet Hospital in Wyomissing or Metropolitan Veterinary Associates, and stay in close contact with both their team and you throughout.
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Grogginess from anesthesia and pain medication — keep confined and supervised
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First walk: short, sling-supported, leash-controlled bathroom breaks only
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Icing the hip/surgical area for 10–15 minutes, 2–3 times the first evening
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Pain medication given exactly as prescribed and on schedule — early, aggressive pain control and movement is especially important for FHO patients
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A reduced appetite the first evening is common; report a dog not eating or drinking at all by the next morning
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Mild swelling, bruising, and a small amount of clear or blood-tinged discharge is normal for the first few days
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Overnight confinement so your dog can't jump, slip, or attempt stairs unsupervised​
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Recheck Appointments & Healing Timeline
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14 days post-op: Suture/staple removal and incision check.
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4 weeks post-op: Recheck exam to assess comfort, range of motion, and how aggressively to progress rehab — this is where FHO recovery differs most from bone-healing surgeries, since early, active use of the leg is encouraged rather than restricted.
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6–8 weeks post-op: Most dogs are showing significant improvement in weight-bearing and comfort.
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3–4 months post-op: Continued strengthening; most dogs reach their functional “new normal” by this point, though small gains can continue for up to a year.
Home Rehabilitation Program
Rehab after an FHO looks different from bone-healing surgeries like TPLO: there's no bone that needs to fuse, so the priority is early, active, frequent use of the leg to shape a comfortable false joint and prevent the muscles from tightening around it.
Weeks 0–2: Early Active Use
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Gentle passive range of motion and massage starting within the first few days, as tolerated
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Frequent, short, assisted leash walks — more frequent and earlier than with bone-healing surgeries, to encourage weight-bearing
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Ice therapy after activity
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E-collar worn at all times to prevent licking
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Avoid jumping, slick floors, and unsupervised stairs
Weeks 3–8: Building Strength & Range of Motion
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Longer controlled walks, gentle inclines, and stepping over low obstacles to encourage full hip extension
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Weight-shifting and three-legged standing exercises on the non-surgical limbs to encourage full weight-bearing on the surgical leg
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Sit-to-stand exercises and cookie stretches for hip flexibility
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Controlled wading or swimming (once incision is healed) is excellent for rebuilding hip range of motion with reduced impact
Months 2–4+: Return to Normal Activity
Most dogs return to normal daily activity within 2–3 months, with continued subtle improvement in muscling and gait for up to a year. The false joint that forms is generally very functional, and many owners find their dog eventually shows little to no visible lameness.
Incision Care: What's Normal vs. What Needs a Call
Normal
• Mild swelling and bruising for the first week
• A small amount of clear or blood-tinged discharge for the first few days only
• Mild discomfort and warmth around the leg
Contact Us Right Away If You Notice
• Swelling that lasts longer than a week, or new swelling appearing later
• Large amounts of discharge or active bleeding
• Discharge that is white, green, or thick/sticky
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A dog that seems to be avoiding using the leg at all several weeks out, rather than progressively using it more
Frequently Asked Questions
How much does FHO surgery cost?
FHO: $2,500 for dogs up to 80 lbs, $2,950 for dogs over 80 lbs — includes pre-operative examination, anesthesia, surgery, local anesthesia and intra-operative pain management, and recovery and nursing care. Rechecks are included; follow-up radiographs/sedation are at an additional cost.
Will my dog have a normal-looking gait after an FHO?
Most dogs, especially smaller and medium-sized dogs with good muscle conditioning, regain very functional, comfortable use of the leg. Some dogs retain a subtle difference in gait or a slightly shorter stride on that leg, but significant, ongoing pain is not expected once healed.
Is early movement really better than rest after this surgery?
Yes! This is one of the more counterintuitive parts of FHO recovery for owners used to “crate rest” advice from other orthopedic surgeries. Because there's no bone that needs to fuse, keeping the leg still actually works against a good outcome by letting the surrounding muscles tighten. We'll guide you through exactly how much activity is appropriate at each stage.
How long until my dog walks normally again?
Many dogs show meaningful weight-bearing improvement within 2–4 weeks, with continued progress over 2–4 months as strength and confidence build around the new false joint.
Will my dog need to stay overnight after surgery?
No. As a general practice, we don't have overnight staffing on-site, so all of our surgical patients go home with their owners the same day. In our experience, most dogs recover just as well, and often more comfortably, resting at home with their family than they would in a hospital kennel overnight. On the rare occasion a pet needs a higher level of overnight monitoring, we'll arrange a direct transfer to a 24-hour facility such as BluePearl Pet Hospital in Wyomissing or Metropolitan Veterinary Associates.
Can I do this surgery at your general practice instead of a referral hospital?
Yes. Dr. Lee and our surgical team perform FHO in-house. As a general practice rather than a large corporate referral center, we're able to offer this level of orthopedic care with less overhead, which often makes it more accessible for families, without cutting corners on anesthesia monitoring or aftercare.
What if my dog doesn't seem to be improving?
Contact us any time during recovery. If your dog plateaus, regresses, or you're simply unsure whether something is normal, we'd rather hear from you early.