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Femoral head and neck excision in cats: medium- to long-term functional

outcome in 18 cats

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DOI: 10.1177/1098612X14556848 · Source: PubMed

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research-article2014
JFM0010.1177/1098612X14556848Journal of Feline Medicine and SurgeryYap et al

Original Article

Journal of Feline Medicine and Surgery

Femoral head and neck excision 2015, Vol. 17(8) 704­–710

© ISFM and AAFP 2014
Reprints and permissions:
in cats: medium- to long-term sagepub.co.uk/journalsPermissions.nav
DOI: 10.1177/1098612X14556848

functional outcome in 18 cats jfms.com

Fui W Yap1, Andrew L Dunn2, Paloma Maria Garcia-Fernandez3,

Gordon Brown4, Ross M Allan5 and Ignacio Calvo1

Abstract
Objective To assess the medium- to long-term functional outcome of cats after femoral head and neck excision
(FHNE) using an owner-completed questionnaire.
Methods Cats that had FHNE and were free of other orthopaedic or medical conditions that could affect their
mobility, other than the studied coxofemoral joint(s), were included. A specific owner-completed questionnaire
was used at a minimum of 4 months postoperatively. The questionnaire assessed the ability of the cats to perform
normal feline activities, change of demeanour or behaviour, the necessity for long-term analgesia and the time
taken to resume normal activities.
Results Eighteen cats had undergone uni- or bilateral FHNE and met the inclusion criteria. All but one cat could
perform normal feline activities without or with slight difficulty at follow-up. The aforementioned cat had notable,
persistent difficulty in climbing. The majority of the cats took between 1 and 2 months to resume normal activity. No
change in demeanour or behaviour was noted in any of the cats and none of the cats required long-term analgesia.
Conclusions and relevance Based on the owner-completed questionnaire, cats have good-to-excellent medium- to
long-term functional outcome after adequately performed FHNE.

Accepted: 29 September 2014

Introduction
Femoral head and neck excision (FHNE) arthroplasty
was first described in 1926 by Gathone Robert Girdlestone
for the treatment and drainage of septic coxofemoral
joints affected by tuberculosis.1 The procedure was
adopted in dogs a few decades later for the treatment of
coxofemoral joint arthropathy, such as chronic osteoar-
thritis and coxofemoral luxations.2
FHNE is a salvage procedure performed to alleviate
pain associated with a diseased or injured coxofemoral
joint.3,4 In cats, FHNEs have been reported for the man-
agement of femoral head and neck fractures, including
FHNE.3,10–12 This recommendation stemmed from con-
cerns about poor gait analysis results in dogs after
FHNEs, the reduced range of motion in the affected
joints, the presence of muscle atrophy and the resulting
‘functional shortening’ of the limb after FHNEs.3,9 This
recommendation in cats has to be viewed cautiously as
1Orthopaedic Surgery Service, Small Animal Hospital, University
of Glasgow, Bearsden, UK
2Adelaide Veterinary Specialist and Referral Centre, Adelaide,

femoral capital physeal fractures, coxofemoral luxations, South Australia, Australia

3Department of Animal Medicine and Surgery, Veterinary School,
acetabular fractures and osteoarthritis.3,5–8 The clinical
Complutense University of Madrid, Madrid, Spain
outcomes for FHNEs in cats have been reported to be 4Grove Referrals, Norfolk, UK

satisfactory-to-good in some studies,3,6,8 but inconsistent 5Pets ‘n’ Vets, Pollokshaws, UK

