{ "id": "epjmmdw4gt", "slug": "ostectomy", "title": "Ostectomy", "updated": "2026-10-15", "topic_path": [ { "id": "life", "label": "Life and health", "api_url": "https://www.edgepedia.org/api/v1/topics/life" }, { "id": "life.health", "label": "Human health and medicine", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health" }, { "id": "life.health.clinical", "label": "Clinical assessment and procedures", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical" }, { "id": "life.health.clinical.clinical-surgery", "label": "Surgery and surgical specialties", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical.clinical-surgery" }, { "id": "life.health.clinical.clinical-surgery.orthopedic-surgery-procedures", "label": "Orthopedic surgery procedures", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical.clinical-surgery.orthopedic-surgery-procedures" } ], "geo": [ { "id": "geo.nongeo.t1800.life.health.clinical.clinical-surgery.orthopedic-surgery-procedures", "label": "Non-geographic · 1800 to 1945: Orthopedic surgery procedures", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800.life.health.clinical.clinical-surgery.orthopedic-surgery-procedures", "path": [ { "id": "geo.nongeo", "label": "Non-geographic", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo" }, { "id": "geo.nongeo.t1800", "label": "Non-geographic · 1800 to 1945", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800" }, { "id": "geo.nongeo.t1800.life", "label": "Life and health", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800.life" }, { "id": "geo.nongeo.t1800.life.health", "label": "Human health and medicine", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800.life.health" }, { "id": "geo.nongeo.t1800.life.health.clinical", "label": "Clinical assessment and procedures", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800.life.health.clinical" }, { "id": "geo.nongeo.t1800.life.health.clinical.clinical-surgery", "label": "Surgery and surgical specialties", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800.life.health.clinical.clinical-surgery" }, { "id": "geo.nongeo.t1800.life.health.clinical.clinical-surgery.orthopedic-surgery-procedures", "label": "Orthopedic surgery procedures", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1800.life.health.clinical.clinical-surgery.orthopedic-surgery-procedures" } ] } ], "excerpt": "Ostectomy is a surgical operation that removes bone tissue, used in orthopedics to eliminate diseased or painfully contacting bone, and in periodontics to excise tooth-supporting alveolar bone.", "snippet": "Ostectomy is a surgical operation that removes bone tissue, used in orthopedics to eliminate diseased or painfully contacting bone, and in periodontics to excise tooth-supporting alveolar bone.", "node": "life.health.clinical.clinical-surgery.orthopedic-surgery-procedures", "markdown": "# Ostectomy\n\nAn ostectomy is a surgical operation that removes bone tissue, performed in orthopedics to eliminate diseased, damaged, or painfully contacting bone, and, with a distinct meaning, in periodontics to excise tooth-supporting alveolar bone.[1](https://link.springer.com/article/10.1007/s11751-017-0296-4) • [2](https://doi.org/10.1111/prd.70001) In the hip, removal of the femoral head and neck (femoral head and neck ostectomy, FHO) is a common salvage procedure used when the joint cannot be preserved.[3](https://pmc.ncbi.nlm.nih.gov/articles/PMC12882995/) The term sits among several similar bone-cutting names: an osteotomy divides bone to realign or lengthen it rather than removing a segment.[1](https://link.springer.com/article/10.1007/s11751-017-0296-4)\n\n| Key fact | Detail |\n|---|---|\n| Definition | Surgical excision of bone tissue; in periodontics, removal of alveolar bone proper (tooth-supporting bone)[2](https://doi.org/10.1111/prd.70001) |\n| Distinction from osteotomy | Osteotomy divides bone for realignment or lengthening; ostectomy removes bone[1](https://link.springer.com/article/10.1007/s11751-017-0296-4) |\n| Common salvage variant | Femoral head and neck ostectomy, a salvage procedure for coxofemoral disease in dogs and cats[3](https://pmc.ncbi.nlm.nih.gov/articles/PMC12882995/) |\n| Mechanism of pain relief | Eliminates bony contact, allowing a fibrous