Thinking of an artificial leg for your 3-legged dog or cat? Wait! Don’t do a thing until you watch the ultimate guide to pet prosthetics webinars by the world-famous veterinary orthopedic surgery and rehabilitation team of Drs. Sherman and Debra Canapp. As founders of Veterinary Orthopedic Sports Medicine Group and Canapp Sports Medicine, they worked with Tripawds to create a RACE-approved pet prosthetics webinar and questions-and-answers session for vets and pet parents.
Keep reading to get the latest information about prosthetics for three-legged pets. Originally aired in November 2020, these important webinars are brought to you by the talented pet prosthetics creators at Dive Design, makers of high-tech support braces and prosthetics for Bionic Pets.
Ultimate Guide to Pet Prosthetics for Vets and Parents, Table of Contents
Vet Experts Share the Best Prosthetics Tips for Amputee Dogs and Cats
In “Tripawds & Prosthetics: How to care for our 3-legged friends” you can learn all about amputation surgery, prosthetics as an alternative to full limb amputation, prosthesis types, rehabilitation, common complications and more. Watch this space next week for Part 2 of our Live Q&A session about pet prosthetics with questions asked by webinar attendees.
Watch the video, download the podcast below, or read the full transcript at the bottom.
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Pet Prosthetics and Braces Questions and Answers
Full Transcript of The Ultimate Guide to Pet Prosthetics for 3-Legged Dogs and Cats
In Tripawds & Prosthetics: How to Care for Our 3-legged Friends, you will learn all about amputation surgery, the use of prosthetics as an alternative to full limb amputation, prosthesis types, rehabilitation, common complications, and more. Tune in to Part 2 for our live Q&A session addressing specific concerns raised by webinar attendees.
Hello, everyone. I’m Dr. Sherman Canapp, a Diplomat of the American College of Veterinary Surgeons as well as a Diplomat of the American College of Veterinary Sports Medicine and Rehabilitation where I’m the past President, Director of National Regenerative Medicine, Rehabilitation and Sports Medicine for Pathway Vet Alliance. I am Co-founder with my wife, Dr. Debra Canapp of the Veterinary Orthopedic & Sports Medicine and Founder and President of Orthobiologic Innovations, which is a translational medicine company taking products from humans to animals and animals to humans.
Project GO is a nonprofit organization helping working dogs, rescue organizations, and wildlife. It’s a 501(c)(3) that we started many years ago. And lastly, Canapp Sports Medicine is a virtual medicine, virtual sports medicine for veterinarians, for owners with telemedicine and teleeducation,
Today, we are going to be talking about Tripawds and Prosthetics: How to Care for Our 3-legged Friends.
I like to begin by acknowledging and thanking the two sponsors you see here from this talk. Also, to share this a little bit of comic relief, Stubby and His Magic Boots, Keep Calm, and Faux Paw.
[0:02:58] Facts About Prosthetics for Three-Legged Animals
Now, what’s really, really important is that we understand when we are talking about the use of these types of devices. It’s absolutely extremely important that we think about proper owner and patient case selection, exact measurements and fitting, rehab-inclined education are absolutely paramount for the best success. Just placing a device on your canine companion is not the silver bullet.
The objectives of this webinar is to talk about subtotal amputations, we will also talk about full amputations and prosthesis as an alternative to full limb amputations and options for full limb amputations as well. We will look at case selection, surgical approaches, prostheses, fabrication in the post-op care, complications that can occur with this rehabilitation therapy. Also, we will talk about retrospective analysis that we published many years ago.
So limb salvage prosthesis, why would we have to consider such a procedure for your canine companion? Well, let’s talk about neoplasia and severe trauma, common causes for amputation. Now giant breeds or dogs with concurrent orthopedic disease may respond poorly in amputation. Therefore, a forelimb and a hindlimb prosthesis may offer an alternative to full limb amputations.
[0:04:23] Types of Prosthetics for Amputee Pets: History, Types and Benefits
Now, when it comes to prosthetics, they’ve been around for a long, long time. The earliest record of limb prosthesis was way back in 44 BC as a Persian soldier who has his foot amputated or had his foot amputated and replaced with a wooden prosthesis that you can see here in this image. We’ve come a long, long way though as you can see here in the bottom right from that wooden foot to where we are with current prosthetics.
Transcutaneous intraosseous pet prosthetics
When we talk about prosthesis in the veterinary space, there are a few different types we can think about. There is transcutaneous intraosseous. And what this means is that we are actually performing amputation and then taking an implant, placing it up inside the bone so it’s being firmly attached either through what’s called prosfit or through bone cement. And you can see those two images to the left versus what we see on the right which is what’s called an external self-suspending prosthetic.
Now when it comes to the transcutaneous intraosseous, there are some benefits and no need for prosthetic adjustments. There is improved energy efficiency during the gait, improved proprioception, lack of skin breakdown, and lack of on/off prosthetics. And this was published back in 2008.
You do have some issues though as well where there is implant infection. There is periprosthetic fracture that can occur, a lack of strength between where the implant and the skin is. The skin just cannot, the soft tissues, grow into these implants.
External self-suspension pet prosthetics
If we are talking about external self-suspension, there are many benefits there, easy application and removal, less complicated surgery with no implants, no chance of infected implants, no chance of periprosthetic fractures. If a patient does not tolerate the prosthesis, it’s simply left off with a stump amputation, and we will take a look at that a little bit later. There is no need for prosthetic adjustments and skin irritation are two of the things we have to consider.
Now with the prosthesis, there is a suspension system. So every prosthetic requires some type of suspension system to keep it from falling off the residual limb. There is a suspension system that includes self-suspension of the socket, suction suspension, and suspension devices or harnesses as you will see here in a second.
