284 Canine Sports Medicine and Rehabilitation
balance, gaiting at different speeds, and ambula
tion over varied terrain. Sensations transmitted
through the device to the skeleton retrain the nerv
ous system; this is called integration, and is critical
to the best outcomes.
Given the consequences of limb loss in the
short and long term it seems appropriate to con-
template before we amputate an entire limb when
only the distal segment is beyond salvage.
Example indications for a prosthesis include
neoplasia, trauma, ectrodactyly, and partial
agenesis. Preservation of at least 50% of the
radius/ulna or tibia/fibula allows application
of a socket‐based prosthetic limb or intraosse
ous transcutaneous amputation prosthesis
(ITAP) in dogs, cats, and other species. Subtotal
amputation is possible at nearly every level of
distal joint as well as distal trans‐tibial and
trans‐radial levels. The basic tenet is to preserve
as much limb as possible while providing a ten
sion‐free closure of the remaining tissues. The
ideal level of amputation for each injury, the
best techniques, and the advantages/disadvan
tages of each level are still being defined.
Considerations for patient and client
selection
Most dogs adapt well to the use of a prosthetic
limb. Although temperment is important, the
use of a prosthetic limb typically does not
require an extraordinarily tolerant animal. The
ability to sit quietly while the limb is checked
and for prosthetic limb donning and doffing is
usually a simple matter of training. Just like
human beings with prosthetic limbs, orientating
to the prosthetic limb, learning to walk properly
with the limb, as well as learning to navigate the
environment are all accelerated with the help of
a certified rehabilitation therapist.
Once fitted and properly adjusted, use of a
prosthetic limb is relatively easy; at the same
time, commitment to lifelong care of the resid
uum and the prosthetic limb is imperative. Like
any animal with a chronic health issue, disabled
animals require daily attention and mainte
nance. Marcellin‐Little et al. (2015) noted that
client‐related contraindications of prosthesis use
include a potential lack of interest, motivation,
supervision, or financial ability. Some important
issues to consider are:
(1) Client tolerance for financial commitment.
At the time of writing, typical initial costs
associated with this treatment plan are
comparable with costs associated with
common orthopedic surgeries. Lifetime
expenses to consider include:
(a) Anesthesia, surgery, and postopera
tive care if subtotal amputation or
revision surgery is required.
(b) Consultation appointment with V‐OP
provider (licensed veterinarian) to
include assessment, treatment plan,
device prescription, limb impression,
or scan.
(c) Device: some patients may require
more than one device in their lifetime
(e.g., puppies).
(d) Fitting, follow‐up, and adjustment
appointments with V‐OP provider
(varies by case).
(e) Professional rehabilitation.
(f) Annual to biannual fit and function
appointments.
(g) Maintenance and repair.
(2) Client tolerance for time commitment:
(a) The residual limb must be checked
daily for skin irritation or breakdown.
(b) A wearing schedule is established for
each patient based on individual tol
erances. This schedule should be
meticulously followed and the device
should never be left on for more than
12 hours without a significant break
(consecutive hours tolerated in the
device will vary among individuals);
overnight wear is not appropriate.
(c) Suitable activity while wearing the
prosthetic limb is established over
time; most dogs are able to resume a
considerably more active lifestyle
than a tripedal dog.
(d) The prosthetic limb must be kept
clean and in good working order at
all times. The prosthetic patient needs
regular health care including at least
twice‐annual check‐ups specific to
the device itself.
(e) Rehabilitation and V‐OP follow‐up
appointments are required.A prosthetic limb is not for every dog or
every client. Frequently, the limiting factors are