Salvage Surgery

When a joint causes continual pain due to instability or inflammation associated with disease, salvage procedures can be considered. This will involve either partial bone removal (ostectomy) or joint fusion (arthrodesis).

Femoral Head and Neck Ostectomy (FHNO)

This procedure is considered for a number of diseases were total hip replacement (THR) is either not possible due to financial constraints, or due to abnormal anatomy which would mean that THR is not possible. Conditions which may include:
1) Legg-Perthes disease or femoral head and neck necrosis
2) Fracture of the femoral head or neck where fixation is either contra-indicated, not possible, or has failed.
3) Hip luxation where reduction and fixation are either contra-indicated, not possible, or has failed.

The surgery involves removal of the “ball” from the ball and socket joint of the hip.

The post operative instructions for FHNO are different to any other orthopaedic procedure because we want to encourage movement relatively soon after surgery. Once the initial post operative healing has progressed (over 10-14 days), movement to allow for as much normal range of motion of the hip is encouraged. This is because once the femoral head has been removed, fibrous tissue is laid down between where the ball of the femur used to be, and the socket. This forms what is termed as a ”pseudoarthosis” or pretend joint, and for it to be as functional as possible, it needs to form under normal range of motion conditions. Ideally we would encourage physiotherapy led rehabilitation, with the inclusion of under water treadmill hydrotherapy. If this is not possible due to geographical, time or financial constraints, physiotherapy exercises to encourage full hip range of motion can be performed.

Arthrodesis
The cartilage is removed from within a joint, bone graft is packed into the joint cavity and the joint is fixed in position to allow for fusion to take place.