So with the self-suspension of the socket, this makes the use of anatomic shape of the residual limb such as what you can see here with this elephant.
With a suction suspension, it’s a method of creating suction suspension by the use of a suction socket design in jaw suspension liner. A suspension device, or harness requires belts or cuffs or wedges, straps, and sleeves. Somehow, we are applying the prosthesis to the distal extremity or the limb where the amputation was performed and then we are holding it in place here as you can see with some sort of harness type apparatus.
[0:07:32] Case Study: External Self-Suspension Prosthesis
Why would we have to consider these things such as external self-suspension prosthesis? Well, here’s a great example of one. This is Ebony. Ebony is an absolutely wonderful patient but unfortunately has some other issues, has elbow dysplasia, elbow arthritis, also hip dysplasia. And all of a sudden, this tumor formed literally overnight practically according to these owners. Ebony was having a real challenge ambulating or walking around with this tumor of course. The worry was that we would not be able to remove this tumor and get clean margins. So unfortunately, our only option for a mass that was this large was to perform an amputation.
Now, Ebony was an 11-year-old female spayed Lab and this was a hemangiopericytoma. So we knew we had to get margins but Ebony with her issues of elbow arthritis, hip arthritis, and her age, we knew we had to do something to add some support to this limb.
In surgery, what you have to do is make sure you have margins so you don’t leave any of the cancer behind but you have to preserve as much bone and as much of the healthy soft tissues as you can. So it’s a fairly challenging complicated procedure but we in the veterinary space can follow what they use in humans.
Following the procedure, you can see the stump. Now, the suture line, this is one of our earlier cases, you want to try to avoid the suture line being at the very end of the stump because that does apply pressure with the bandage, with the splint, with the compression sleeve and device we are going to put on her temporarily as well as with the prosthetic device. So the future ones that we have done have all had the incision closure higher up the limb from where the amputation site was performed.
Managing Ebony’s post-op amputation swelling
Following the procedure, they tend to want to swell a little bit. They can have some drainage, some edema so it’s important that we stay on top of that very quickly. So what we use is a combination of adjustable cold therapy and active pneumatic compression which through a microprocessor regulates through a control unit. Now, this control unit is filled with ice and water and then you wrap this securely around the limb and this is a great device for allowing for this cold therapy or cryo-type therapy.
With that, we want to make sure that we maintain post-op reduction of swelling because if we do not, we cannot do the cast mold for the prosthetic until the swelling is down. Cast molding is preferably perform somewhere between 7 to 10 days post-op. We are going to allow for immediate swelling to reduce, and that can be with our cryotherapy. It can also be with a bandage, compression wrap. And we want to get that prosthesis on as quickly as possible, usually by two weeks if we can because the longer they go without it, they start to become aware, “Hey, you know what? I can get around without this,” and it’s harder to get them to accept it and to ambulate with it.
No need to minimize a time from post-op to the prosthesis. We need to actually take or we need to minimize the time from post-op to prosthesis just to get incisions to heal, swelling to go down, and of course, the prosthesis fabricated.
This is an example you saw Ebony. And we immediately made the cast mold from Ebony’s limb. This was sent off for fabrication, carbon fiber, plastic type insert. You can see it’s a polypropylene with a strap on the inside that will go around the stump.
[0:11:12] Amputee Dog Walks with a New Prosthetic
Here’s an example of Ebony. Now, this was a few weeks after the procedure. Again, we don’t just place this one and say, “Okay, go for a walk in the grass and the leaves.” This is working closely with the rehabilitation therapist, also with the owners to get Ebony introduced to this device.
And after placing it on, you have them just stand there with aesthetic then you have them take a few steps then you take it off. You do slow introductions of these types of devices so that they’re not overwhelmed and they get comfortable and you can make sure that there are no complications as far as rubbing and that is fitting appropriately.
Now, we are stepping off a curb. Okay. That stayed on, which is always a good sign. You can see we just sniff the bag. Our little sniffer is still working.
The most challenging thing is can they ambulate and navigate stairs? So here’s an example of Ebony with our first stairs. Not too bad, OK? Again, this is going to take some work. It’s going to take some training and patience. But again, the right patient and the right owner.
[0:12:25] Pet Prosthetic Design, Creation, Pricing and Complications
For these prosthetics that we are going to be looking at, there are two orthotists that we work with, one is Derrick Campana from Animal Orthocare and the other is Jeff Collins from K-9 Orthotics and Prosthetics. I could ask commonly, what’s the range? And this is just a ballpark. But for many of these that we will be looking at, they range somewhere for the actual device itself, between the upper hundreds to low thousand dollar range. And this is going to be US.
Complications, unfortunately, this can occur. It happens in humans, in animals. And so, it’s really, really important, education, education, education with the owner that they know what to look for. So we got to make sure with the wounds, is it a question with the fit? Is it a question with the mold? Remember, we are creating a mold and sending it off to have this fabricated. If our mold wasn’t exact then the product we are going to get back in place of it is not going to be exact either because we have pressure points. Is there a lack of padding somewhere within the device?
Owner and patient complains. Did the dog go swimming with this device on? Or did it go running around the yard chasing squirrels? Was there not a good enough break-in period or long enough break-in period?
Pet prosthetics complications remedies
Some of the remedies that we can have, we can place what’s called Surgi-Sox or it’s like that little sock that goes over top of it. We can add some extra padding within the prosthesis.
Remodelling. So if it’s just not fitting, we recast, we send it back to the orthotist or sometimes we actually just have to have some minor adjustments to the current mold by the orthotist.
