Topics in Companion An Med 33 (2018) 89 96

Research Article

Postamputation Orthopedic Surgery in Canine Amputees: Owner Satisfaction

and Outcome
Elena T. Contreras, DVM, MS*, Deanna R. Worley, DVM, DACVS-SA,
Ross H. Palmer, DVM, MS, DACVS,
Felix M. Duerr, Dr. med. vet., MS, DACVS-SA, DECVS, DACVSMR

Keywords: A B S T R A C T
Amputation
amputee Surgical management of postamputation orthopedic disease (PAOD) in canine amputees has rarely been docu-
cranial cruciate ligament
mented, and no reports describing outcome of stifle surgery in canine amputees are available. The objective of
dog
this multisite retrospective case series was to describe cases and evaluate satisfaction with and outcome of post-
orthopedic disease
stifle surgery amputation orthopedic surgery in canine amputees. Data was obtained through medical records and owner sur-
vey responses; data included signalment, amputation cause, diagnosis, surgical treatment, timeframes, and
outcome assessment. Outcome was categorized as acceptable or unacceptable, and complications were classi-
Department of Clinical Sciences, College of
fied as catastrophic, major, or minor. Eleven thoracic limb amputees and 6 pelvic limb amputees with surgically
Veterinary Medicine, Colorado State University,
300 West Drake Road, Fort Collins, CO 80523,
treated PAOD were identified. Surgically treated PAOD was reported at a median of 9.7 months (range 0.5-110
United States months) after amputation. All 17 amputees were treated for pelvic limb disease, predominantly for cranial cru-
ciate ligament disease that occurred in 11 of 17 dogs. Major complications following orthopedic surgeries per-
formed in 3 thoracic limb amputees consisted of infection (n = 2) and uncontrolled pain (n = 1). No major
complications were reported following orthopedic surgeries performed in pelvic limb amputees. Acceptable
mid-to-long-term outcome was achieved in 16 of the 17 canine amputees. Surgical treatment of pelvic limb dis-
ease did not appear to be associated with a high number of major complications in this case series. These find-
ings suggest that orthopedic surgery, specifically stifle surgery, in canine amputees might be considered a
feasible treatment option. Although there are inherent methodological limitations of retrospective studies and
owner surveys, our case series provides new information that might help guide surgical treatment decisions in
canine amputees suffering from orthopedic disease. Prospective studies using objective outcome measures eval-
uating surgical management of PAOD are necessary to confirm the provided information.
© 2018 Elsevier Inc. All rights reserved.

Introduction joint (n = 10) or shoulder joint (n = 1).15-17 Orthopedic surgery to treat

Canine limb amputation is a commonly performed surgical proce-
dure in small animal practices; indications for amputation include treat-
ment of neoplastic tumors, severe trauma resulting in untreatable
neurologic or orthopedic injury, congenital deformity, osteomyelitis, or
unmanageable lameness.1,2 Literature regarding canine amputation has
focused mostly on oncologic outcome, owner satisfaction postamputa-
tion, and biomechanical compensation mechanisms.1-6
The changes attributable to tripedal locomotion include alterations
in the center of gravity, redistribution of weight, joint range of motion,
stride, and stance duration, and increased forces on the remaining
limbs.4,5,7-9 Although it is unknown whether these biomechanical com-
pensation mechanisms contribute to later musculoskeletal or joint
pathology, canine amputees might face future orthopedic disease in the
remaining limbs, since many quadrupedal canines suffer from orthope-
dic disease as well.10-12 Some of these orthopedic diseases might neces-
sitate orthopedic surgery as the treatment of choice.13,14
Surgical treatment of orthopedic disease in canine amputees has
only been described in 3 reports, totaling 11 cases; all cases described
surgical management of joint luxations in either the coxofemoral
stifle pathology in canine amputees has not been reported in the liter-
ature, even though cranial cruciate ligament disease (CCLD) is one of
the most common canine orthopedic diseases, and it is regularly
treated surgically.10,13,14 There is clearly a knowledge gap regarding
surgical management of orthopedic diseases other than luxations in
canine amputees. Stifle disease and surgery, in particular, warrant
consideration in the literature.
Pet owners often experience initial trepidation and reluctance sur-
rounding amputation of their canine’s limb.1-3,18 Owners might similarly
experience apprehension regarding postamputation orthopedic surgery
in a canine already compromised by tripedal locomotion. Without
objective data regarding outcome and owner satisfaction with specific
orthopedic surgeries postamputation, veterinarians are unable to pro-
vide owners with accurate information to help with informed decision-
making. Documenting outcome of and owner satisfaction with a num-
ber of postamputation orthopedic surgeries is necessary for both own-
ers and veterinarians to better guide decisions concerning these
treatment modalities in canine amputees. The objective of this study
was to document cases of postamputation orthopedic surgery in canines
and evaluate owner satisfaction and outcome.