in another study owing to concern over dorsal displace-

ment of the affected femur.9 Corresponding author:
Fui Yap BVMS, MANZCVS, MRCVS, Small Animal Hospital,
Total hip replacement (THR), another salvage proce- University of Glasgow, 464 Bearsden Road, Bearsden,
dure, has been recommended by some authors for the G61 1QH, UK
treatment of coxofemoral joint arthropathy in cats over Email: fuiwenyap@gmail.com
Yap et al 705
long-term functional outcome comparison between the
two procedures in cats is lacking. In addition, differences
in the rate and severity of the complications associated
with each procedure, and the difference in cost between
the two procedures should be taken into consideration.
The importance of evaluating the quality of life from the
owner’s daily observation after a procedure, in addition
to the changes in objective measurements, should not be
overlooked.13
Cats appear to be less demonstrative of pain when
compared with dogs and the assessment of pain in the
feline patient can be difficult.14 As a result, the evalua-
tion of lifestyle changes, such as willingness to jump, has
been recommended for the assessment of lameness in
cats.14 One study has shown that assessment using an
owner-completed outcome measure questionnaire was
comparable with objective measures in detecting life-
style and mobility changes.15 In addition, an owner-com-
pleted questionnaire has been shown to be a practical
alternative to objective assessment for functional out-
come in cats after carpal and tarsal arthrodesis and after
surgical stabilisation of sacroiliac luxations.16–18
The objective of this study was to evaluate the
medium- to long-term functional outcome in cats after
FHNE using an owner-completed questionnaire.
Materials and methods
Data
Clinical records of all cats that underwent FHNE at two
university teaching hospitals and three private practices
between 2000 and 2013 were reviewed. Cats with ortho-
paedic diseases/injuries in addition to the studied coxo-
femoral joints (such as contralateral femoral fracture) or
medical conditions that might affect mobility were
excluded from the study. One exception to this was pubic/
ischial fracture; cats with pubic and/or ischial fractures
only, in addition to the injuries of studied coxofemoral
joints, were included. These cats were included in the
study as, in our opinion, the pubic and ischial fractures
were unlikely to affect the result of the outcome assess-
ment in this study.
Postoperative radiographs were evaluated by a board-
certified orthopaedic surgeon (IC) to determine adequacy
of the excision of the femoral head and neck. For the pur-
pose of this study, an inadequate FHNE was defined as
an incomplete excision of the femoral neck with bone
spur at the ostectomy site. Cats with inadequate excision
were excluded from the study and, as a result, the func-
tional outcome of these cats was not determined. Cats
were also excluded from the study if the owner-com-
pleted questionnaire was not obtained (n = 3).
The questionnaire to be completed by the owners was
adapted from previous studies on feline joint diseases (see
Table 1 in Supplementary material).16,17 Questionnaires
were sent to each of the owners to assess the medium-
(>4 months and <12 months) to long-term outcome (>12
months) of the cats after FHNE. A minimum period of 4
months was required between the surgery and the com-
pletion of the questionnaire. A minimum follow-up
period of 4 months was chosen as, from anecdotal experi-
ence, cats would have returned to their ‘normal activities’
by this stage. If a cat had bilateral FHNE performed as
staged procedures, the age of the cat at the time of the sec-
ond surgery was used and the follow-up period was
recorded as the period between the second surgery and
the completion of the questionnaire
The owner-completed questionnaire examined the abil-
ity of the cats to perform normal feline activities during the
immediate postoperative period and at the time of
medium- to long-term follow-up (at the time of question-
naire completion) using a simple, descriptive, discontinu-
ous scoring system (see Table 1 in Supplementary material)
– disability score (DS) of individual activity. Score 0 indi-
cates that the cat is able to perform the activity without
difficulty; score 1 represents a slight and occasional diffi-
culty in performing this activity; score 2 represents a slight
but frequent difficulty in performing the activity; score 3
represents an important and permanent difficulty in per-
forming the activity; and score 4, the highest score, repre-
sents an inability to perform the activity. The average
disability score (ADS) for each cat was defined as the aver-
age of the DSs for all the activities (seven activities). An
excellent outcome was defined as having an ADS of ⩽0.50;
these cats did not have or had slight and occasional diffi-
culty in performing normal feline activities. A good out-
come was defined as having an ADS between (and
inclusive of) 0.51 and 1.0; these cats had a slight but fre-
quent difficulty in performing normal activities. Cats that
had an ADS between (and inclusive of) 1.01 and 1.50 were
considered to have a satisfactory functional outcome. Cats
that had an ADS of >1.51 were considered to have a poor
functional outcome. The mean of the ADSs of all the cats
was termed as the overall disability score (ODS) for FHNE,
in line with a previous study.16 The questionnaire also
assessed for a change of demeanour or behaviour, the
necessity of long-term analgesia and the time taken to
resume normal activities. In the questions enquiring about
lifestyle changes, owners were asked to assess the out-
comes as dichotomous variables (yes or no).
Surgery
The FHNE was performed as previously described.19 In
brief, the patient was positioned in lateral recumbency
with the affected site facing upwards. The caudolateral