Another thing you can use is talc type power. So you can place that down inside if there’s some rubbing. You can also use a Tuf-Foot Pad as well.
Now, I get asked quite commonly. It seems like the surgery is fairly technical and complicated. It seems like the immediate post-op period is very, very crucial to get the swelling down, protect the incision. But what then goes through as far as the process of actually getting these types of prosthetics created and getting them back because it’s really important that we get this thing molded appropriately, accurately, precisely, and sent back as readily as possible so we can start introducing it to the patient.
So the fabrication process, first thing we are going to do is take a soft cast material. This is a 3M material.
[0:14:39] Making a hind limb amputee dog prosthetic
All right. Then what’s the next step? So you saw – that was Derrick Campana, an orthotist from Northern Virginia that we work with very, very closely and frequently. And what you saw was, that was the cast mold of the – what we call distal extremity, which is the area of the stump. And now, what’s going to happen is he slides off that cast mold. He is going to take it back to his shop and he is going to go through a step-by-step-by-step-by-step process. It’s fairly technical to actually create the final device.
Derrick was kind enough to walk us through this process. So we have the mold that’s shipped to the orthotist, in this case, it’s going to be with Derrick Campana. And then what we have here is we have Duct tape to seal the mold and we are going to stabilize this in a sandbox.
It starts with Plaster of Paris
The next that’s going to happen is you mix your Plaster of Paris and you have a rebar that’s placed to reinforce the device.
Now, this Plaster of Paris will set up within about 5 minutes to 1 hour. So we have to wait a fairly variable as to how long it takes before it gets solid.
Then the cast molds are ready for plastic application. You can see here, this was the mold that was placed on inside the cast made from Plaster of Paris. It’s almost like a reverse mold if you would.
Next, what you’re going to do is you’re heating the sheet of plastic mold in an oven. So this comes as a firm type plastic material. Once you heat it, it’s malleable.
Heating and applying the transfer paper
You can see here then what they have done or Derrick has done is he has taken that plastic mold once he has heated it and wrapped it around the cast mold that he created with the Plaster of Paris. Then he is going to do a heating transfer of the paper. And what you do then is you actually apply the transfer paper. That was the plastic material, the mold, and then this is going to be the transfer paper applied now over top of the actual device.
There are all different types of transfer papers. You name it. It really depends on your personal choice as to the different ones that you would want for your pet.
Then you’re going to cut the foam interface and you are going to apply the thread to the rocker bottom of the foot. OK. So now, we are talking about the portion that they actually walk on. OK. This is what they call the rocker bottom. And you can see there are little kind of grips on the bottom of that foot as well.
Applying the rocker bottom foot
Then you apply the shank in the rocker bottom foot to the shell. OK. So you can see the little foot portion at the bottom. There is what we call the shank area. It’s a metal bar basically and it’s then going to attach to the actual plastic mold. And then that’s sent back and applied to the patient.
That was for what we call a partial amputation, partial limb amputation, whether it’s a forelimb or a hindlimb. Now, what we are going to look at is a prosthetic for a full forelimb amputation. And we are going to take you through that process.
[0:20:54] Making a forelimb pet prosthetic
All right. So you could see then that it has come a long way. Every from the actual cast mold which was able to be to be created around this patient’s body, they were able to then use software to scan that. Then they were able to take that, input it into 3D modeling or 3D rendering to get the final material that was 3D printed. And because of that, if it’s absolutely perfect to the mold which fits absolutely perfect to the patient.
So – and now, up here so we can do this with 3D modeling and get them extremely accurate. And before, we really weren’t able to do prosthetics for any patients that had complete limb amputations. Now you can see in this particular patient that we are able to actually apply a prosthesis to a forelimb that has been fully amputated.
[0:21:50] Pet prosthetic training and follow up care
Follow-up care. OK. So we’ve placed the prosthesis. We slowly start to introduce it to the patient. We are going to assess it for fit. We are going to train the client about the procedure. So putting it on, taking it off, watching, dealing with the skin and soft tissues, training on proper care with the device, monitoring for limb fit, any trauma to the skin if there’s rubbing. Imagine if you put a pair of shoes on that just don’t quite fit and you go for a run, all of a sudden, you’re going to have blisters. And if you don’t take them off but you have a blister, it can actually wear its way all the way down to level of the bone and we can see that unfortunately in patients that have these that weren’t monitored or didn’t fit appropriately.
Initial break-in schedule. You place it on. You just get them use to it. Introduce it. Take it off. OK. Put it on. Have them stand for a minute. Take it off. Put it on. Have them take a few steps. So again, it’s a very, very slow process getting them introduce and used to it. And a recheck schedule with the rehabilitation therapist.
[0:23:33] Watch a video of pet prosthetic rehabilitation therapy
For the external self-suspension prosthesis, there is the ambulation phase. So it’s a break-in of the prosthesis. We will do CO laser, manage the skin for any wounds, joint for soreness, any trigger points, manual therapy, range of motion, tension. Because again, we are not just dealing with the area that has been amputated, we are dealing with the whole body because we are affecting the chain and we are affecting everything from the forelimb to the hindlimb, nose to the tail. So we really have to think of the whole body and whole body health.
We are going to aid them by mechanics. This can be with TheraBands, with booties, underwater and land treadmill to help them get used to using it and start to build their mechanics and function, maintaining muscle mass which we will talk about in a minute which is so important.
