Retrospective Study on External Canine Limb Prosthesis used in 24 patients

Abstract

Objective: The purpose of this retrospective study is to provide data regarding external prosthetic use in small animal patients, evaluate the common complications associated with external prosthetics, and evaluate the outcome of patients using an external prosthetic.

Background: The use of external canine limb prosthetics is relatively uncommon in veterinary medicine today.  However, there is growing interest in prosthetics and their clinical application because these devices may offer an alternative to euthanasia in severe cases where full amputation or alternative methods of limb spare are not an option. The goal of the prosthesis is to provide a better quality of life, help prevent further deformation and degeneration of existing joints, decrease leg length discrepancies, increase exercise and activity levels, provide a means to participate in rehabilitation therapy and maintain the ability to perform daily acts of living. To the author’s knowledge, there is no report of external prosthetic use in small animal veterinary medicine, providing the profession with baseline information for use in, not only general practice or referral practice, but also future research.

Evidentiary value: This retrospective study provides data regarding external prosthetic use in small animal patients, evaluates the procedures, manufacturing, rehabilitation and common complications associated with external prosthetics, and evaluates the factors that determine a patient’s prosthetic candidacy.

Methods: Patients that had an external prosthesis custom manufactured for them at Animal Orthocare, LLC and had a complete medical record were identified for this study.  A client survey was completed via e-mail or telephone to collect further data about the patients, including age, weight, breed, sex, affected limb(s), reason for prosthesis, level of amputation, activities patient could perform with prosthesis in place, prosthetic fit, prosthetic migration (e.g. rotating or slippage), quality of mobility comparing pre-prosthetic mobility to post-prosthetic mobility, prosthetic integrity, client’s post-prosthetic mobility expectations, complications encountered post-prosthetic application, and client’s perspective of patient’s quality of life comparing pre-prosthetic and post-prosthetic placement. 

Results: Of the 76 patients who were identified for this study and received a survey, survey information was obtained for 24 patients. There were 50% (n=12) forelimbs affected and 50% (n=12) hind limbs affected. Bilateral hind limb prosthesis was found in 8.33% (n=2) of the 24 cases included. Causes for the prosthesis were found to be due to trauma in 37.5% (n=9) of cases, congenital causes in 37.5% (n=9) of cases, neoplasia in 16.66% (n=4) of cases, infectious in 4.17% (n=1) of cases, and unknown in 4.17% (n=1) of cases. Of the 24 patients, 50% (n=12) of clients felt the prosthesis had an excellent fit; 20.83% (n=5) felt the prosthesis had a good fit; 16.67% (n=4) felt the prosthesis had an acceptable fit; 4.17% (n=1) felt the prosthesis had a less than satisfactory fit; lastly, 8.33% (n=2) felt the prosthetic had a poor fit. Of the 24 patients, 91.66% (n=22) were able to stand using the prosthesis; 87.5% (n=21) were able to walk using the prosthesis; 79.17% (n=19) were able to trot using the prosthesis; 70.83% (n=17) were able to climb stairs using the prosthesis; 54.17% (n=13) were able to jump on or off furniture using the prosthesis; 79.17% (n=19) were able to play fetch using the prosthesis.  From these cases, 50% (n=12) of clients felt the patient’s mobility improved post-prosthetic placement. Expectations were met in 70.83% (n=17) of cases; expectations were somewhat met in 4.17% (n=1) of cases; expectations were not met in 25% (n=6) of cases.  Prosthetic migration affected 37.5% (n=9) of cases; residuum sore or infection affected 20.83% (n=5); refusal to use the prosthetic limb occurred in 20.83% (n=5) of cases; concurrent orthopedic disease occurred in 0% of patients; prosthetic failure (breaking) occurred in 20.83% (n=5) of cases. Finally, clients were asked to rate the quality of life of patients after prosthetic placement when compared to pre-prosthetic placement on a scale of 1 – 5 (1 = much worse than before, 5 = much better than before). Patients rated a quality of life of 5 were 20.83% (n=5); a rating of 4 was given to 20.83% (n=5); a rating of 3 was given to 45.83% (n=11); a rating of 2 was given to 4.17% (n=1); a rating of 1 was given to 8.33% (n=2). 

Conclusion: External prosthetics may help improve quality of life and should be considered as an alternative to euthanasia where full amputation or alternative methods of limb spare are not an option.

Application: These results should be considered by veterinarians and prosthetists when searching for an alternative to full amputation or other limb spare surgical methods.