* Corresponding author. Materials and Methods

E-mail address: elena.contreras@colostate.edu (E.T. Contreras).
Abbreviations: CCLD, cranial cruciate ligament disease; CSU VTH, Colorado State Case Identification
University Veterinary Teaching Hospital; FHO, femoral head and neck ostectomy;
PAOD, post-amputation orthopedic disease; PLA, pelvic limb amputee; TLA, thoracic
limb amputee; TPLO, tibial plateau leveling osteotomy Cases of canine amputees that underwent postamputation ortho-
pedic surgery were identified by 2 methods. First, a short online

http://dx.doi.org/10.1053/j.tcam.2018.07.001
1938-9736/© 2018 Elsevier Inc. All rights reserved.
90 E.T. Contreras et al. / Topics in Companion An Med 33 (2018) 89 96
questionnaire (http://www.surveymonkey.com) requesting volun-
tary reporting by owners of canine amputees, was publicized online
for 46 days by a community support forum website for owners of
canine amputees (http://tripawds.com). The online survey consisted
of 8 short, closed and multipart open questions (Appendix A. Supple-
ment 1), and willing owners were then contacted individually for
access to medical records and additional information including
canine age at amputation, date of subsequent orthopedic surgery,
owner satisfaction with surgery, and inclination to recommend the
postamputation surgery to others (Appendix B. Supplement 1).
Second, the Colorado State University Veterinary Teaching Hospi-
tal (CSU VTH) database was queried for records of canine amputees
that had a subsequent diagnosis, finding, or procedure containing any
of the following key words or abbreviations: elbow, carpal, shoulder,
patella, trochleoplasty, total hip replacement (THR), femoral head
and neck ostectomy (FHO), tibial plateau leveling osteotomy (TPLO),
tibial tuberosity advancement, cranial cruciate ligament, cruciate,
arthrodesis, meniscectomy, luxation, or fracture between 1/1/2000
and 12/31/2013. Only canines that underwent orthopedic surgery fol-
lowing limb amputation were included.
Data Retrieval
Case and outcome information was collected via a combination of
medical record review and radiograph review if available, owner
responses to the questionnaires (Appendices A and B), and email cor-
respondence between the primary investigator and those owners.
Data retrieved included the following: patient signalment, age at and
reason for amputation, amputated limb, medical diagnoses, age at
time of surgically treated postamputation orthopedic disease (PAOD),
timeframe between amputation and surgically-treated PAOD diagno-
sis, body weight, surgical procedure(s) performed, the training level
of the veterinarian performing postamputation orthopedic surgery,
type of veterinary facility providing medical records, other treatment
(s), and assessment of recovery, rehabilitation, complications, and
outcome as outlined below. From the survey questionnaire, owner
satisfaction with the surgery and owner-reported inclination to rec-
ommend surgery to other owners of canine amputees with similar
orthopedic disease, were also recorded. Dogs were categorized as a
thoracic limb amputee (TLA) or pelvic limb amputee (PLA).
Patient age at amputation was recorded as 4 months if owner
report and medical records did not specify but indicated amputation
occurred as puppy prior to adoption as a young dog, whereas it was
recorded as 1 year if owner report and medical records did not specify
but indicated amputation occurred as a young dog prior to an adop-
tion as an adult dog. Information from owner reports was verified by
medical records and radiographs when available.
Clinical Outcome
Timeframes of clinical outcomes of orthopedic surgical treatments
following amputations were grouped as perioperative (0-3 months),
short-term (>3-6 months), and mid-to-long-term (>6 months) out-
come data.19 Cases were included if, at minimum, short-term out-
come data were available for evaluation.
For the survey cases, outcome categorizations were based on author
review of medical records from veterinary orthopedic surgery centers
and teaching hospitals, veterinary canine rehabilitation facilities, and
general practitioner veterinarians when available; owner report was
also used as supporting information that included the owner’s open-
ended responses to question numbers 5 and 6 (see Appendix B). For
the CSU VTH cases, outcome categorizations were based on author
review of veterinary teaching hospital medical records only; owner
report, if available, was used as supplementary information. Informa-
tion gathered from the medical records in both survey and CSU VTH
cases included documentation regarding healing progress,
postoperative radiographic review, and assessment of pain, effusion,
range of motion, recovery, and complications.
Subjective clinical outcomes were categorized using a modifica-
tion of a previously reported clinical orthopedic outcome scale 19 that
divided outcome into the categories of full function (i.e., “restoration
to, or maintenance of, full intended level and duration of activities
and performance from preinjury or predisease status without medi-
cation”), acceptable function (i.e., “restoration to, or maintenance of,
intended activities and performance from preinjury or predisease sta-
tus that is limited in level or duration and/or requires medication to
achieve”), and unacceptable function (i.e., “all other outcomes”). 19 To
reduce the potential for differential misclassification due to informa-
tion or interviewer bias, the present study incorporated full function
into the acceptable function category, resulting in the 2 outcome cat-
egories of acceptable and unacceptable.
Complications, if present, were also categorized using the defi-
nitions in Cook et al 2010 19 that divided complications or associ-
ated morbidities into the categories of catastrophic (i.e., “causes
permanent unacceptable function, is directly related to death, or is