[0:24:02] All About Hind Limb Pet Prosthetics
What about hindlimb? OK. So we just looked at the fabrication for one for the forelimb. Let’s look at a hindlimb amputation. Now, this is a 1 and a half year old Great Dane. OK, really, really young guy. This is a juvenile osteosarcoma case unfortunately. And you can see the swelling. And boy, they can come up very, very rapidly. And so, we are going to be looking at an external self-suspension prosthesis for the hindlimb.
Again, surgical planning is absolutely crucial. We need to make sure we get margins or we place this poor patient through a procedure only to find out that we really have not done justice. It’s also important of course that they’ve taken thoracic or chest radiographs to look for any signs of metastasis. Many times, recommendation is to do a CT scan which can see mets in the chest that we can’t appreciate on radiographs. We want to make sure we’ve already in advanced talked to the oncologist if chemotherapy is going to be something that we follow up with, which of course is going to be recommended especially if we are looking at trying to improve long-term survival.
We need to make sure that we plan this appropriately, that we leave enough soft tissue, a) for the closure of the wound, of the surgical site but also to make sure we have soft tissue covers that is adequate for the application of the prosthesis.
So in this patient’s situation, the procedure was performed. And now, you can see we have a compressive wrap on there. Again, trying to decrease any swelling, edema, bruising, drainage that could come from a site. If we don’t stay on top of that, it takes us longer to be able to get the prosthetic on to the limb.
[0:25:43] Videos of hind leg pet prosthetic on a dog
Here’s an example of a patient that had a partial hindlimb amputation. You can see the prosthesis on. Now, this patient has been working with a rehab therapist to the point where we are fairly comfortable. You can see we are going to start to go almost into a trot here, using it fairly well.
All right. Another situation. OK. This is one where it was due trauma. So we are going to be talking about a suction suspension. This is a 5-year-old female spayed German Shepherd. Wonderful dog. Incredible owners. Unfortunately, this dog was hit by a car many, many years ago. It had a left tarsus and posed severe trauma. They amputate the right limb. And what you’re going to see is there was a pelvic fracture. You can see here on the x-rays down to the left, hip fracture, and then we have this stump that you can see on the right side. This is on the left hindlimb.
[0:27:02] Making a hind leg prosthetic for dogs
Just like before, we are going to be making a mold. OK. So we take a stack in that or a little soc-type material, place it over top of that. Use a harder material to create the cast mold. Sent off and then we will have the device brought back and applied to the limb. And so here, we have a sock and a gel insert that will go over top of the stump.
[0:27:30] Video of hind leg pet prosthetic on a dog
What you are looking at here was the patient going down a long pressure mat. And this is called an objective gait analysis. In other words, we want to make sure that the patient is placing the right amount of weight on that limb. If not, is it because it’s not the right fit? Is it because it’s uncomfortable?
[0:28:28] Evaluating hind leg prosthetic fit
We want to make sure that we are seeing objectively with data that the limb is working functionally. So there are sensors within this mat. And as the patient walks on it, it gives us the weight distribution. It gives us stride length and step length. And most dogs, it’s a 60:40 ratio. That means 60% of the weight is upfront, of course, because of their deep chest, and 40% is in the back. So each forelimb should be carrying 30, 30 and each hindlimb should be carrying 20, 20. So when we look at the data, we should see fairly even left to right in the fronts, left to right in the rear.
If you look here, what we are doing is we are loading the forelimb a bit and we are not playing as much weight on the left hindlimb which is the one with the prosthesis that we could be. OK? So this is going to be something where we are going to make some adjustments. And now all of a sudden, you can see here 22. OK. So we’ve actually put more pressure now, the loading that we should be seeing on that limb.
Watching for stump changes
If we start to get rubbing, you can see here, the image to the right, there are they starting to get some little ulcerations, irritation to the skin, dermatitis from the device rubbing. We got to make sure, was it the fit? Was it not an ample padding? Had the padding moved? Rotate the prosthetic out to avoid any contralateral limb during amputation. So we need to make sure that we are seeing changes not occurred just to the limb that was amputated, we got to watch the opposite leg as well to make sure we are not seeing any compensatory issues.
Here, we can go ahead and take the Surgi-Sox. We can take little kind of [0:30:14] [Indiscernible], almost like a – we call it stocky net. Apply that over the top of the area. Add some extra padding. Worst case scenario, we can do remodeling by the orthotist or some adjustments maybe needed by the orthotist. And we talked earlier about applying a Tuf-Foot Pad or some talc powder or even a Neosporin topical antibiotic ointment to any areas where there are some wounds.
[0:30:37] Amputee pets supplements tips
What about maintenance? OK. We’ve talked a lot about patient selection. We’ve talked a lot about the procedure. We’ve talked a lot about how we make, how we place it, the importance of the rehab afterwards and teaching them to become adjusted to the device. But what do I mean by supplements? OK. Because we’ve performed potentially a partial amputation or even a full amputation but if you think about it, as we know, the weight distribution as we saw on that last gait analysis, is shifted to other areas of the body. And that dog that we just saw a second ago, more weight was shifted upfront to the forelimbs.
Well, that means with more biomechanical load to these other joints, we could see some earlier arthritis, progressing arthritis, we could see some soft tissue compensation, break down of soft tissues. So we need to think of full body maintenance when it comes to long-term maintenance of these patients that have had partial amputations or full amputations.
The first thing we think about is joint supplements. Imagine if your hindlimb is amputated. You are putting your weight to the forelimb as a dog, to the opposite leg as a dog, and so therefore they’re going to have those challenges. If it was a partial amputation and they are not putting the amputated limb through full range of motion, OK, because they had a stump and the socket above or the joint spaces above aren’t maintaining or needing to do full range of motion, anytime the joint is slightly immobilized or increased load or traumatized, they get over time arthritis.