abdomen, the caudal lumbar region, the base of the tail
and the affected limb from the level of coxofemoral joint
to distal tibia were aseptically prepared for surgery.
A craniolateral approach to the affected coxofemoral
joint was performed. A skin incision was made from
just dorsal to the dorsal border of the ilium to
706 Journal of Feline Medicine and Surgery 17(8)
the proximal third of the cranial border of the femur,
centring at the greater trochanter. The fascia was incised
along the skin incision to expose the underlying mus-
cles around the coxofemoral joint. The middle gluteal
muscle was identified and separated along the inter-
muscular septum from the deep gluteal muscle. A ten-
otomy was performed at the insertion of the deep
gluteal muscle, leaving enough portion of tendon at the
insertion site for suturing. The middle and deep gluteal
muscles were retracted caudoproximally and the artic-
ularis coxae covering the joint capsule was visualised.
An incision was made in a cranioproximal to caudodis-
tal direction (along the axis of the femoral neck) on the
joint capsule, transecting the overlying articularis
coxae. Approximately the cranial third to half of the ori-
gin of vastus lateralis was elevated from the femoral
neck. The femoral head was luxated by severing the
round ligament. The femoral head and neck were then
exposed by the placement of a Hohmann retractor cau-
dal to the femoral head and by applying lateral and
external rotational forces on the distal femur, lifting the
femoral head from the acetabulum. Care was taken
during the placement of the retractor to avoid entrap-
ment of the sciatic nerve, which wraps around the cau-
dodorsal aspects of the acetabulum, deep gluteal
muscle and the greater trochanter.
After the femoral head and neck were exposed, an
ostectomy of the femoral head and neck was performed
using an oscillating saw. The ostectomy was made along
a line connecting the mid-trochanteric fossa proximally
to just proximal to the lesser trochanter distally. The
ostectomy site was then palpated for any sharp and
irregular edges, which were smoothed using a bone
rasp. The surgical site was lavaged with saline before
routine closure. The incised joint capsule was not sutured
closed. The deep gluteal muscle was sutured to the ten-
don of insertion with a mattress suture pattern and the
elevated vastus lateralis was sutured to the cranial edge
of the superficial gluteal muscle. The fascia was closed in
layers and skin sutures or skin staples were applied.
All cats received postoperative opioid analgesia (up
to 24–72 h postoperatively) and non-steroidal anti-
inflammatory medications. The duration of the opioid
analgesia used depended on the level of analgesia
required in each individual case. Different drugs were
used at the discretion of the primary surgeon. All cats
were discharged home with instructions on early pro-
motion of activity and joint movement.
Postoperative assessment
A ventrodorsal view of the pelvis centred over the
extended coxofemoral joints was taken to assess the ade-
quacy of the excision postoperatively. Complete excision
of the femoral neck with no bone spur at the ostectomy
site was considered adequate.
Results
Background
Thirty-nine cats were evaluated and 18 (46%) were
included in the study. Cats were excluded if the owners
were not contactable (n = 14), the owner-completed ques-
tionnaire was not returned (n = 3), owners were reluctant
to participate in the study as the cat had died from a con-
dition unrelated to the affected coxofemoral joint (n = 2)
or the FHNE was deemed inadequate (n = 2). Of the
included cats, there were six female and 12 male cats. The
breeds included in the study were domestic shorthair (n
= 9), Maine Coon (n = 3), British Shorthair (n = 3),
Tonkinese (n = 1), Ragdoll (n = 1) and Bengal (n = 1). The
mean age at surgery was 20 months (SD = 15.5 months).
Sex, breed, age at time of surgery, injury or injuries, and
the follow-up period were recorded (Table 1). Ten cats
had femoral capital physeal fractures, two cats had femo-
ral neck fractures, two cats had coxofemoral joint luxa-
tions, one cat had coxofemoral joint luxation and an
acetabular fracture in the same joint, one cat had femoral
neck and acetabular fractures in the same joint, one cat
had severe osteoarthritis in the joint from a previous
trauma and one cat had a metaphyseal osteopathy (Table
1). One of the cats with coxofemoral joint luxations also
had an acetabular fracture in the same joint and FHNE
was performed as the treatment of the injuries in this
joint. Six cats had bilateral FHNE performed; three of
these were performed in a single session.
Complications
No intra- or postoperative complications were reported
in any of the procedures. Revision surgery was not
required in any patient.
Follow-up
Eighteen (86%) of the 21 owner-completed question-
naires were returned. The mean follow-up period was 34
months (SD = 27 months).
One section of the questionnaire (the DS) could not be
evaluated in one cat (cat 15) owing to invalid entries
(boxes were ticked instead of scores being assigned). The
entries for the rest for the questionnaire for this cat (such
as the time taken for recovery) were included in the
study. Twelve cats (12/17 valid entries; 71%) had an ADS
of <0.5 and were considered to have an excellent
medium- to long-term functional outcome (Table 2). Five
cats (5/17; 29%) had an ADS between (and inclusive of)
0.5 and 1.0; these cats were considered to have a good
medium- to long-term functional outcome. At follow-
up, the median DSs for running, climbing, jumping
down, walking, playing and grooming were 0; the
median DS for jumping up was 1. The DS for each cat is
available in Table 2 of the Supplementary material. The
ADS for each cat is listed in Table 2. The ODS for FHNE
was 0.28 (best score = 0, worst score = 4).
Yap et al 707