pseudoarthrosis lined by synovial membrane[4](https://assets.ctfassets.net/4dmg3l1sxd6g/7t79GuPM1i9j1juR4W2Pca/3e2395333b30b473ab672589dc19a16a/femoralheadandneck-4795-article.pdf) |\n| Dental endpoint | Periodontal healing with minimal bone removal and final probing depth ≤3 mm[2](https://doi.org/10.1111/prd.70001) |\n| Reported gait outcome (dogs) | 91.67% (11/12) of dogs ≤20 kg and 100% (15/15) of dogs >20 kg showed a normal gait within 12 months[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC12116107/) |\n| Main complications | Reduced hip range of motion, limb shortening, muscle atrophy, infection, and bony regrowth in young dogs[4](https://assets.ctfassets.net/4dmg3l1sxd6g/7t79GuPM1i9j1juR4W2Pca/3e2395333b30b473ab672589dc19a16a/femoralheadandneck-4795-article.pdf) |\n\n## How it works\n\nRemoving bone treats disease in two main ways. The first is elimination of bony contact: in FHO, excising the femoral head and entire neck stops the proximal femur from grinding against the acetabulum, and the gap fills with dense fibrous tissue lined by a synovial membrane, forming a pain-free pseudoarthrosis.[3](https://pmc.ncbi.nlm.nih.gov/articles/PMC12882995/) • [4](https://assets.ctfassets.net/4dmg3l1sxd6g/7t79GuPM1i9j1juR4W2Pca/3e2395333b30b473ab672589dc19a16a/femoralheadandneck-4795-article.pdf) The procedure is simple but non-reversible; the entire femoral head and part of the neck are removed obliquely.[6](https://ejournals.epublishing.ekt.gr/index.php/jhvms/article/view/40194)\n\nThe second rationale is removal of painful or infected tissue. Before antibiotics and joint replacement were available, resecting the femoral head was a common option for infectious or post-traumatic lesions of the hip, and the resulting clinical state became eponymously known as the \"Girdlestone situation\".[7](https://jbji.copernicus.org/articles/4/203/2019/jbji-4-203-2019.pdf) In periodontics, the rationale is contour rather than joint mechanics: osseous resective surgery changes diseased bone contour to reproduce a more physiologic anatomy and establish minimal probing depth.[8](https://onlinelibrary.wiley.com/doi/10.1002/9781119830344.ch7)\n\n## How it is done\n\nPlanning begins with imaging. For FHO, an ideal osteotomy angle is measured preoperatively on standard ventrodorsal hip-extended radiographs taken in the Orthopedic Foundation for Animals (OFA) position, and a similar postoperative radiograph checks completeness of the ostectomy before anesthetic recovery.[9](https://todaysveterinarypractice.com/soft-tissue-surgery/ventral-femoral-head-and-neck-ostectomy/) In general bone-cutting surgery, X-rays or CT scans define the exact size, dimension, and angle of the bone section to be removed, sometimes with computer-assisted planning.[10](https://my.clevelandclinic.org/health/articles/22688-osteotomy)\n\nFor the femoral neck cut, an osteotome and hammer, an oscillating saw, or a Gigli bone saw can be used; the osteotome width should match the femoral neck diameter, at least 2.5 cm in a large dog, and the osteotome should be avoided in osteoporotic bone because it may fracture the greater trochanter or femoral diaphysis.[11](https://hjcam.hcavs.gr/en/v8-i2-femoral-head-excision-en) The cutting instrument, at least 2 to 3 cm wide, is tilted toward the patient's head so the cut runs caudally and medially, with the limb in external rotation.[4](https://assets.ctfassets.net/4dmg3l1sxd6g/7t79GuPM1i9j1juR4W2Pca/3e2395333b30b473ab672589dc19a16a/femoralheadandneck-4795-article.pdf) Absence of crepitus during passive flexion and extension of the hip indicates the surface is sufficiently smooth.[11](https://hjcam.hcavs.gr/en/v8-i2-femoral-head-excision-en) Keys to success include removing all of the femoral neck in addition to the head, taking the hip through range of motion before closure, and obtaining postoperative radiographs.[12](https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/9781394159970.ch46)\n\nIn periodontal osseous surgery, after full-thickness flap reflection and root debridement, bony shelves and exostoses are removed first with round burs ([osteoplasty](https://www.edgepedia.org/osteoplasty)); end-cutting burs then remove bone toward the lingual side to the depth of the interproximal defect, and flame-shaped burs, chisels, and bone files smooth the surfaces before flap closure with inverting mattress sutures.