[0:32:05] Dasuquin for joint support
And so we want to do things to support the joints, slow down the progression of arthritis to the best of our ability. So things like glucosamine, chondroitin sulfate, ASU, this is something where the Dasuquin product, you can see at the bottom of the screen is one that we like to use in our patients whether they’ve had an amputation or even just for any other orthopedic condition. And we do like the one that has MSM in there as well. So this is a glucosamine, chondroitin sulfate, avocadoes, soy bean, unsaponifiable with MSM-type product and there’s even more ingredients that they’ve added most recently. So a wonderful product. There is data out there with this product showing that it does work for the canine for arthritis.
[0:32:48] Welactin for joint support
Another product that’s absolutely proven, great data, that I really, really believe in when it comes to whole body wellness especially if we are talking about in these situations where we are worried about loading the joints and the soft tissues is the fish oils or omega-3s. My preference is the Welactin product. This is something that’s easy to apply to the dog food. They really do tolerate the taste of this. It’s easier to get the concentration you need. It’s really hard to get the high concentration you need in some of the capsules but you can in this liquid formation fairly easily. So another ingredient is going to be added to our maintenance does will be our omega-3 fatty acids.
[0:33:30] 1TDC Anti-Inflammatory pain control
A fairly new one is called 1TDC. This is another very, very important anti-inflammatory. It was first used for dental disease and then they realized in the human patients that we are using them for dental disease, all of a sudden, their joints were feeling more comfortable. They were able to be more active and they found out very quickly that this has not only an anti-inflammatory effect for periodontal disease, but also for joint inflammation, for myofascial pain and a bunch of other conditions. So definitely one that if we have a patient that has had an amputation, we are going to be using this for whole body health.
[0:34:05] MYOS Muscle Building Supplement
Absolutely I think one of the most important supplements you can use is one called MYOS. And I’ll explain why. When you perform an amputation especially if we are trying to keep a prosthesis on, we will start to see muscle atrophy. OK? We need to do anything in our power to try to maintain muscle mass and function of that stump or that limb. Also we may not be as active as a dog because of the fact that we are 3-legged or we have a prosthesis and we may start to atrophy other locations.
For these dogs, even prior to the procedure, I go ahead and I start these patients on MYOS, which is a canine muscle formulation. They do have this for humans as well. It’s called Yolked. And there is a ton of research and this is just an example of some of the papers. You can go to our Google Scholar or PubMed and find these. But one, at Kansas State University, really was impressive. This was on the canine after knee surgeries and they were able to maintain and increased their muscle mass compared to a placebo-controlled patient group. So definitely something, MYOS is one that we recommend.
[0:35:11] How to protect a Tripawd’s remaining limbs
Aside from the joint supplements, your glucosamine, chondroitin sulfate, avocadoes, soy bean, unsaponifiable, or your Dasuquin with MSM, your omega-3s, your 1TDC, your MYOS, we also need to think about protecting the other limbs and soft tissues, not just the joints. So what do I mean by that?
What we saw that the weight distribution was increased in other limbs after the amputation. And this is an example here in the center where you can see a carpal hyperextension, meaning that the front leg, the wrist, is starting to drop towards the ground. All those soft tissues are carrying more load than they are used to carrying and therefore, they can start to stretch out. They can start to break down. So not only are we going to have some potential arthritic changes in that joint, we are also going to have some soft tissue challenges.
We need to do something to try to protect these joints. The first is going to be our supplements we talked about. Rehabilitation therapy is crucial and also, orthopedic devices are something that can help with maintaining normal function ambulation and protect those soft tissues.
[0:36:15] Leg supports, braces for amputee pets
So this is a neoprene carpal wrap. It’s called a Carpo Wrap by Thera-Paw. And what you will also see is there is a thermoplast or plastic insert in the back side. Depending on the size of the dog and depending on the amount of weight they are placing upfront and the amount of breakdown that we are seeing, sometimes it’s just the light neoprene wrap, sometimes it’s just an even lighter sports wrap, or sometimes if it’s a really heavy dog and they are really loading the forelimb and we are seeing breakdown, we will add this plastic thermoplast insert that we can cast mold. We kind of take a piece of – it’s a plastic temp, it’s where you heat it up. It becomes malleable. And then you apply it. So it’s the right standing angle for that particular type of breed or canine.
[0:36:58] Tripawd Quality of Life: a Study
So we spent a lot of time looking at these devices and they look pretty cool and the whole process seems pretty involved. But do they actually work? Do they work in dogs the way that we see that they work in humans? So we wanted to answer that question. And published a paper years ago looking at the outcome measures of how these patients did after we performed these partial amputations and applied an external canine limb prosthesis. And these were 24 patients that we had followed out.
The conclusion of the paper was that we did see improved quality of life and that this was something that as an alternative to full amputation or other limb-spared surgical procedures, you could consider a partial amputation. So let’s look at the study.
There were 76 cases that we looked at. They ranged from 9 weeks to 15 years of age, mean and medium were around 4, weight anywhere from 4 pounds all the way up to 155 pounds. You can see here the mean being about 61 and 59 pounds.
[0:38:03] Dog breeds and prosthetics
When it came to the different breeds, all the different breeds, you can see Coonhound, mixed breeds, Beagles, Rottweiler, Basset hounds, South African, I mean it’s – domestic short hair is thrown in there, Border Collies, you name it. It seems like we have performed unfortunately an amputation or partial amputation in these patients or these types of breeds.
