Chapter 11 Veterinary Orthotics and Prosthetics 277where 42 of 44 dogs adapted satisfactorily
to tripedal locomotion. However, 50% of
respondents in this survey stated that they
had serious objections to amputation, but it
was concluded that these objections appeared
to have been based more on emotional grounds
than on rational judgment of facts. In these
reports, any concerns expressed by the clients
were attributed to comparison of the effects of
similar surgery in humans and were seem
ingly attributed to unfounded client anthropo
morphism. In 2015, Dickerson et al. published
a retrospective telephone survey of client‐
perceived recovery from limb amputation,
which was overall good over the time studied.
Their findings correlate with others, indicat
ing that dogs rapidly adjust to tripedal gaiting
(Dickerson et al., 2015).
Despite these studies, questions remain and
over the past two decades tripedal gaiting stud
ies have emerged, with several recent studies
including kinematic evaluation (Kirpensteijn
et al., 2000; Hogy et al., 2013; Jarvis et al., 2013;
Fuchs et al., 2014; Goldner et al., 2015). Inte
restingly, using force plate analysis, Kirpensteijn
et al. objectively investigated tripedal canine
ambulation, finding that control dogs carried
59.8% and 39.2% on the thoracic and pelvic
limbs, respectively, whereas thoracic limb
amputees carry 46.9% of their body mass on the
remaining thoracic limb and 53.1% on the pel
vic limbs. This study supported earlier work
that showed that the thoracic limbs of quadru
peds are most important in braking forces,
whereas the pelvic limbs primarily generate
propulsion (Budsberg et al., 1987; McLaughlin
& Roush, 1995; Lee et al., 1999). In contrast to
the earlier study on client satisfaction, the
Kirpensteijn et al. (2000) force plate study con
cluded that amputation of a limb causes signifi
cant changes in the gait of walking dogs. Kinetic
differences were found to exist for both pelvic
and thoracic limb amputees when compared
with quadrupeds, but were greater in dogs
undergoing thoracic limb amputation; these
findings warrant thorough evaluation. A sig
nificant conclusion was that changes in gait
caused by the amputation of a limb may lead to
an increased incidence of orthopedic disease of
the remaining limbs.
Thirteen years later, Jarvis et al. (2013) and
Abdelhadi et al. (2013) reported similar changes
in mass distribution in two different popula
tions. Although the Abdelhadi et al. (2013)
study simulated thoracic limb lameness (not
amputation) and emphasized that comparisons
should be drawn with caution, their conclu
sions may be relevant. They concluded that the
long‐term effects of load distribution and shift
of the center of mass should be evaluated to
establish prospects for patients with chronic
lameness (or missing limbs). Jarvis et al. (2013)
found that in dogs with a thoracic limb ampu
tation, the vertebral column, carpus, and ipsi
lateral hip and stifle joints showed significant
biomechanical changes compared with normal
quadrupedal dogs. They concluded that altered
motion of the vertebral column may have a
long‐term impact for an amputee because of
increased demands on muscular control and
trunk strength. Further, they noted that gait
alterations and compensatory strategies may
place thoracic amputees at increased risk for
musculoskeletal injury in one of more of the
remaining limbs.
The Jarvis study noted that a higher load was
applied over a longer duration in stance phase
of the gait for the remaining limbs. Cartilage
degradation is presumed to progress faster
with supraphysiological loading during cycli
cal movement, such as walking (Fujisawa et al.,
1999). This study also showed that the remain
ing limb had increased overall carpal joint
range of motion, in particular hyperextension
during stance phase. This change was attrib
uted to increased distribution of body weight to
this limb. Interestingly, the joint kinematics of
the remaining elbow and shoulder remained
relatively unchanged; therefore, the carpus of
the thoracic limb amputee undergoes a signifi
cant increase in stress and strain, which is exac
erbated by increased gait velocity. Lastly, this
study showed that the ipsilateral pelvic limb of
the thoracic limb amputee takes on a dual role
of propulsion and braking and thus may be
more susceptible to acute and chronic injury.
This important, objective work is in stark
contrast to subjective assessment of patient
outcomes. Although amputation is undoubt
edly necessary in some cases, it may be appro
priate to rethink our long‐held paradigms.
Consideration must be given to the data
suggesting thoracic limb amputation is not
benign (Figure 11.10).