cause for euthanasia”), major (i.e., “requires further treatment
based on current standards of care and requires surgical or medical
treatment to resolve based on current standard of care”), and
minor (i.e., “not requiring additional surgical or medical treatment
to resolve”). 19
Statistical Analyses
Descriptive statistics were calculated, and categorical data were
expressed as frequencies, while continuous data were expressed as
medians and ranges.
Results
Case Identification
One hundred twenty-six unique respondents were generated
from the online survey, and 1151 canines that underwent limb
amputations were identified within the CSU VTH database (Fig 1).
Fifteen percent (n = 19) of the 126 canine amputees identified by
survey, and 1% (n = 6) of the 1151 canine amputees identified from
the database, had a reported surgically treated PAOD. One canine
amputee from the survey was excluded due to a diagnosis of
immune-mediated erosive polyarthritis. Of these remaining 24 dogs
meeting the above criteria, a thoracic limb had been amputated in
62.5% (n = 15), and a pelvic limb had been amputated in 37.5%
(n = 9). Short-term outcome data was unavailable for 7 of the 24
dogs; those 7 dogs were therefore excluded from this case series. A
total of 17 dogs (Table 1) consisting of 11 TLAs and 6 PLAs were
included in this study (Fig 1).
Amputations
Amputation was performed at a median age of 9.0 months (range
3.6-103 months). Trauma accounted for 10 of the 17 amputations,
and the median patient age for post-trauma amputation was 5.0
months (range, 4.0-36 months). Neoplasia accounted for 5 of the 17
amputations, and the median age at amputation for these dogs was
74 months (range 39-103 months) (Table 1). Neoplasia type is listed
in Table 1. The other 2 of the 17 dogs had amputations due to a con-
genital defect and osteomyelitis; age at amputation was 3.6 months
and 72 months, respectively.
Diagnosis of Surgically Treated PAOD
Surgically treated PAOD was diagnosed in the 17 dogs at a median
of 9.7 months postamputation (range 0.5-110 months) (Table 1). For
 E.T. Contreras et al. / Topics in Companion An Med 33 (2018) 89 96
Fig 1. Source of amputee data, thoracic or pelvic limb amputee (TLA, PLA), case numbers, surgical joint, surgical procedure, outcome and major complications.
the 10 dogs that had an amputation due to trauma, surgically treated
PAOD was diagnosed at a median of 16 months (range 2.0-110) post-
amputation, and for the 5 dogs that had an amputation due to neopla-
sia, it was diagnosed at a median of 6.0 months (range 0.5-43)
postamputation (Table 1). Surgery was performed within 3 months of
diagnosis for 14 of the 17 amputees; 3 of the 17 amputees (Cases 2, 3,
11) underwent surgery between 3 and 12 months after diagnosis.
CCLD occurred in 11 of the 17 dogs, and 2 of these 11 dogs, also
had concurrent patellar luxations. Patellar luxation without concur-
rent CCLD occurred and was surgically treated in only 1 (Case 11) of
the 17 dogs (Fig 1). Coxofemoral joint diseases were surgically treated
in 5 amputee dogs; 1 of these dogs also underwent surgical treatment
for elbow dysplasia.
Orthopedic Surgical Procedures
All canine amputees (n = 17) included in the study, underwent
pelvic limb surgery, and 1 of the dogs, Case 14, also had a thoracic
limb (elbow) surgery prior to bilateral pelvic limb surgery (Table 2).
Median body weight at surgery was 25 kg (range 6.6-46 kg). Of the 11
TLAs, surgery was performed on the ipsilateral pelvic limb in 4 dogs,
on the contralateral pelvic limb in 3 dogs, and on both limbs via bilat-
eral, staged, pelvic limb surgeries in 4 dogs (Fig 1). All 6 of the PLAs
had contralateral pelvic limb surgery (Fig 1). The 17 amputee dogs,
therefore, underwent a total of 22 postamputation orthopedic surger-
ies. Of the 22 surgeries, 14 were stifle surgeries, which included 2
bilateral, staged, surgeries, and 7 were hip surgeries, which included
2 bilateral surgeries, and 1 was a thoracic limb (elbow) surgery (Fig 1).
Of the 11 amputees with CCLD, TPLO was utilized in 7 amputees,
and 2 of these 7 underwent staged, bilateral, TPLO surgeries, resulting
91
in a total of 9 stifles treated with TPLO surgery (Fig 1). Surgical proce-
dures other than TPLO were used in the other 4 dogs with CCLD, 2 of
which had concurrent CCLD and patellar luxation surgeries within
the same stifle (Fig 1). The 1 TLA with patellar luxation without con-
current CCLD was treated with femoral trochleoplasty and tibial
tuberosity transposition (Fig 1).
Coxofemoral joint luxation was treated with unilateral FHO in 2
amputees, bilateral staged FHO in 2 amputees, and THR in 1 amputee
(Table 2). Elbow dysplasia was surgically treated in 1 TLA that also
subsequently underwent bilateral staged FHOs (Fig 1).
Surgeries were performed by small animal board-certified sur-
geons in 12 of the 17 dogs (Table 2). The surgeons’ advanced training
credentials were unknown for Cases 7 and 9.
Clinical Outcomes and Complications: Overall
Outcome data was recorded at a median of 10 months (range 4-54
months) postoperatively. Fifteen of the 17 amputees had mid-to-
long-term outcome data available for review (Fig 1). Primary outcome
information was derived from orthopedic veterinary specialist or
rehabilitation facilities in 13 of the 17 cases, general practice veteri-
nary clinics in 2 of the cases, and solely from owner report in 2 of the
cases (Table 2). For all cases with both medical records and owner
report, owner reported outcomes agreed with medical record out-
comes.
No catastrophic complications were reported during any of the
periods for any of the amputees. Unacceptable outcomes with major
complications occurred in a total of 3 TLAs (Table 2). Major complica-
tions were due to infection of the surgical limb in 2 of the cases; both
had concurrent osteosarcoma. Uncontrolled pain occurred in the
92 E.T. Contreras et al. / Topics in Companion An Med 33 (2018) 89 96

