Clinical outcome and complications of thoracic and pelvic limb stump and socket prostheses

Summary

Objectives: To describe the use, quality of life, compliance, complications, and outcome of animals fitted with stump socket prostheses.

Methods: Medical records of dogs fitted with a stump socket prosthesis were reviewed. Functional outcome, quality of life and complications were retrospectively assessed from an owner questionnaire.

Results: Thirteen stump socket prostheses (12 dogs) were fitted for a variety of reasons including trauma, congenital abnormalities, and neoplasia. Eight dogs had a good outcome overall and four a poor outcome. Quality of life (QOL) remained good or excellent in 10/12 dogs. Nine complications were seen in 7/12 dogs, most were manageable; surgical wound complications (n = 2) and pressures sores (n = 4) were the most frequently encountered. One dog suffered multiple complications. Thoracic and pelvic limb stump socket prostheses had a similar complication rate, however all animals with a poor outcome had a thoracic limb stump socket prosthesis; two were small breed dogs (under 10 kg) and two had bilateral thoracic limb abnormalities.

Clinical significance: Stump socket prostheses are feasible and versatile in animals. In correctly selected cases, good to excellent outcomes are possible. However, complications are frequent but often manageable. Further investigations are required into the risk factors for poor outcomes and prospective studies are required to assess changes in biomechanics, function, and QOL before and after fitting of a stump socket prosthesis. Until further evidence is available, careful consideration should be given before fitting bilateral thoracic limb stump socket prostheses or thoracic limb stump socket prostheses to small breed dogs.

Supplementary Material to this article is available online at https://doi.org/10.3415/VCOT-16-09-0127