[13](https://www.ncbi.nlm.nih.gov/books/NBK599507/)\n\n## Origin\n\nHistorical accounts record an early femoral head and neck resection performed on a 9-year-old child with septic non-union of a hip fracture.[7](https://jbji.copernicus.org/articles/4/203/2019/jbji-4-203-2019.pdf) The eponymous \"Girdlestone situation\" refers to excision arthroplasty of the hip described as a salvage procedure for septic arthritis.[7](https://jbji.copernicus.org/articles/4/203/2019/jbji-4-203-2019.pdf) Veterinary adoption followed in the early 1960s, with the technique modified and used extensively in dogs and cats, and results regarded as beneficial by 1966.[11](https://hjcam.hcavs.gr/en/v8-i2-femoral-head-excision-en)\n\n## Variants\n\n**Femoral head and neck ostectomy (FHO/FHNE)** is a common salvage procedure for coxofemoral pathologies. In cats it is used for chronic coxofemoral osteoarthritis, fractures, luxation, avascular necrosis, and failed total hip replacement.[3](https://pmc.ncbi.nlm.nih.gov/articles/PMC12882995/) In dogs, reported indications span hip dysplasia, Legg-Calvé-Perthes disease, femoral head and neck fractures, epiphyseolysis, acetabular or pelvic fractures, chronic irreducible coxofemoral luxation, severe osteoarthritis, and failed total hip arthroplasty.[11](https://hjcam.hcavs.gr/en/v8-i2-femoral-head-excision-en) Both craniolateral and ventral approaches are described; the craniolateral approach preserves gluteal support of the femur and reduces the risk of iatrogenic femoral fracture, while the ventral approach spares the [gluteal muscles](https://www.edgepedia.org/gluteal-muscles) and dorsal joint capsule and allows bilateral simultaneous surgery without repositioning.[11](https://hjcam.hcavs.gr/en/v8-i2-femoral-head-excision-en) • [9](https://todaysveterinarypractice.com/soft-tissue-surgery/ventral-femoral-head-and-neck-ostectomy/)\n\n**Periodontal ostectomy** removes alveolar bone proper, as distinct from osteoplasty, which reshapes the alveolar process without removing supporting bone.[2](https://doi.org/10.1111/prd.70001) It is used to eliminate persistent pockets after cause-related therapy, aiming at periodontal healing with minimal bone removal and a final probing depth ≤3 mm; in [crown lengthening](https://www.edgepedia.org/crown-lengthening) the endpoint is instead extension of supragingival tooth structure.[2](https://doi.org/10.1111/prd.70001)\n\n## Applications\n\nA retrospective series from 1978 to 1989 recorded FHO in 132 dogs and 51 cats, used when preservation of the joint was not feasible or practical; the most frequent indication in dogs was avascular necrosis of the femoral head (Legg-Calvé-Perthes disease), and 75% of patients were under two years old.[14](https://orthovet.org/sites/default/files/vcot-full-paper/vcot_2010-23-5_13649.pdf)\n\nForce-plate gait analysis in 27 dogs after FHNE found no significant difference in peak vertical force between operated and non-operated limbs at a median functional recovery time of 4 months for dogs ≤20 kg and 3 months for dogs >20 kg (p = 0.33).[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC12116107/) Within 12 months, 11 of 12 dogs (91.67%) in the ≤20 kg group and 15 of 15 (100%) in the >20 kg group showed a normal gait, defined as a peak vertical force difference between limbs of ≤5% body weight (p = 0.44).[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC12116107/) The study concluded that FHNE provides satisfactory functional outcomes and is suitable for medium- to large-breed dogs.[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC12116107/) This aligns with a shift in the literature: outcomes in dogs over 20 kg (44 lb) were historically considered inconsistent, but more recent reports describe similar outcomes regardless of patient size.[9](https://todaysveterinarypractice.com/soft-tissue-surgery/ventral-femoral-head-and-neck-ostectomy/) A 2025 JAVMA study found that acute and chronic coxofemoral disease were associated with similar long-term functional outcomes after the procedure.[15](https://avmajournals.avma.org/view/journals/javma/aop/javma.25.04.0272/javma.25.04.0272.xml) In dentistry, osseous surgery typically yields significant probing depth reduction in pockets greater than 4 mm.