Table 1
Reason for Amputation, Signalment, Median Age at Amputation, Median Months Between Amputation and PAOD

Median age (months) at Median months between amputation

Reason for amputation MC FS Breed
amputation and surgically treated PAOD
Boxer (n=1)

Great Pyrenees (n=1)

Labrador retriever (n=1)

Trauma (n=10) 8 2 5.0 (range, 4.0 to 36) 16 (range, 2.0 to 110)
Mixed-breed (n=3)

Pit bull terrier-type (n=3)

10 (range, 2.0 to 110)
Toy poodle (n=1)

Congenital (n=1) 0 1 Mixed-breed (n=1) 3.6 5.6

Osteomyelitis (n=1) 0 1 Pit bull terrier (n=1) 72 10

c
Australian cattle dog (n=1)
*Neoplasia
a
Exotic canine (n=1)
a
Osteosarcoma (n=3)
4 1 b
Miniature pinscher (n=1) 74 (range, 39 to 103) 6.0 (range, 0.5 to 43)
b
Soft tissue sarcoma (n=1)
a
Pit bull terrier (n=1)
c
Synovial cell sarcoma (n=1)
a
Rottweiler (n=1)

TOTAL TLA (n=11) 6.0 (range, 3.6 to 103) 10 (range, 0.6 to 99)

TOTAL PLA (n=6) 30 (range, 4.0 to 72) 6.1 (range, 0.5 to 110)

TOTAL (n=17) 9.0 (range, 3.6 to 103) 9.7 (range, 0.5 to 110)

__________________________

FS: female spayed

MC: male castrated

*Neoplasia type indicated as: a) osteosarcoma; b) soft tissue sarcoma; c) synovial cell sarcoma

surgical limbs of 1 of the cases; that case had multiple limb surgeries
(Fig 1, Table 2). No major complications nor unacceptable outcomes
were reported for PLAs. Minor complications with acceptable out-
comes occurred in 3 amputees.
Clinical Outcomes—Major Complications: Perioperative Period
Perioperative outcome was acceptable in 15 of the 17 dogs. Cases
14 and 17 had major perioperative complications with unacceptable
perioperative outcomes (Table 2). One major perioperative complica-
tion occurred in Case 17, a Rottweiler TLA that experienced septic
arthritis after TPLO surgery on the ipsilateral pelvic limb. This dog
had had a previous CCLD extracapsular repair on the same pelvic
limb 3 years prior to the thoracic limb amputation. Several days after
thoracic limb amputation for osteosarcoma, the previous extracapsu-
lar repair on the ipsilateral pelvic limb failed. The ipsilateral stifle was
then treated with TPLO surgery, after which the dog received chemo-
therapy for osteosarcoma; septic arthritis subsequently occurred and
resolved with medical management. The dog was euthanized for sus-
pected lung metastasis 5 months after the TPLO surgery. The other
major perioperative complication occurred in Case 14, a mixed-breed
TLA that experienced uncontrolled pain at the surgical sites after
elbow arthrotomy for medial coronoid process fragment removal and
biceps ulnar release, and after an FHO performed on the contralateral
pelvic limb one month after the elbow surgery.
continued uncontrolled pain despite multimodal analgesic strategies
(Fig 1). This dog continued to present for pain up to 4 months after
both the elbow and contralateral FHO surgeries; he was also diag-
nosed with panosteitis during the postoperative period. The dog also
had an FHO performed on the ipsilateral pelvic limb 2 years after the
initial FHO; no major complications were reported by the owner after
the ipsilateral FHO.
Clinical Outcomes—Major Complications: Mid-to-Long-Term Period
Mid-to-long-term outcome was acceptable in 16 of the 17 ampu-
tee dogs (Fig 1, Table 2). The only major long-term complication and
unacceptable outcome occurred in Case 16, an American pit bull ter-
rier TLA that experienced a TPLO site infection 1 year after TPLO sur-
gery on the ipsilateral pelvic limb. The infection occurred during
concurrent rupture of the contralateral cranial cruciate ligament. The
ipsilateral TPLO-plate was removed, and a TPLO was performed on
the contralateral limb 2 weeks later. Perioperative and mid-to-long-
term outcome was subsequently acceptable following explant sur-
gery on the ipsilateral limb, and the TPLO on the contralateral limb
had short and long-term acceptable function with no reported com-
plications in CSU VTH medical records (Fig 1, Table 2). The dog was
euthanized due to osteosarcoma metastasis 1 year later.
Clinical Outcomes—Minor Complications