Keywords

Prostheses - orthotic - partial amputation

• References

• 1 Seguin B, Weigel J. Amputations. In Tobias KM, Johnson AJ. Editors Veterinary Surgery: Small Animal. St.Louis: Elsevier; 2012: 1029-1036.
• 2 Kirpensteijn J, van den Bos R, Endenburg N. Adaptation of dogs to the amputation of a limb and their owners’ satisfaction with the procedure. Vet Rec 1999; 144: 115-118.
• 3 Raske M, McClaran JK, Mariano A. Short-term wound complications and predictive variables for complication after limb amputation in dogs and cats. J Small Anim Pract 2015; 56: 247-252.
• 4 Kirpensteijn J, van den Bos R, van den Brom WE. et al. Ground reaction force analysis of large breed dogs when walking after the amputation of a limb. Vet Rec 2000; 146: 155-159.
• 5 Liptak JM, Dernell WS, Farese JP. et al. Musculoskeletal System. In Kudnig ST. Séguin B, editors. Veterinary Surgical Oncology. Chichester: Wiley; 2012: 491-567.
• 6 Liptak JM, Dernell WS, Ehrhart N. et al. Cortical allograft and endoprosthesis for limb-sparing surgery in dogs with distal radial osteosarcoma: a prospective clinical comparison of two different limb-sparing techniques. Vet Surg 2006; 35: 518-533.
• 7 Buracco P, Morello E, Martano M. et al. Pasteurized tumoral autograft as a novel procedure for limb sparing in the dog. Vet Surg 2002; 31: 525-532.
• 8 Seguin B, Walsh PJ, Mason DR. et al. Use of an ipsilateral vascularized ulnar transposition autograft for limb-sparing surgery of the distal radius in dogs. Vet Surg 2003; 32: 69-79.
• 9 Liptak JM, Pluhar GE, Dernell WS. et al. Limb-sparing surgery in a dog with osteosarcoma of the proximal femur. Vet Surg 2005; 34: 71-77.
• 10 Kuntz CA, Asselin TL, Dernell WS. et al. Limb salvage surgery for osteosarcoma of the proximal humerus: outcome in 17 dogs. Vet Surg 1998; 27: 417-422.
• 11 Coomer A, Farese J, Milner R. et al. Radiation therapy for canine appendicular osteosarcoma. Vet Comp Oncol 2009; 7: 15-27.
• 12 Farese JP, Milner R, Thompson MS. et al. Stereotactic radiosurgery for treatment of osteosarcomas involving the distal portions of the limbs in dogs. J Am Vet Med Assoc 2004; 225: 1567-1572.
• 13 Brånemark R, Berlin Ö, Hagberg K. et al. A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. J Bone Joint 2014; 96: 106-113.
• 14 Drygas KA, Taylor R, Sidebotham CG. Transcutaneous tibial implants: a surgical procedure for restoring ambulation after amputation of the distal aspect of the tibia in a dog. Vet Surg 2008; 37: 322-327.
• 15 Fitzpatrick N, Smith TJ, Pendegrass CJ. et al. Intraosseous transcutaneous amputation prosthesis (ITAP) for limb salvage in 4 dogs. Vet Surg 2011; 40: 909-925.
• 16 DeVasConCellos P, Balla VK, Bose S. et al. Patient specific implants for amputation prostheses: design, manufacture and analysis. Vet Comp Orthop Traumatol 2012; 25: 286-296.
• 17 Ploeg AJ, Lardenoye JW, Vrancken Peeters MPFM. et al. Contemporary series of morbidity and mortality after lower limb amputation. Eur J Vasc Endovasc Surg 2005; 29: 633-637.
• 18 Mavrogenis AF, Pala E, Angelini A. et al. Proximal tibial resections and reconstructions: Clinical outcome of 225 patients. J Surg Oncol 2013; 107: 335-342.
• 19 Renard AJ, Veth RP, Schreuder HWB. et al. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol 2000; 73: 198-205.
• 20 Pollard J, Hamilton GA, Rush SM. et al. Mortality and morbidity after transmetatarsal amputation: retrospective review of 101 cases. J Foot Ankle Surg 2006; 45: 91-97.
• 21 Pezzin LE, Dillingham TR, MacKenzie EJ. et al. Use and satisfaction with prosthetic limb devices and related services. Arch Phys Med Rehabil 2004; 85: 723-729.
• 22 Mich PM. The emerging role of veterinary orthotics and prosthetics (V-OP) in small animal rehabilitation and pain management. Top Companion Anim Med 2014; 29: 10-19.
• 23 Brown DC, Boston R, Coyne JC. et al. A novel approach to the use of animals in studies of pain: validation of the canine brief pain inventory in canine bone cancer. Pain Med 2009; 10: 133-142.
• 24 Yazbek K, Fantoni DT. Validity of a health-related quality-of-life scale for dogs with signs of pain secondary to cancer. J Am Vet Med Assoc 2005; 226: 1354-1358.
• 25 Brown D. Evidence-Based Medicine and Outcomes Assessment. In Tobias KM, Johnson AJ. editors Veterinary Surgery: Small Animal. St. Louis: Elsevier; 2012: Pg.140-145.
• 26 Dickerson VM, Coleman KD, Ogawa M. et al. Outcomes of dogs undergoing limb amputation, owner satisfaction with limb amputation procedures, and owner perceptions regarding postsurgical adaptation: 64 cases (2005-2012). J Am Vet Med Assoc 2015; 247: 786-792.
• 27 Buskirk TD, Stein KD. Telephone vs. mail survey gives different SF-36 quality-of-life scores among cancer survivors. J Clin Epi 2008; 61: 1049-1055.
• 28 Robinson V, Sansam K, Hirst L. et al. Major lower limb amputation - what, why and how to achieve the best results. Orthop Trauma 2010; 24: 276-285.
• 29 Dudek NL, Marks MB, Marshall SC. et al. Dermatologic conditions associated with use of a lower-extremity prosthesis. Arch Phys Med Rehabil 2005; 86: 659-663.
• 30 Salawu A, Middleton C, Gilbertson A. et al. Stump ulcers and continued prosthetic limb use. Prosthet Orthot Int 2006; 30: 279-285.
• 31 Lyon CC, Kulkarni J, Zimerson E. et al. Skin disorders in amputees. J Am Acad Dermatol 2000; 42: 501-507.
• 32 Rosenberg DE, Turner AP, Littman AJ. et al. Body mass index patterns following dysvascular lower extremity amputation. Disabil Rehabil 2013; 35: 1269-1275.