Femoral head resection

The femoral head resection is a surgical procedure in which the head of the thighbone ( femur ) is surgically removed. In humans, resection of the femoral head is a necessary step in the insertion of an artificial hip joint . Without the insertion of a hip joint endoprosthesis, however, the operation is only carried out in rare exceptional situations, for example in the case of purulent inflammation of the hip joint that does not respond to treatment . It leads to a severe impairment of the ability to walk in humans.

In dogs , the femoral head ostectomy is performed more frequently. The main indications here are aseptic femoral head necrosis and chronic, extremely painful hip joint arthrosis , such as those that occur primarily in hip dysplasia (HD). Resection of the femoral head leads to the formation of a connective tissue connection between the pelvis and thigh bone ( pseudarthrosis ), which usually leads to functional impairment in the hip, but offers the animal an adequate quality of life. It is used when an artificial hip joint is out of the question for reasons of cost or age.

Resection of the femoral head in the dog

The procedure is performed under general anesthesia . In most cases, access to the hip joint is chosen from the cranio-lateral (side-front). After a skin incision above the hip joint, the fascia at the front edge of the biceps femoris muscle is divided . The gluteus superficialis muscle is displaced backwards, and its insertion tendon may also be severed. The gluteus medius muscle is shifted backwards (dorsally) with retractors , the biceps femoris muscle to the rear. The insertion of the gluteus profundus muscle is then partially severed and the vastus lateralis muscle is detached from the thigh bone at its origin . With a bone lever, the head of the thigh bone can now be levered out of the pelvic socket, and if the thigh bone head ligament ( ligamentum capitis ossis femoris ) is intact, it is severed. The femoral neck is now osteotomized with a saw or, after drilling channels have been created, with an osteotome . In the case of femoral head necrosis, the head can also be removed gradually with a chisel pliers . Then the wound is closed.

Resection of the femoral head in humans

Resection of the femoral head is a necessary step in the implantation of a hip joint endoprosthesis . As the sole measure, it is only extremely rarely indicated in humans , for example in the rare cases of chronic, therapy-resistant purulent coxitis . In these cases, endoprosthetic treatment is usually sought after the infection has been repaired. Stubborn infections as a complication of a prosthesis implantation occasionally force the prosthesis to be removed temporarily, which then also results in the situation of a femoral head resection. A so-called Girdlestone situation then remains : the greater trochanter is supported on the pelvic shovel , which results in a very limited ability to walk on forearm crutches with significant leg shortening.

Individual evidence

1. ↑ J. Rüdiger Dohler: Lexicon of orthopedic surgery: Standard terminology for orthopedists and trauma surgeons . Springer, Berlin - Heidelberg 2002, ISBN 3-540-41317-0 , pp. 59 ( online here ).

literature

• Theresa Welch Fossum: Small Animal Surgery. Mosby, 2nd ed. 2002, ISBN 0-323-01238-8 , p. 1100.

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