RE: Bilateral FHNE

Malcolm Ness — Tue, 24 Mar 2020 09:23:25 GMT

The short answer to your question, "Would you consider bilateral FHNE in this patient?" is No, not yet.

Remember to treat the cat and not the radiograph bearing in mind that had you radiographed these hips 5 years ago, they would probably have looked a lot like they do today - a reasonable therapeutic aim in this cat is to get it back to how it was 4 or 5 years ago - happy, reasonably active and apparently pain-free but with radiographically ugly hips!

FHNE is a salvage procedure aimed at reducing pain while sacrificing some function. This cat is currently, "not obviously lame" and although there is some evidence of pain, FHNE is not a panacea. I note that the cat has had a variety of medical interventions including Gabapentin - that is a drug which I have found a use for only very infrequently. There is currently good evidence to support the use of "joint supplements" in an otherwise adequately fed patient. That said, this cat is obviously overweight so a decent attempt at weight reduction should be part of the management here. (I appreciate that it is almost as difficult to get weight of a cat as it is to lose weight oneself!)

I would stop other meds and start this cat on what should be a lengthy course of NSAID - six weeks or more. Carefully monitor the cat over that time for evidence of pain - I would expect to see a slow increase in activity over time although a degree of physical impairment due to the inevitable joint stiffness will remain (FHNE will not return the the joints to anything near normal.)

If there is a benefit with the longer course NSAID, I would then continue with 'episodic' NSAID therapy - a six week course then stop with a view to repeating a full six week course as soon as signs of discomfort/increasing disability re-appear.

IF this medical approach is inadequate ( we are not looking for perfection!) then that is the time to consider salvage surgery. Bilateral FHNE or bilateral total hip replacements (THR) are the options. THR is technically challenging and so costly as to be beyond almost all clients but in the right hands (they are few and far between) can give a near-normal outcome. Bilateral FHNE can be effective in reducing pain (but almost certainly, it does not eliminate pain). It is technically feasible for most surgeons. I would do bilateral surgery at the same time using a craniotomy-lateral approach which preserves almost all of the gluteal tendinous attachments. The Gluteal transection approach is discouraged, especially with bilateral surgery as it is substantially more traumatic and associated with an extended convalescence and probably a higher risk of complication and failure.