Clinical Outcomes—Major Complications: Short-Term Period
Short-term outcome was acceptable in 16 of the 17 dogs (Table 2).
The only major short-term complication and unacceptable outcome
occurred in Case 14, the same mixed-breed TLA that experienced
Three minor complications with acceptable outcomes were identi-
fied. One minor complication occurred in Case 12, an American pit
bull terrier TLA that experienced pain and lameness at 1 and 5
months after an extracapsular repair for CCLD on the contralateral
pelvic limb; this canine also had hip dysplasia. The pain was managed
 E.T. Contreras et al. / Topics in Companion An Med 33 (2018) 89 96 93

Table 2
Case Number, Breed, Amputated and Surgical Limb, Surgical Procedure, Board Certification of Surgeon, Outcome, Complications, and Source of Outcome Information

Survey Board-
Amputated Surgical Timeframe and Timeframe and Source of
Case or Breed Surgery1 cerfied
Limb Limb Clinical Outcome Complicaons Outcome Informaon
database Surgeon

1. Medical records:
perioperave: acceptable perioperave: none a. orthopedic veterinary surgeon
Mixed breed Pelvic
1 Survey Pelvic Le TPLO yes short: acceptable short: none b. veterinary teaching hospital
(Terrier) Right
mid-to-long: acceptable mid-to-long: none c. primary care veterinarian
2. Owner report

1. Medical records:
perioperave: acceptable perioperave: none a. orthopedic veterinary rehabilitaon facility
Labrador Pelvic
2 Survey Pelvic Le THR no short: acceptable short: none b. emergency and specialty center
Retriever Right
mid-to-long: acceptable mid-to-long: none c. primary pracce veterinarian
2. Owner report

SPBT perioperave: acceptable perioperave: none 1. Medical records:

Pelvic
3 Survey (Staffordshire Pelvic Le TPLO yes short: acceptable short: none a. orthopedic veterinary surgeon
Right
Terrier) mid-to-long: acceptable mid-to-long: none 2. Owner report

1. Medical records:
a. orthopedic veterinary surgeon
Great Pelvic perioperave: acceptable perioperave: none
4 Survey Pelvic Le TPLO yes b. orthopedic veterinary rehabilitaon facility
Pyrenees Right short: acceptable short: minor
at veterinary teaching hospital
2. Owner report

1. Medical records:
perioperave: acceptable perioperave: none
Miniature Pelvic a. veterinary emergency and specialty facility
5 Survey Pelvic Right EC, FT/LI no short: acceptable short: none
Pinscher Le b. primary pracce veterinarian
mid-to-long: acceptable mid-to-long: none
2. Owner report

SPBT
perioperave: acceptable perioperave: none 1. Medical records:
(Staffordshire Thoracic Pelvic
6 Survey TTTA yes short: acceptable short: none a. orthopedic veterinary surgeon
Terrier/ Le Le
mid-to-long: acceptable mid-to-long: none 2. Owner report
Whippet mix)

perioperave: acceptable perioperave: none

Thoracic Pelvic
7 Survey Mixed breed TPLO unknown short: acceptable short: none 1. Owner report
Le Le
mid-to-long: acceptable mid-to-long: none

1. Medical records:
perioperave: acceptable perioperave: none
Mixed breed Thoracic Pelvic a. veterinary specialty facility
8 Survey FHO yes short: acceptable short: none
(Chow chow) Le Le b. primary pracce veterinarian
mid-to-long: acceptable mid-to-long: minor
2. Owner report

Bilateral:
perioperave: none
Thoracic Pelvic perioperave: acceptable
9 Survey Toy Poodle FHO unknown short: none 1. Owner report
Le Bilateral short: acceptable
mid-to-long: none
mid-to-long: acceptable