Table 1  Age, breed, injury or injuries, and follow-up period of the cats

Cat Age (months) Breed Injury/injuries Follow-up period (months)

1 3 Tonkinese Femoral capital physeal fracture 10

2 18 DSH Bilateral femoral capital physeal fractures 12
3 26 DSH Femoral capital physeal fracture 7
4 73 DSH Severe osteoarthritis secondary to previous trauma 18
5 5 DSH Femoral neck fracture 42
6 14 DSH Coxofemoral joint luxation 51
7 14 DSH Acetabular and femoral neck fractures 55
8 5 Maine Coon Bilateral femoral capital physeal fractures* 5
9 22 Maine Coon Bilateral femoral capital physeal fractures* 8
10 16 DSH Femoral neck fracture 10
11 24 Maine Coon Metaphyseal osteopathy 22
12 21 DSH Coxofemoral joint luxation 50
13 14 Bengal Femoral capital physeal fracture 67
14 22 British Shorthair Bilateral femoral capital physeal fractures 84
15 5 DSH Coxofemoral joint luxation and acetabular fracture 90
16 26 Ragdoll Femoral capital physeal fracture 28
17 30 British Shorthair Bilateral femoral capital physeal fracture* 43
18 23 British Shorthair Bilateral femoral capital physeal fracture 14

*Bilateral femoral head and neck excision was performed as staged procedures
DSH = domestic shorthair