[13](https://www.ncbi.nlm.nih.gov/books/NBK599507/)\n\n## Limitations and alternatives\n\nComplications of FHO include decreased range of motion, especially hip abduction and extension, limb shortening, muscle atrophy, infection, and loss of function; bony regrowth is sometimes seen in dogs younger than 9 months of age.[4](https://assets.ctfassets.net/4dmg3l1sxd6g/7t79GuPM1i9j1juR4W2Pca/3e2395333b30b473ab672589dc19a16a/femoralheadandneck-4795-article.pdf) The permanent excision can alter hip biomechanics, producing dorsal displacement of the femur, restricted range of motion, lameness, and pain during passive movement.[16](https://vetsci.org/DOIx.php?id=10.4142%2Fjvs.2015.16.1.131) Outcome is associated with dog size, with generally poorer results reported in larger breeds, although the cause has not been determined.[17](https://actavetscand.biomedcentral.com/articles/10.1186/s13028-018-0382-8) Early, aggressive postoperative physiotherapy is reported to improve limb function after FHO by preventing excessive pseudoarthrosis fibrosis, improving muscle mass, and maximizing range of motion; rehabilitation focusing on hip extension and muscle mass is considered critical, especially for larger patients.[15](https://avmajournals.avma.org/view/journals/javma/aop/javma.25.04.0272/javma.25.04.0272.xml) • [9](https://todaysveterinarypractice.com/soft-tissue-surgery/ventral-femoral-head-and-neck-ostectomy/)\n\nThe amount of bone removed matters in both directions. If too much femoral neck remains on postoperative radiographs, the surgeon should be prepared to return to surgery.[12](https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/9781394159970.ch46) No general quantified safe limit for bone removal appears in the published literature; only procedure-specific rules of thumb, such as preserving approximately 1 cm of medial bone at a distal femoral osteotomy hinge, have been described.[18](https://www.orthopediatrics.com/wp-content/uploads/2024/06/ST-1050-17-00-Rev-B-DFOS-Addendum-May-2024.pdf)\n\nInstrument choice involves a trade-off. Power saws and high-speed burrs can cause thermal necrosis of bone ends and adjacent soft tissue, whereas the Gigli saw and drill-and-osteotome techniques preserve the periosteal blood supply as low-energy procedures.[1](https://link.springer.com/article/10.1007/s11751-017-0296-4) In an ex vivo study of eight canine cadavers, however, osteotome-based FHNE produced more peri-ostectomy bone fragments, cortical fissures, irregular margins, and residual femoral neck volume than a microsagittal saw, and would require post-ostectomy modification clinically.[19](https://www.thieme-connect.com/products/ejournals/abstract/10.3415/VCOT-14-12-0183)\n\nThe main alternative for coxofemoral disease is total hip arthroplasty, described as a widely accepted gold standard definitive treatment for many such conditions.[15](https://avmajournals.avma.org/view/journals/javma/aop/javma.25.04.0272/javma.25.04.0272.xml) Conversion to total hip replacement after a failed FHO is technically difficult because of fibrous tissue, periarticular muscle contracture, altered morphology from bony proliferation, and increased luxation risk.[16](https://vetsci.org/DOIx.php?id=10.4142%2Fjvs.2015.16.1.131) In periodontics, osseous surgery alone is not recommended for deep localized bone defects greater than 3 mm, where extraction or regenerative surgery is preferred.[13](https://www.ncbi.nlm.nih.gov/books/NBK599507/)\n\n## References\n\n1. [The history, evolution and basic science of osteotomy techniques](https://link.springer.com/article/10.1007/s11751-017-0296-4)\n2. [The European contribution to osseous resective surgery for the treatment of residual pockets and furcation defects](https://doi.org/10.1111/prd.70001)\n3. [Femoral head and neck ostectomy via ventral approach in cats using a standardized three-dimensional-printed ostectomy guide](https://pmc.ncbi.nlm.nih.gov/articles/PMC12882995/)\n4. [Femoral Head & Neck Ostectomy (surgical technique article)](https://assets.ctfassets.net/4dmg3l1sxd6g/7t79GuPM1i9j1juR4W2Pca/3e2395333b30b473ab672589dc19a16a/femoralheadandneck-4795-article.pdf)\n5. [Force Plate Gait Analysis