Then what we did is we sent out a survey to these owners that had these procedure performed and were in these prostheses for partial amputations. And of those that were able to get back to us, of those 20, and again, it’s challenging even though we’ve had 70 some cases, to always get the surveys back. We got 20 of them back. And that’s a good margin for surveys in our industry. And we could see of those patients, age range was 5 months to 12 years, mean being about 3.8, medium about 1.75. Here, the weight range again, very light, 4 pounds all the way up to 155 pounds with our mean being right around 61, 62.
Of these 20 cases, Golden, Lab, Boxer, Maltese, a mix of 25% Pitts, Border Collie, the South African, English Mastiff, Shiloh Shepherd, Giant Schnauzer, German Shepherd. You can see here, the female to male ratio, how many were altered or spayed or neutered compared to how many were intact.
Reasons for the need for a partial amputation and the prosthesis.
OK. This is something where a cancer unfortunately was 20% of these cases. Trauma was 40% of these cases. Something congenital where they were born with some sort of defect to their limb was 35 cases and some other cause was 5%.
Now, the survey was objective and it was a survey in which we could actually follow the course of outcomes objectively over time following the application of the prostheses. So the first question was, how long did it take your pet to get used to wearing the device?
We had a few that just never got used to the device, a bunch that were absolutely immediately. You could see some were one week, less for two weeks, less for three weeks, less for 16 weeks. OK. So it varies. And that’s something that comes with the education to the client that we are not just going to put this on. The dog is going to absolutely get used to it and say, “Hey, let’s go for a hike.”
[0:40:33] How do dogs use a prosthetic?
Some of these dogs, it’s going to take some time and some will never get used to it. They just would not accept it, and that’s important to realize because you’re placing your patient or your canine companion through this procedure and you’re going through the whole modeling device, the cascade of events that needs to occur in order to get the prosthesis sent back to you and applied and there’s going to be a situation where certain ones just don’t tolerate. But it’s always worth the try for those that you feel would be a good candidate.
What activities could your pet do once they got used to wearing the prosthetic? Could they stand? 90%. Or could they walk? 90%. Did they trot? 85%. Could they climb stairs? 75%. Jump on and off the furniture? Not something I would probably recommend but they were doing it 65% and play fetch was actually 85% of these dogs once they were in a prosthetic.
[0:41:26] Does the prosthetic fit?
How well do the prosthetic fit? Poorly in a few. Less than satisfactory, acceptable. Easy, good. Excellent were the majority. OK? But those that were poorly or less than satisfactory, again, it’s something where did we lose muscle mass? Did we not have a proper cast molding to begin? Or did something shift? Need more padding? So there are all these things that we need to consider for those that just weren’t doing what we needed them to do.
Did the prosthetic slip? Yes, often in some of these cases, sometimes. No, very occasionally. And the nos again were the majority. But again, something that we need to make sure, was it a fabrication issue? Was it a padding issue? Do we lose muscle mass? Stay on top of that and see if we can improve it.
After your pet got used to using the prosthetic, how will did your pet move in comparison to before? A fewer, worse. Some just could not get used to it. A few were no different. And actually, you see these that were improved following the use of the prosthesis.
[0:42:27] Did the pet prosthetic meet expectations?
Did the device break? There were ones that broke. OK. This could be something with the fabrication, or could be something where the dog dig jump off a bed and the bed was a very high bed. It could be something where he got caught on something like a piece of furniture as he was running around in the house. You can see that the majority did not break.
Did the prosthetic meet your mobility expectations? Majority were yes. You can some were no and some were somewhat.
What were challenges met? You can see the highest one was the prosthetic is slipping often. OK. So it’s important that you maintain it, that you check that the straps are adjusted, that it’s fitting, that the padding isn’t shifting, that it’s adequately padded, that we haven’t lost muscle mass. Refusing to use the limb you can see in some of these. The prosthetic breaking in some of these as well.
[0:43:19] Rating quality of life for amputee pets with prosthetics
How would you rate your pet’s quality of life before versus after prosthetic placement? You can see one, much worse than before, you can five, all the way up to much better than before. So the average right there in the center, you can see were somewhere between much worse and much better. But we had quite a few that were much better than before as well. Again, there are always going to be some, a few case that you can see here, that just weren’t able to get used to the device.
[0:43:51] Amputation for a Great Dane family member
Now, what about when it hits home? OK. What do I mean by that? As an orthopedic surgeon and someone boarded in sports medicine and rehab, I see these cases commonly. We perform this procedure commonly, we get referrals from other surgeons around the country because it’s a bit challenging and something that they may not have been trained in or feel comfortable with the entire process. So while I’m used to dealing with this from a surgical standpoint, from a client education standpoint, from a veterinary education standpoint, it’s another thing when it hits home to one of your family members.
Well, meet Armani, he is awesome. Armani is my daughter’s Allyson’s Great Dane and she has had many Great Danes. And Armani is just one of the coolest dogs, running, jumping, playing, nothing stops this dog. We go hiking. He goes kayaking. And all of a sudden one day, Ally called me. She said, “I just woke up this morning and it looks like the area around his hock or his ankle is swollen and it wasn’t like that last night.”
A lump appeared from nowhere.
And so I was like, “Really?” I’m like, “Did he slip or fall or spider bite or dog fight or did he get his leg caught on something?” All the things we think about. “No, none of those happened. He was with me, went for a walk after dinner. Went to bed. Woke up this morning and that’s how I found him.” And he has a huge dog bed and the giant breeds as we all know, they like to crawl up into little ball and they just kind of chill for a while.
Well, I said, “Well, go ahead. Bring Armani straight into work.” And Ally works with me. She is actually my coordinator, my surgical coordinator and helps to Canapp Sports Medicine. She brought Armani into the clinic and we took radiographs right away after we palpitated and it was swollen. It was uncomfortable, firm to the touch.
