On September 26, 2025, Topics in Companion Animal Medicine published a groundbreaking case report documenting successful physiotherapy management

 of a geriatric dog undergoing femoral head and neck ostectomy (FHNO) with concurrent contralateral hindlimb amputation. 

The report, authored by veterinary rehabilitation specialists, describes a 10-year-old, 36-kg mixed-breed dog whose left hind limb had been amputated one year prior following a road traffic accident, 

and who subsequently developed end-stage hip osteoarthritis in the remaining right hindlimb.

Total hip replacement (THR) was deemed financially prohibitive for the owners, leaving FHNO as the only surgical salvage option. 

Two weeks post-FHNO, the dog remained unable to stand independently and could only walk a few steps with harness assistance.

 A structured multimodal physiotherapy protocol was then initiated, including daily manual therapy (massage and passive range of motion), 

weekly underwater treadmill sessions, zonal laser therapy for pain management, systemic nonsteroidal anti-inflammatory drugs (NSAIDs),

 joint supplements, and full-spectrum cannabidiol (CBD) oil at 2 mg/kg twice daily.

The results were remarkable. After eight hydrotherapy sessions, thigh circumference increased by 5 cm, 

indicating substantial muscle regrowth and strength improvement. By two months post-rehabilitation initiation, 

the dog could walk independently without support. At 14-month follow-up, the owner reported continued favorable function, with the dog maintaining good quality of life.

Dr. Majid Rajabian, who has published extensively on postoperative physiotherapy protocols, 

noted in a related study: "Muscle atrophy is the single strongest predictor of poor functional outcomes following major orthopedic surgery. 

Our case series of five small-breed dogs following patellar stabilization surgery demonstrated that early, structured rehabilitation—including neuromuscular electrical stimulation, 

therapeutic ultrasound, and targeted exercises—produced measurable gains in quadriceps girth, passive range of motion, and Timed Up and Go test performance within four weeks".

The FHNO case report is particularly significant because it demonstrates that delayed rehabilitation (initiated two weeks post-surgery) can still yield excellent outcomes,

 even in a geriatric patient with complex comorbidities. 

The authors emphasize that physiotherapy should be considered not an optional adjunct but a critical component of multimodal management in three-legged dogs undergoing salvage procedures.

 With an estimated 15,000 canine limb amputations performed annually in the United States alone, these findings have broad applicability to veterinary rehabilitation practice.