in Dogs After Femoral Head and Neck Excision](https://pmc.ncbi.nlm.nih.gov/articles/PMC12116107/)\n6. [Prognostic factors associated with femoral head and neck excision outcomes in 108 dogs. A retrospective study](https://ejournals.epublishing.ekt.gr/index.php/jhvms/article/view/40194)\n7. [The Girdlestone situation: a historical essay](https://jbji.copernicus.org/articles/4/203/2019/jbji-4-203-2019.pdf)\n8. [Practical Periodontal Diagnosis and Treatment Planning, Second Edition (Chapter 7)](https://onlinelibrary.wiley.com/doi/10.1002/9781119830344.ch7)\n9. [Ventral Femoral Head and Neck Ostectomy](https://todaysveterinarypractice.com/soft-tissue-surgery/ventral-femoral-head-and-neck-ostectomy/)\n10. [Osteotomy (Bone Cutting): What It Is, Procedure & Recovery](https://my.clevelandclinic.org/health/articles/22688-osteotomy)\n11. [Femoral head and neck excision in dogs and cats (Hellenic Journal of Companion Animal Medicine, Vol 8, Issue 2, 2019)](https://hjcam.hcavs.gr/en/v8-i2-femoral-head-excision-en)\n12. [Femoral Head and Neck Ostectomy (FHO) - Techniques in Small Animal Soft Tissue, Orthopedic, and Ophthalmic Surgery](https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/9781394159970.ch46)\n13. [Overview of Periodontal Surgical Procedures - StatPearls - NCBI Bookshelf](https://www.ncbi.nlm.nih.gov/books/NBK599507/)\n14. [Retrospective study of FHO in 132 dogs and 51 cats (1978–1989) (Veterinary and Comparative Orthopaedics and Traumatology)](https://orthovet.org/sites/default/files/vcot-full-paper/vcot_2010-23-5_13649.pdf)\n15. [Acute canine coxofemoral disease and chronic canine coxofemoral disease were associated with similar long-term functional outcomes following femoral head ostectomy (JAVMA, ahead of print)](https://avmajournals.avma.org/view/journals/javma/aop/javma.25.04.0272/javma.25.04.0272.xml)\n16. [Total hip replacement after failed femoral head and neck ostectomy in two dogs (Journal of Veterinary Science)](https://vetsci.org/DOIx.php?id=10.4142%2Fjvs.2015.16.1.131)\n17. [Use of clinical and computed tomography findings to assess long-term unsatisfactory outcome after femoral head and neck ostectomy in four large breed dogs (Acta Veterinaria Scandinavica)](https://actavetscand.biomedcentral.com/articles/10.1186/s13028-018-0382-8)\n18. [Osteotomy System (Distal Femoral Osteotomy System addendum, May 2024)](https://www.orthopediatrics.com/wp-content/uploads/2024/06/ST-1050-17-00-Rev-B-DFOS-Addendum-May-2024.pdf)\n19. [Comparison of osteotome versus microsagittal saw for FHNE performed by novice veterinarians (Veterinary and Comparative Orthopaedics and Traumatology)](https://www.thieme-connect.com/products/ejournals/abstract/10.3415/VCOT-14-12-0183)\n\n---\n*Topic: Encyclopedia › Life and health › Human health and medicine › Clinical assessment and procedures › Surgery and surgical specialties › Orthopedic surgery procedures*\n\n*Initially written Sep 29, 2026 · Edited: Oct 15, 2026*\n\n*Copyright 2026 EdgeChat AI, a subsidiary of Biostate AI.*\n\nLicense: Edgepedia Community License 1.0, https://www.edgepedia.org/edgepedia/license\n", "same_as": [], "url": "https://www.edgepedia.org/ostectomy", "markdown_url": "https://www.edgepedia.org/ostectomy.md", "license": { "name": "Edgepedia Community License 1.0", "url": "https://www.edgepedia.org/edgepedia/license", "summary": "Free with credit, commercial use included. AI training is open to everyone. For other uses, organizations over USD 100M in revenue or 100M monthly users license separately.", "spdx": "LicenseRef-Edgepedia-Community-1.0" }, "credit": "\"Ostectomy\", Edgepedia (EdgeChat), https://www.edgepedia.org/ostectomy. Edgepedia Community License 1.0.", "credit_md": "\"[Ostectomy](https://www.edgepedia.org/ostectomy)\", Edgepedia (EdgeChat), [https://www.edgepedia.org/ostectomy](https://www.edgepedia.org/ostectomy). [Edgepedia Community License 1.0](https://www.edgepedia.org/edgepedia/license).", "credit_html": "\"Ostectomy\", Edgepedia (EdgeChat), https://www.edgepedia.org/ostectomy. Edgepedia Community License 1.0.", "speakable": "Ostectomy is a surgical operation that removes bone tissue, used in orthopedics to eliminate diseased or painfully contacting bone, and in periodontics to excise tooth-supporting alveolar bone." }