SPBT Bilateral:
perioperave: none 1. Medical records:
(American Pit Thoracic Pelvic perioperave: acceptable
10 Survey TPLO yes short: none a. orthopedic veterinary surgeon
Bull Terrier Le Bilateral short: acceptable
mid-to-long: none 2. Owner report
mix) mid-to-long: acceptable

perioperave: acceptable perioperave: none 1. Medical records:

Thoracic Pelvic
11 Survey Boxer mix FT/TTT yes short: acceptable short: none a. orthopedic veterinary rehabilitaon facility
Le Right
mid-to-long: acceptable mid-to-long: none 2. Owner report

SPBT perioperave: acceptable perioperave: minor 1. Medical records:

Thoracic Pelvic
12 Survey (Pit Bull EC no short: acceptable short: minor a. orthopedic veterinary rehabilitaon facility
Le Right
Terrier mix) mid-to-long: acceptable mid-to-long: none 2. Owner report

perioperave: acceptable perioperave: none 1. Medical records from

Australian Pelvic
13 Database Pelvic Right TTA yes short: acceptable short: none veterinary teaching hospital:
Heeler Le
mid-to-long: acceptable mid-to-long: none radiology, orthopedic surgery, oncology

Le FHO and Le Thoracic:

perioperave: unacceptable
short: unacceptable 1. Medical records from
Pelvic
Mixed breed mid-to-long: acceptable perioperave: major veterinary teaching hospital:
Thoracic Bilateral, FHO,
14 Database (Labrador yes short: major radiology, orthopedic surgery, neurology,
Right Thoracic BURP
Retriever) Right FHO: mid-to-long: none integrave/rehabilitaon medicine
Le
perioperave: acceptable 2. Owner report
short: acceptable
mid-to-long: acceptable