Table 2  Disability scores of the cats at follow-up postoperatively. According to the owners, two cats (cats
4 and 16) did not resume normal activities after the sur-
Cat Combined disability score gery. These two cats were less active in their day-to-day
1 0 routines, but when performing the assessed activities,
2 0.71 they only had slight difficulty in climbing and jumping
3 0 up and down. They did not have any difficulty in per-
4 0.29 forming other activities. None of the cats required anal-
5 0 gesia at the time of follow-up. Change of demeanour (eg,
6 0.57 increased aggression, seeking seclusion, resentment of
7 0 handling) was not noted in any of the cats at the time of
8 0.14 follow-up. Owners of 15 (83%) of the 18 cats were willing
9 0 to bring the cats back for a veterinary examination if
10 0.86 required.
11 0.86
12 0.29
13 0
Discussion
This study showed that the medium- to long-term func-
14 0
tional outcome of cats after adequately performed uni-
15* –
16 0.71
or bilateral FHNE was good to excellent based on an
17 0.29 owner-completed questionnaire assessment, which was
18 0 consistent with the findings of previous studies.3,6,8
Overall disability 0.28 According to our study, the ODS for FHNE compared
score of FHNE favourably with that of carpal arthrodesis (medium- to
long-term ODS 0.81) and dorsal pantarsal arthrodesis in
*The scoring entries were not valid for this cat cats (medium-term ODS 0.44; long-term ODS 0.04).16,18
FHNE = femoral head and neck excision
All but four cats were able to run, climb, jump, walk,
play and groom normally without or with only slight
Seven cats had reduced height of jump at follow-up intermittent difficulties. Three of the four aforemen-
(Table 3); three of these cats (cats 2, 10 and 17) had bilat- tioned cats had slight but frequent difficulties in climb-
eral FHNE performed. Eleven (61%) of the 18 cats took ing and jumping up. One of these cats had bilateral
between 1 and 2 months to resume normal activities FHNE (cat 2). The fourth cat (cat 10) had slight but
708 Journal of Feline Medicine and Surgery 17(8)