[0:45:35] Osteosarcoma in a Great Dane
And you can see her on the x-rays, what we are looking at is that there are changes to the bones. So if we look higher up the x-rays of the tibia, this is the lower bones, the knees up higher in the x-ray. You could see how smooth the bone margin is and all of a sudden when we get down to the next joint space which is the ankle or the hock, the bone is very remodeled. We would call some areas inside here a bit lytic. It means it looks like a moth was there kind of chewing at it, a thing called periosteal reaction. So we can see all these changes in the bone surrounding that area.
What’s happening here is the cancer cells are starting to break down the bone. The healthy cells are trying to lay down new bone and trying to fight the battle. And so, the osteoclast unfortunately, the ones that turn bone over and break it down are winning the battle compared to the osteoblast. We start to see the bone get larger from our modeling and proliferation but also getting holes within it in areas that we call lytic or lysis. You can see that in the opposite x-ray over here. That was a side view to the left. To the right is a front view. And you can see darker areas in here, that’s what we call lysis or areas where we’re actually losing bone.
How much limb can we spare for a prosthesis?
We went ahead and performed a partial amputation on Armani. He is a huge Great Dane and we wanted to see if we could go ahead, spare the remainder of the limb, and even consider a prosthesis for Armani if we felt it was going to be something that would be into his benefit. Now, luckily, his forelimbs are solid. His other hindlimb is solid. No arthritis, CCL injury, or challenge with any kind of breakdown. And this was very acute. We caught this very early.
This is the x-ray as you can see right after the procedure. There was the stump. You can see this is the knee, that’s above, that’s the joint. And then you can see all the way down where we’ve actually made the cut in the bone and the soft tissues that surround it. Then you can see six months after the amputation, you can see everything has remained the same. We see no changes to the bone. OK? When we do the amputation, we did have clean margins which was very, very important. Chest was clear as well.
This is Armani. This is right after the amputation.
We used this thing called an Ioban. It’s like a – it’s a sticky type drape material that sticks to the skin. So there’s a bandage down underneath it, adding a little compression and then it’s held in place by Ioban.
The problem that we run into with many dogs, when you place an actual bandage on the leg, it falls off. It can slip, it can slide, it can turn. So trying to get something to stick there, the Ioban Drape does a really nice job of that. So if you’re going to have this procedure performed by your veterinarian, just mention this and feel free to share this talk or this slide with them.
Six months after Armani’s osteosarcoma amputation
Here is Armani. This is six months after the amputation. Armani was in chemotherapy with an oncologist but you can see there, the stump, we still maintain very, very nice muscle mass. You can see the quads. You can see the hamstrings, even the distal stump area still has nice muscle mass. And again, we placed Armani on MYOS as well as the other supplements straight away after this procedure. Armani was actually on the joint supplements since he was a pup but the MYOS we just started at the time in this condition.
We just this past week took Armani camping and celebrated Armani’s 9th birthday. Now, this was one year post amputation. OK? No sign of changes in the chest, or changes radiographically at the site of the amputation or the stump. And Armani is still super duper happy, healthy Great Dane who just loves life. You can see him here running on the beach. This was camping just this past weekend. Yes, it was 27 degrees at night. We are on tents. Armani wasn’t so happy about that. But just being out there, hiking, running in the sand, he doesn’t know that he has three legs.
[0:49:40] Why do a partial amputation for dogs with osteosarcoma?
What you’re going to see though is he is using that other leg to balance. So a lot of veterinarians or surgeons may do a full limb amputation and not consider a partial. Even if you don’t plan on placing a prosthetic on, by doing the partial, it helps them with weight balance. He uses that to sit on, to balance when he is running, when he is playing. You will see his stump actually move. He is using it just like he still has the full limb and it really does help him with coordination and function. So absolutely partial amputation whether using a prosthesis or not I would recommend.
[0:50:14] Paw Wave Massage Therapy benefits for animal amputees
Now, we talked about supplements, we talked about MYOS for muscle mass. What else can you do to keep your dog, your tripawd comfortable? Well, there’s a new device that’s just coming out that’s by PAW WAVE, and this is a massage therapy one specifically made for dogs. And there are different types of heads, depending on if you are using for the back or for the shoulder. This particular thing, we are trying to keep this area comfortable. Why? Because they will get trigger points, they will get spasms. Again, we are trying to maintain the muscle mass and function.
You can see we want to keep those muscles comfortable.
We want to keep them relaxed. And so, this is a great device not only if your dog has had an amputation, just if you have a dog in general. Think about it. So we go to get massages. We use massage guns and massage therapy ones, they really appreciate as well. You can see he is moving his leg saying, “Hey, I want some more of that.” And so, they tolerate it quite well. There are different heads that go in this device for different areas of the body. But you can see Armani is just sitting here chilling. We’ve even use it on our cat. And so, once they get used to the sound and they feel like, “Oh man, I really, really enjoy this.”
Especially with the dogs that have had the amputations, we are trying to keep muscles functioning, comfortable, reducing trigger points, spasms, really something that we want to consider. So if you haven’t seen this before, this is something that is just launching. He is reaching out, asking for more. This is something that’s just about to launch. It’s by company called PAW WAVE. It is a pet massager. There are all these different types of device heads that are there for different size and shapes of dogs on different locations of their body. So stay tuned for that.