(continued)
94 E.T. Contreras et al. / Topics in Companion An Med 33 (2018) 89 96
Thoracic Pelvic
15 Database Exoc canine FHO
Right Le
SPBT
(American Thoracic Pelvic
16 Database TPLO
Pitbull Right bilateral
Terrier)
Thoracic Pelvic
17 Database Roweiler TPLO
Right Right
medically. Another minor complication occurred in Case 8, a mixed-
breed overweight TLA that experienced decreased range of motion
and muscle mass in the rear limbs 2 years after an FHO on the ipsilat-
eral limb. Review of the radiographs showed a large amount of femo-
ral neck remaining and a bone fragment at the surgical site. A third
minor complication occurred in Case 4, a Great Pyrenees overweight
PLA that experienced delayed healing after a TPLO surgery; the
delayed healing was observed on 3-month postoperative radio-
graphs, but no stifle discomfort nor stifle effusion was appreciated
during the 3-month recheck.
Owner-Reported Overall Satisfaction
All 12 survey respondents were satisfied with the postamputation
orthopedic surgeries and outcome. All respondents stated they would
recommend surgery to other owners of canine amputees with similar
orthopedic diseases. Postoperative rehabilitation and therapy serv-
ices were used in all cases reported here.
Discussion
The present study retrospectively evaluated surgical management
of orthopedic disease following limb amputation in dogs. All amputee
dogs in this study underwent subsequent pelvic limb surgery for
PAOD, and surgical treatment for stifle disease was the most com-
monly performed orthopedic procedure. Overall outcomes were
good, and complications reported were comparable with complica-
tions reported for quadrupeds undergoing similar surgeries.20-26 The
presented data adds a larger number of cases to provide evidence
supporting the feasibility of surgical treatment of PAOD. This is
encouraging for both owners and veterinarians considering orthope-
dic surgery in canine amputees, however, the data must be inter-
preted cautiously given the study design, and prospective studies are
needed to confirm this suggestion.
The over-representation of pelvic limb surgeries as compared to
thoracic limb surgeries in our study could be due to the more trau-
matic and debilitating nature of pelvic limb disease such as cruciate
ligament rupture. Thoracic limb orthopedic disease such as medial
shoulder instability, myofascial issues, chronic spinal neuropathic
pain, or carpal hyperextension might go undiagnosed or under-
reported.27,28 However, traumatic thoracic limb disorders such as
thoracic limb luxations or fractures were also not identified in this
series. The lack of thoracic limb surgeries could therefore be due to
different anatomical musculature affording further protection of the
thoracic limb joints and bones, or potentially better compensation in
the thoracic limbs after the amputation of a limb. Some studies have
found that the coxofemoral and stifle joints and vertebral columns of
perioperave: acceptable perioperave: none 1. Medical records from
yes short: acceptable short: none veterinary teaching hospital:
mid-to-long: acceptable mid-to-long: none oncology, orthopedic surgery, cardiology
Right TPLO:
perioperave: acceptable
short: acceptable
perioperave: none 1. Medical records from
mid-to-long: unacceptable
yes short: none veterinary teaching hospital:
Le TPLO:
mid-to-long: major radiology, orthopedic surgery, oncology
perioperave: acceptable
short: acceptable
mid-to-long: acceptable
1. Medical records from
perioperave: unacceptable perioperave: major veterinary teaching hospital:
yes
short: acceptable short: none radiology, orthopedic surgery, neurology,
oncology
TLAs were susceptible to subsequent increased stress, strain, and bio-
mechanical changes postamputation.4,5 PLAs also might develop
compensation mechanisms that could lead to contralateral pelvic
limb disease.7,8 In studies of dogs with lameness limited to their pel-
vic limb, the dog’s functioning contralateral limb absorbed more
power at the stifle and hock joints, generated more power at the cox-
ofemoral joint, and joint forces were increased vertically and cranio-
caudally.29,30 PLAs have been found to compensate for the loss of a
pelvic limb by placing extra forces on the contralateral limb and thor-
acolumbar region.7,8 Pelvic limb amputation may therefore result in
further increased forces and weight bearing on the contralateral pel-
vic limb, leading to compromised balance, vertebral range of motion
and contralateral pelvic limb instability.4,7 Future prospective studies
might evaluate likelihood and risk factors for postamputation trau-
matic injury in the pelvic limb as compared to the thoracic limb and
as compared to quadrupeds.
TPLO was the most commonly performed orthopedic surgery
following amputation. Complications were similar to those
reported for TPLOs in studies of quadrupedal canines.13,21 Even
with the reported complications, follow-up surgical interventions
yielded acceptable mid-to-long-term outcomes in this case series.
The only TPLO complications (infection) occurred in 2 dogs under-
going treatment for concurrent osteosarcoma; neoplasia and
chemotherapy may have contributed to the complications.31,32
Based on our findings, surgery to correct deficient cranial cruciate
ligament stifles seems a reasonable option for canine amputees.
Although not formally evaluated in this study, postoperative reha-
bilitation and therapy might be another component aiding in suc-
cessful postoperative recovery.
Outcomes following the surgeries localized to the coxofemoral
joint were similar to those reported in other studies of both PLAs and
quadruped canines. THR complications in quadruped dogs have been
reported to be between 10% and 30%, and complications from FHO
surgeries in quadruped dogs can be high.24-26,33-35 A retrospective
case series of THRs performed in 9 PLA dogs indicated good subjective
outcome following THR of the contralateral pelvic limb; however,
complications occurred in 4 dogs, all of whom required revision sur-
gery.16 A clinically successful outcome was also described in a case
report of an FHO performed in a PLA.15 Eventual recovery was
attained for those cases as well as for the dogs in our study.
The 1 thoracic limb (elbow) surgery performed after amputation
in our study was ultimately satisfactory based on owner assess-
ment; however, the dog experienced uncontrolled pain and lame-
ness for 4 months postoperatively. Only 1 other report in the
literature discusses thoracic limb surgery in a TLA.17 The authors
described a successful outcome following surgical management of
shoulder luxation in the remaining thoracic limb; however,
 E.T. Contreras et al. / Topics in Companion An Med 33 (2018) 89 96
multiple surgeries and external coaptation devices were required.17
Considering this limited data on 2 dissimilar cases, generalizations
regarding thoracic limb surgery in canine amputees cannot be
made at this time.
No major complications were reported for PLAs in our study. It
is possible that weight and compensatory mechanisms are more
efficiently distributed in PLAs as compared to TLAs. However, this
discrepancy could also be due to chance and small sample size
(n = 6 PLAs). The major complications in the TLAs might also have
been unrelated to limb amputation and instead related to neoplas-
tic and chemotherapeutic processes, as discussed above, or
complications and outcome could have been related to other pre-
existing conditions.
There were several limitations to this study that must be consid-
ered when extrapolating these results to clinical practice. First, there
are inherent limitations of small retrospective case series.36 Although
evidence obtained from any case series must be interpreted with cau-