Table 3  Presence of reduced height of jump and recovery contact of a normal coxofemoral joint after FHNE
period before resumption of normal activity after femoral resulted in weaker propulsion in the hindlimbs for these
head and neck excision activities. Despite this speculation, it is vital to remem-
ber that the lack of bone–bone contact plays an impor-
Cat Is there reduced Recovery time to resume
height of jump at normal activity (current
tant role in the successful outcome after FHNE.
follow-up? activity level) after surgery* Seven cats had reduced height of jump. The large pro-
portion of cats having reduced height of jump in this
1 N 3 study was similar to a previous study assessing func-
2 Y 4 tional outcome of cats after partial or pancarpal arthro-
3 N 2 desis.16 The underlying reason for this was unclear but
4 Y 1 we speculated that the reduced height of jump was a
5 N 3
more sensitive way to detect subtle difficulty in jumping.
6 N 3
None of the cats required long-term analgesia and there
7 N 3
was no obvious change in demeanour and behaviour.
8 N 3
These findings, in addition to the ADS, were consistent
9 Y 4
with a good-to-excellent medium- to long-term func-
10 Y 3
11 N 3
tional outcome and indicate a good quality of life. It is
12 Y 2 crucial to remember that functional outcome after FHNE
13 N 3 is heavily influenced by the adequacy of the ostectomy
14 N 4 as inadequate ostectomy will impinge on joint function
15 N 3 and result in chronic lameness.3,4
16 Y 1 Femoral capital physeal fracture was the most com-
17 Y 3 mon indication for FHNE in cats in this study. This was
18 N 3 a reflection of the fact that the majority of the cats with
traumatic coxofemoral joint injuries had other concur-
*1: never gone back to normal, there is a degree of disability; rent orthopaedic conditions, such as sacroiliac luxation,
2: <1 month; 3: between 1 and 2 months; 4: >2 months
Y = yes; N = no and were excluded from the study. In our opinion, pri-
mary surgical stabilisation should be considered before
deciding on a salvage procedure of the coxofemoral
frequent difficulty in jumping up and had permanent joints, such as FHNE and THR. The most commonly per-
difficulty in climbing. It was unclear as to why this cat formed surgical stabilisation for femoral capital physeal
had a particularly high DS in these activities as this cat fractures is with the use of multiple Kirschner wires.20,21
only suffered a unilateral femoral neck fracture and it However, reduced bone stock and chronicity of the inju-
was also a relatively young cat (16 months old at the time ries may preclude the possibility of primary stabilisa-
of injury and 26 months old at the time of follow-up). tion. In these cases, a salvage procedure, such as a FHNE,
The difficulties noted in these four cats could be second- should be considered to eliminate the pain associated
ary to reduced joint mobility and altered joint mechanics with the condition and to improve joint mobility and
after FHNE, residual pain or discomfort associated with function.
the FHNE, concurrent underlying orthopaedic disease, Some of the reported changes in objective outcome
such as osteoarthritis, or inadequate femoral neck exci- assessment in cats after FHNEs are caudodorsal mal-
sion that was not detected on the postoperative position of the femur, shortening of the limb, muscle
radiographs. atrophy, reduced range of motion and pain on passive
The majority of the cats in this study took between 1 movement.3,9 The clinical significance of the malposition
and 2 months to resume normal activities. This lag in of the femur after FHNE is not clear.9 In a large retro-
recovery time was required for the pseudoarthrosis of spective study of FHNE in dogs and cats, all the cats that
the joint to form and for the gradual recovery of joint were returned for physical examination between 4 and 6
motion and muscle mass. Two cats did not resume nor- weeks after FHNE had moderate muscle atrophy and a
mal activities. However, these two cats were assessed to variable degree of reduced range of motion in the
have a good-to-excellent functional outcome as they affected joint.3 Despite this, all of the assessed cats were
only had slight and occasional difficulties in climbing reported to be using the affected limb at the time of
and jumping, and were able to perform other assessed assessment, with minimal or no obvious lameness.3 In
activities without difficulty. It was unclear why these our study, no further veterinary reassessment was per-
cats did not resume normal activities and why the cats formed to evaluate the long-term changes in the muscle
were showing particular difficulty in these two activi- mass and the range of motion as the studied cats were
ties. However, we speculate that the lack of bone–bone not returned for examination at the time of follow-up.
Yap et al 709
Micro-THRs have been reported in a limited number
of cats for the treatment of femoral capital physeal frac-
tures, coxofemoral luxation and as revision surgeries
after unsuccessful FHNEs.4,9–12,22 Good-to-excellent clini-
cal outcomes were reported in most of the cats in these
studies. Despite this, recurrent lameness has been
reported in cats after micro-THR.4 Some of the reported
complications of micro- and nano-THRs are luxation of
the coxofemoral joint (10–20%), penetration of medial
acetabular cortical wall (62%), penetration or fissuring of
the femoral cortex (4–18%), post-THR medial patellar
luxation needing surgical correction (6–12%), delayed
postoperative femoral fracture (3%), acetabular cup loos-
ening, sciatic neurapraxia (1%) and distal femoral med-
ullary canal infarction.4,11,12,22–24 Some of these
complications necessitated additional surgeries for the
resolution. According to one study, 18% of micro-THR
joints required additional surgeries as a consequence of
intra- and postoperative complications.11 Unmanageable
or catastrophic complications of micro-THRs have also
been reported at a rate of 9–12%; most of these patients