[0:52:02] Meet Canapp Sports Medicine
You can go to our CanappSportsMed.com page where we have pet products, everything from supplements to other types of devices, the dog beds, you name it. These are products that we believe, that have been tested and proven that there was data that we use not only for our patients but also for our own dogs. But this will be launching and you can watch the company is just creating their website. This is a human company that’s one of the leaders in the field of this type of technology for humans and they are launching these for dogs. And we’ve been able to beta test these in dogs and cats and different areas of their body. I’m really excited about this product coming out.
[0:52:44] Conclusion: Prosthetics are an option for dogs who need amputation
So in conclusion, external self-suspension prosthesis may be considered as viable option for dogs requiring a distal limb amputation. Also, if your dogs had a full forelimb amputation, you saw now with 3D printing, we are able to actually make a full forelimb amputation device or prosthesis for these dogs to now ambulate.
It requires careful patient and client selection, OK? This wasn’t a silver bullet. We don’t just do the procedure and hand you this device and say, “Put it on and go for a hike.” OK? It’s really a dedicated team approach between your veterinarian, your surgeon, your rehab therapist, your orthotist, all those people together, and of course you play the most important part as the owner. And so, when it comes to this, I think it’s absolutely something that we need to sit down and say, “Hey, the partial amputation even if we don’t use the prosthesis, they can use the rest of that extremity to help to sit, to lay, to balance, to roll over, when running and hiking, they still have it there to help them kind of support the rest of their body and support the entire chain.
Pet prosthetics owner satisfaction is high
Looking at our retrospective study, these were dogs that had that prosthesis on for quite a bit of time and you can see that statistically significantly, owners were satisfied and we didn’t see a significant amount of complications. But there has always going to be some. There are going to be soft tissue wounds. There’s going to be issues where it slips or slides. There are going to be issues where sometimes the little device starts to bend or break on you and you have to make some modifications, but that’s to be expected.
For questions regarding these types of techniques or devices that are out there, please feel free to reach out to Alyse Carter. She is my Research and Development Coordinator through our translational medicine company, Orthobiologic Innovations.
[0:54:40] Contact Canapp Sports Medicine for a Prosthetic and Animal Orthopedics Consultation
If you are interested in anything regarding telemedicine, teleeducation, products that we talked about, feel free to go to CanappSportsMed.com. So for this, we do telemedicine for owners. We do telemedicine for veterinarians. Say, you have a challenging situation, you’re a vet and you want to run a case by us or you need help with a procedure, we actually have software. We can actually do the procedure with you whether it’s a surgery, rehab, ultrasound, you name it.
For owners, you may have a dog that has a challenging condition and you really want to learn more about what your options are or your vet hasn’t been able to figure it out but you have a lot of diagnostics or you want to know which diagnostics you should have or you want to see if you can find somewhere in your area of the world someone that can help you with your canine’s condition or problems. So feel free to go Canapp Sports Med and reach out.
With that, we have additional educational papers. We have videos. The products that we talked about, the different supplements as well as others are there. And there is a discount on these products as well. We really try to keep the prices down so that you guys can afford to actually utilize these types of products for your canine and feline companions.
Reach out to Canapp Sports Med for more information about pet prosthetics
We have a wall of fame. These are some of the dogs that have had procedures from around the world that have gotten back to their sports and the fun things that they do. And we are about to include a concierge service with this as well. You can see our coordinator, Ally, and that was her Great Dane that we looked at. That’s our daughter, Ally. And feel free to reach out to her for any of these types of things.
On behalf of the VOSM and Pathway Vet Alliance and Orthobio and Canapp Sports Med and Project GO, we thank you and hope that this was helpful, educational, and may bring some insight as to things that you can do to help your tripawd. Thank you so much. Stay safe and stay well.
Many thanks to Dr. Canapp for letting us share this valuable information. Learn more about Dr. Canapps’ work at VOSM.com and tune in to part 2 of this webinar for our live Q&A session with answers to questions about Tripawds and prosthetics, how to care for our 3-legged friends. Find many more videos and veterinarian interviews about prosthetics for 3-legged dogs and cats at Tripawds.com.
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GOT QUESTIONS? SEE PART TWO:
Pet Prosthetics and Braces Questions and Answers
Get a Veterinary Orthopedic and Prosthetics Video Consultation with Canapp Sports Medicine
If you are thinking about a prosthetic for your Tripawd, please don’t do anything until you meet with an orthopedic veterinarian with experience in pet prosthetics. Better yet, talk to Drs. Canapp yourself! This dynamic duo offer remote consultation to pet parents on issues related to musculoskeletal injuries, lameness, undiagnosed orthopedic conditions, performance related issues, early identification and prevention. Learn more at Canapp Sports Medicine.
About Debra Canapp, DVM, CCRT, DACVSMR
Dr. Debra Canapp is your go-to doc for canine sports-related injury, sport rehabilitation and performance. Her formal bio is here, but in short, she’s a gifted veterinarian who is also certified in canine rehabilitation, traditional Chinese veterinary medicine and acupuncture, stem cell therapy and ultrasound-guided regenerative medicine injections. She also lectures vets on the subjects of orthopedic injuries in the sporting/working dog and the current rehabilitation techniques used to treat them.
Meet Dr. Sherman Canapp, DVM, MS, CCRT, DACVS, DACVSMR
Dr. Sherman Canapp has a mighty impressive background in his chosen field, which you can read about here. To sum it up, Dr. Canapp is the co-founder of the Veterinary Orthopedic & Sports Medicine Group (VOSM) in Annapolis Junction, MD. Dr. Canapp routinely receives referrals for sports related injuries, arthroscopic procedures and regenerative medicine treatments from domestic and international sources. Dr. Canapp’s primary caseload is performance, sporting and working dogs.