tion, information obtained can be helpful, especially considering the
current absence of evidence from prospective, randomized clinical
trials, cohort studies, or case-control studies for this topic.24,37 Even
though our sample size was small, the addition of our cases to the lit-
erature strengthens the existing published case studies to suggest
that postamputation orthopedic surgery might be a reasonable thera-
peutic option to maintain quality of life in affected dogs. Prospective,
larger studies utilizing objective outcome measures are necessary
before definitive conclusions can be made.
Since our objective was to find cases of amputees that underwent
postamputation orthopedic surgery, we did not include a medically
treated PAOD amputee control group, for comparison with the surgi-
cally-treated PAOD amputees. A prospective controlled study might
be considered in the future; such a study could evaluate outcomes
utilizing standardized quality of life assessments38 and gait analysis
in amputees undergoing postamputation orthopedic surgery as com-
pared to amputees choosing medical management alone.
Another limitation of our study was inherent in our case selection
methodology. Survey response bias and recall and selection bias are
limitations of using surveys for case selection.37,39 Our survey was
posted on a canine amputation-focused website and solicited volun-
teer participation from owners of any canine amputee. In order to
reduce self-selection bias, we did not specifically request participa-
tion from amputees which that a PAOD, but rather if the amputee did
not have a PAOD, the survey was ended for the responder. Neverthe-
less, it is possible that owners that had favorable experiences with
their amputees were those who frequented the website and who
would be more willing to answer the survey.39
University database demographic bias is another limitation of our
case selection methods. Cases retrieved from the CSU VTH database
were primarily from neoplasia-related amputation, which could
influence the follow-up timeframe and complications, depending on
neoplasia-related prognoses and treatments. Neoplasia itself might
have also biased our findings. A canine amputee’s prognosis might
depend on reason for amputation, such as neoplasia in a mature dog
vs. trauma in a puppy. And although the timeframe between amputa-
tion and surgically treated PAOD appeared to be numerically different
between those dogs that had an amputation due to trauma as com-
pared to dogs that had an amputation due to neoplasia, the small
sample size of this study and lack of a priori hypotheses precluded
statistical evaluation. This warrants future investigation. Further-
more, the low incidence of surgically treated PAOD reported from the
CSU VTH database was likely because the majority of amputations
performed at the university tertiary care facility were neoplasia-
related; those dogs likely had a shortened lifespan postamputation,
and many likely had primary veterinarians to which the owner and
canine returned for subsequent care.
Very few cases were identified from the public forum and univer-
sity database. One possible explanation is that orthopedic surgeries
95
are infrequently performed on canine amputees. The lack of cases
could also be due to the limited search strategies. Because the overall
number of cases was limited, factors such as breed, amputation cause,
age at amputation, PAOD, age at PAOD, other medical conditions, and
surgical facility varied between amputees. This wide variety of cases
with acceptable outcomes may also add support to the feasibility of
orthopedic surgery in canine amputees.
Estimations of incidence of PAOD in canine amputees cannot be
extrapolated from this study. Our study specifically sought cases of
canine amputees that underwent subsequent orthopedic surgery,
and we did not seek cases of amputees with nonsurgically treated
orthopedic disease. Incidence and timeframe of subsequent orthope-
dic disease with or without surgery in canine amputees compared to
normal quadrupeds or quadrupeds with another orthopedic disease
such as CCLD need further evaluation.
The data that were used to assign outcome category in our case
series also had limitations. The canine amputees and their outcomes
were not directly assessed by the authors, as this was a retrospective
case series; we used medical records documentation and owner
report to obtain information and assign outcome category. Data avail-
ability and accuracy issues and subjective interpretation of the data
could have, therefore, affected our findings. However, postsurgery
evaluations and assessments were documented in the medical
records from 15 of the 17 amputees, and owner reports regarding
acceptable outcome and complications were consistent with medical
records in the survey cases. Owner report was therefore considered
an acceptable measure of outcome for the 2 survey cases without
medical records available for review. Owner perception of quality of
life of a pet is important when choosing treatments and surgical pro-
cedures for the pet. Although owner report is a subjective measure,
owner surveys and questionnaires have been used to evaluate owner
satisfaction and subjectively reported outcome with limb amputation
surgery and orthopedic surgery in canines.1,2,18,33,35,40 Canine limb
amputation is still a procedure that might cause apprehension in
owners, thus surgery postamputation might trigger further hesitance.
Since owners are generally able to identify catastrophic complications
such as implant failures, poor outcome would typically be apparent to
the owner. If owners expressed satisfaction with the procedures per-
formed on their amputee dog, we felt that provided valid supporting
information regarding outcome. Future studies may consider a more
quantitative scoring system using standardized quality of life owner
assessments.38
Although our case series had inherent methodological limitations,
our findings yielded information that begins to fill an existing knowl-
edge void and may be useful in pet owner counseling as well as in the
design of future prospective studies. Future research is needed to
determine if there is a relationship between canine amputation and
subsequent orthopedic disease, including potential factors, forces, or
events such as neurologic, body condition, age, activity level, hor-
monal, genetic, or comorbidities that might predispose an amputee
to develop orthopedic disease. Associations between reason for
amputation and PAOD as well as the temporal relationship of the
development of PAOD also warrant exploration.
Conclusions
This is the first case series describing post-amputation orthopedic
surgery and outcome in both TLAs and PLAs and the first report of
postamputation stifle surgery and outcome in canine amputees. Our
findings suggest that pelvic limb surgery might be a feasible treat-
ment option for both TLAs and PLAs suffering from surgically-treat-
able pelvic limb disease. This new information regarding surgical
management of primarily stifle disease in amputees provides owners
and veterinarians with more information if considering orthopedic
surgery in canine amputees. Further research is indicated to confirm
these suggestions with objective data.
96 E.T. Contreras et al. / Topics in Companion An Med 33 (2018) 89 96
Acknowledgments
The authors would like to thank the following for assistance with
case identification: tripawds.com, the online animal amputee support
community, and Rani Veeramachaneni.
Supplementary materials
Supplementary material associated with this article can be found,
in the online version, at doi:10.1053/j.tcam.2018.07.001.
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