required explantations or revision surgeries.11,22 During
the explantations or the revision surgeries, some of these
coxofemoral joints would have to be converted to
FHNE.11
The intra- and postoperative complication rates for
micro- and nano-THRs are not insignificant. These may
have significant financial and emotional implications for
owners, as well as increased morbidity for the patients. In
contrast, no revision surgery was required for any of the
procedures in this study and there were no intra- or post-
operative complications in any of the cats. Postoperative
care after micro-THR in cats commonly consisted of 1–2
days of hospitalisation and cage confinement for 6
weeks.10,11 This is in contrast to the postoperative care in
cats after FHNEs, where cage confinement is minimal,
and early mobility and ambulation are encouraged.
Studies comparing the complications and long-term
functional outcome of THR and FHNE in cats are lack-
ing. One study examining the objective and subjective
outcomes in cats after micro-THRs and FHNEs found
that all the objective outcome measurements (thigh cir-
cumference, angles of hip flexion and extension, and
dorsal displacement of the femur) were similar between
the THR and FHNE groups when the non-surgical limb
was used as a control, except for the dorsal displacement
of the femur, which was only reported in the FHNE
group.9 The significance of the dorsal displacement of
the femur in cats is currently not clear.9 It is noteworthy
that measurements such as thigh circumference or joint
angles have poor intra- and inter-observer correlation,
and that measurement of these parameters under seda-
tion will alter the results.25,26
Some authors have strongly recommended micro-
THR over FHNE in cats.10–12 Although we acknowledge
that THR in cats is an important advancement in feline
orthopaedics, one should not overlook the risk of severe
complications associated with this, and one should care-
fully weigh up the risks vs the potential benefits.
Veterinary surgeons should be cautioned against choos-
ing a treatment option based on the technical or intellec-
tual challenge and the appeal of performing a novel
technique.27 Another factor to take into account when
considering THRs in smaller patients is that smaller
dogs and cats tend to live longer than larger dogs; the
longevity of the micro-THR in cats, especially when per-
formed at a young age, has not been examined.22
The main limitations of this study are the number of
cats studied, its retrospective nature and the lack of vet-
erinary examination as part of the follow-up. The small
number of recruited cases is a reflection of the fact that
many of the cats had other concurrent orthopaedic inju-
ries secondary to trauma, as well as the fact that a por-
tion of the suitable candidates were treated with surgical
reduction and stabilisation. Inclusion of patients with
other orthopaedic injuries will bias the results as they
have the potential to alter the lifestyle and the mobility
in these cats.
Owing to the retrospective nature of the study, impor-
tant information, such as pre- and postoperative pain
scores, was not recorded in all cases. In addition, the ret-
rospective nature of the study also precluded the stand-
ardisation of the postoperative care and treatment
protocol.
Veterinarians may notice subtle lameness from thor-
ough veterinary examination, which may be overlooked
by the owners. The slight difficulty in jumping and
climbing in some of the cats might be due to some degree
of pain that was overlooked by the owner and hence the
requirement for long-term analgesia was underesti-
mated. Veterinary examination was not conducted in
our follow-up assessment owing to concern of stress
exerted on the patients during these trips to the practice
and the potential reluctance of owners to bring their cats
in for the examination. In place of a veterinary examina-
tion, we employed owner-completed questionnaires to
assess the medium- to long-term functional outcome.
Owner-completed questionnaires can guide owners to
evaluate their cats’ mobility and their ability to perform
normal feline activities, especially those that are affected
by pain associated with degenerative joint disease, such
as jumping, running, climbing and reduced height of
jump.28 A well designed owner-completed questionnaire
has been shown to yield comparable results to objective
measures in assessing orthopaedic pain in cats.15
Conclusions
FHNE is a salvage procedure that results in good func-
tional outcome in cats. Salvage procedures, such as
FHNE and THR, are viable alternatives if primary
710 Journal of Feline Medicine and Surgery 17(8)
surgical treatment of the coxofemoral joint arthropathy
is not an option, either owing to patient factors, such as
lack of bone stock for placement of implants, and/or cli-
ent factors, such as financial constraint (primary
surgical repair vs FHNE) or the inability to restrict the
patient’s activity level. When choosing the type of sal-
vage procedure, surgeons should carefully and critically
weigh up the benefits against the potential risks. Factors
such as the type and severity of complications associated
with a procedure, long-term functional outcome and
quality of life of the patient, and financial impact associ-
ated with the procedure should be taken into considera-
tion. A prospective study comparing FHNE and THR
using objective analysis tools, such as force plate analy-
sis, will be useful to guide us in which salvage procedure
is more appropriate in cats.
Supplementary material
Table 1:  Owner-specific questionnaire
Table 2:  The disability scores of the cats based on the owner-
specific questionnaire
Conflict of interest  The authors do not have any potential
conflicts of interest to declare.
Funding  This research received no specific grant from any fund-
ing agency in the public, commercial or not-for-profit sectors.
References
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