POST-FHO HOMEWORK SUGGESTIONS FOR CATS
POST-FHO HOMEWORK SUGGESTIONS FOR FELINES
(Femoral Head Ostectomy/Removing the Ball off the Femur at the Hip Joint)
First and foremost: pay attention to the discharge instructions your veterinarian has given you and really try to follow them. These instructions usually include keeping your cat as subdued as possible for at least two weeks, preferably subdued with only controlled activity for 8-12 weeks. I highly recommend you not allow playing, no cat rugby, no no toys, no “I’m still the bossiest kitty” smack-downs from the surgery kitty to the other kitties, etc…and definitely no jumping onto things for 8-12 weeks. Given the opportunity, it is highly likely your cat will escape from you upon arriving home from the hospital and will promptly and speedily dash to some hiding place. It is better to keep your cat in their crate and upon arriving home from the clinic, keep them in a place of your choosing to govern them during this time of healing. I’m pretty sure controlled restriction will work out better than if you end up pulling your cat by the armpits out from under the bed.
During this surgery, there was cutting of muscle and other tissue that will require care and time to heal. Please follow the icing instructions noted on a separate sheet and which are also available on my websites if your cat will allow it.
In physical rehabilitation after FHO we should aim at keeping the “false” joint comfortable after surgery by promoting hip flexion and extension through therapeutic exercises that stimulate leg use, leading to muscle strengthening and avoiding chronic disuse of the operated limb.
The muscle that was cut into during the FHO requires a little over 6 weeks to achieve a normal collagen ratio and will take longer to heal more fully. This should be considered when you think your cat is ready to jump onto high places at 2 weeks after surgery. Don’t let them if you hope for the best outcome from the surgery. On the other hand, the bone that was cut does not require the same care that a fracture repair would; there is no need to be concerned that you will cause further damage to the bone by allowing exercise.
In light of this information I recommend working on some of the rehab activities noted below:
Some cats are accustomed to going on walks, even leash walks, with owners, and if your cat is one of them, then the standard walking homework I write for canines may be followed for cats as well. You may want to try to implement that homework even if you have not previously “walked” your cat. Please use a harness to introduce this walking activity.
During the first two weeks especially, we want your cat to walk and stretch and use their operated leg in a natural, yet controlled manner and with moderate to slow movements. Any walking is fine, i.e., to the litter box, to food and water, but pouncing, jumping and dashing are to be avoided altogether or as much as possible.
If your cat is using the leg fairly well a day or two after surgery, then I encourage you to slowly increase the time of consistent leg use and otherwise start some structured walking at five days after surgery. If your cat will not go for structured walks with you, then another possibility is to use a favorite treat to coax them to walk slowly across the floor. You could hold up the treat at head height and crawl along with your cat to get them to walk along in a continual gait pattern as best possible.
Two to five minutes of this walking a couple of times a day for the first week will be beneficial for the cat and possibly hard on you. This same treat method may be used in conjunction with another person holding a leash on a harness on the cat to introduce the concept of leash walking, which would be easier on you. Some cats will follow a string or feather, etc…pulled slowly across the floor, and this method may be used if your cat will walk sluggishly. However, many cats will wait for distance and then pounce on the string or feather, so use your knowledge of your cat to act as wisely as possible.
The goal is to encourage enough continual, weight-bearing leg use so as to create a callous of scar tissue within the compartment where the top of the femur now rides. Too much activity and/or abrupt, jumping movements could tear up the scar tissue we want and instead create more scarring from the new damage. Eventually, with too much activity, there could be a bulk of scar tissue and increased pain. This doesn’t happen as often in cats as it does in dogs, primarily because they do not weigh as much, and therefore do not put as much pressure on the surgery leg. That extra, harsh, impact pressure is what can cause the top of the femur to tear into the healing area where we’d like to have a callous of scar tissue form. Slow, steady, easy exercise brings the best healing in most cases.
After about five days, and especially if your cat is not using the leg much, then I recommend you speak to your veterinarian about finding some additional pain control medications that will suit your cat. Recovery will improve if your pet feels less pain and is able to use their leg more “normally”, yet gently. Pain medicine helps achieve this, and it seems the medications are needed for an average of 4 weeks for cats after this surgery.
There are a variety of ways to get your cat to stretch out that operated hind leg and any may be utilized as long as the end result is not further injury. I find that with careful restrictions and exercise, along with proper pain medication, cats will usually come around to using their leg as fully as ever without anyone stretching it or forcing movement.
If I see a cat more than 6 weeks out from surgery, and they have plenty of pain medication yet aren’t using the leg in good extension, I will work on exercises and drills that encourage the cat to stretch on their own. Sometimes I get a cat to extend from the floor to a couch for a treat or toy and then I draw them back to the floor again. During the first four weeks this works best if the cat does not end up jumping onto the couch. A stretching drill like this should be done 2-4 times per day with 10 repetitions each time. Please allow your cat to rest and recovery at least 2 hours between exercise sessions.
After three weeks, then more structured play to encourage stretching, leg use and muscle strengthening may be implemented. One example of this is to use a feather or string in the air that your cat will rise onto their hind legs and reach to bat. Two to three minutes of this type of play or twenty repetitions at this time, twice per day is beneficial.
At four weeks, if your cat will walk with you up and down stairs without bounding, it is good to start this exercise. Some cats will follow the owner for continual repetitions. Some cats will need a leash and harness. Where and when possible, a set of five times eight to ten stairs once every other day could be a good workout. Any slow climbing is better than none, and more repetitions in a row serve the muscles better than only one or two stairs here and there.
By three to four weeks, your cat will be wanting to run around more and will function as if they are ready for all the “usual” household activities. I still prefer to avoid very harsh movements at this time so that cats don’t disrupt the good scar tissue that has formed. I tell people that the tissue we want is very much like what you get when you ride a bike a lot. If you have not ridden in a while and you go out for a longer ride, the bones at your seat will likely feel like they hurt the next day when you sit in a hard chair. People who frequently ride have scar tissue that operates as padding between bone and tissue. After a couple of riding sessions, the appropriate scar tissue forms and it is no longer painful to sit. This is very similar to the type of tissue I want to see your cat form after an FHO; they need a slow build-up of scar tissue to cushion between the femur and the muscle, and while it is forming due to friction from consistent leg use, I don’t want to tear it or otherwise disrupt it with harsh movements. That could lead to formation of more bulky scar tissue which makes it harder for the leg to move and sometimes causes nerve pain. Similarly, we don’t want to allow the animal to not use the leg, because scar tissue will form that will bind the leg into a place of diminished function and it will always then hurt to do some favorite activities in the future. Not too much, not too little.
If your pet is not using the operated leg after week 1, then I recommend calling your vet or me for rehab intervention and to get them started on beneficial exercise and pain medications. If you follow the exercise prescription well and after week 4 would like advanced exercises, then a rehab consult is necessary. I have some separate recommendations for canine FHO’s, so feel free to contact your vet for a copy of that if you need it.
And if your cat does end up hiding under the bed when you get home because you felt sorry for them and let them out of their crate, don’t pull them out from under the bed by the armpits J I do recommend that you shut the doors to the bedroom, closet, and bathroom, though, so that when they do come out from under the bed, you will have a better chance of collecting them and getting them back into a crate.
©2007 Rehabilitation and Conditioning for Animals
Deborah Carroll CCRP, CSCS
Filed under: Hips Tagged: cat hip surgery, cat rehab after surgery, exercises for my cat after surgery, FHO, rehabilitation for cats, therapy for cat

