OrthoPets Blog

May 2017 OrthoPets Case Study for the Canine Rehabilitation Institute

We love when we are given a challenge to solve an unusual problem and always get excited when we are approached to work with a less common species! In this case it was a Pekin Duck named “Dutchess.” We were approached by her owner to discuss the possibility of fabricating a prosthesis for one of her limbs as she was missing her foot as well as a portion above it.

 

In June 2015, Dutchess was found at the town’s Aquatic Park with other wild ducks. A Good Samaritan brought her to the veterinary hospital that the current owner worked at after noticing she had fishing line wrapped around one of her legs. After further evaluation, it was determined the affected portion of the limb was not viable. A partial limb amputation was performed to save as much limb as possible.

 

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Left: Dutchess’s x-ray. Center: Dutchess on Day 1. Right: Dutchess’s prosthesis.

 

The next morning, they found her standing in her kennel hissing at the staff. At that point, her current owner decided that she would be able to have a better recovery at home as she had a few other ducks that could help motivate her. After several months of bandage changes and restriction, she was able to go out in the pen with the other ducks. In addition, all of the handling during the healing process helped tame her. Dutchess was doing well but her owners now noticed that she was starting to struggle with some normal activities such as grooming and getting around in the winter. Her owner sought out OrthoPets hoping to improve her mobility enough that she could spend some time in the water and have enough balance to groom properly.

When we started the process, there were a few challenges we needed to overcome. The owner had tried to make an impression of the limb, but Dutchess did not want any part in that process. Since sedation was too risky for Dutchess, we used calibrated radiographs and circumferential measurements of her limb in lieu of a fiberglass impression. Our computer modification system allowed us to create a 3D model of the shape of her residual limb. The next challenge was a device she could use in the water that replicated a flipper. When her foot moved forward we wanted little to no resistance against the water and when she pushed her foot back we wanted the device to somewhat open so that water could be scooped and she could propel forward. This concept was achieved by making what is called a “shroud” out of a flexible piece of plastic that is set up to flap open and closed along a bolt. The inside of the device is fabricated similarly to a standard prosthesis to ensure comfort when walking.

 

Dutchess and her owners were so happy to have her prosthesis and try it on for the first time. Though Dutchess is going to take some time to adjust to it, the owners are very dedicated to her rehabilitation and have been working with her at home. Dutchess has been seen shaking her feathers while in her device which lets the owners know she is happy with it and they feel with some time she will figure it out and greatly improve her mobility. You can see more of Dutchess’s progress in videos on our Vimeo video channel.

Shia

Shia

I want to sincerely thank OrthoPets for their amazing work and expertise with animal orthotics. My 6 yo Carolina Dog, Shia, suffered a partial CCL tear after some play. I was advised to proceed with surgery. After reviewing studies and alternative options, I decided to pursue a conservative treatment plan to see if we can get her to heal without the trauma of surgery Under the direction of my rehab Vet, we decided to purchase a stifle brace from OrthoPets. Wise decision! The quality and design of the product I received was unbelievable – perfect fit and molded specifically for her leg taking into account her anatomy! After 4 months of strict rehab and wearing the brace, Shia has returned to nearly total weight bearing on the limb with and without the brace. We continue to use the brace for protection as she tolerates it very well. I highly recommend this company to help with your pet’s rehabilitation.

Thank you OrthoPets!
Michael and Shia

Michael and Shia

OrthoPets Patient Feature: Mocha

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Mocha’s first time in her Wheelie Vest, clearly wondering what this strange contraption is!

If you’re reading our blog, you are probably familiar with “Daffodil on Wheels,” the plucky and awe-inspiring two-legged Chihuahua who uses an OrthoPets Wheelie Vest. Daffodil has her own Facebook page and many friends and fans who love to see videos of her hiking, popping wheelies and generally kicking butt in (and out of!) her wheels. While Daffodil took to her wheels with a combination of sheer talent and work doing rehabilitation with her owner, not every dog is such a natural when they first receive their OrthoPets Wheelie Vests.

Meet Mocha, a 9-year old, 12 pound Chihuahua mix. Mocha was born with agenesis of her left forelimb. She also had two different IVDD (slipped disc) events in her history that were causing her pain and discomfort. Her owners found OrthoPets when they were searching for ways to help her avoid future back injuries and give her easier and more comfortable mobility.  

The two options that Rachel, Mocha’s OrthoPets Case Manager, presented to Mocha’s owners were either a hoppy/wheelie vest or a carpal orthosis to support Mocha’s “good” forelimb with a possible combination of both in the future. Mocha was not a candidate for a prosthetic on her residual limb since to build a functional forelimb prosthetic, the patient needs at least 40-50% of the radius and ulna remaining. Ultimately, Mocha’s owners, veterinarian, and Rachel opted for the Wheelie Vest with an option to add a carpal support later if Mocha started to show any signs that additional carpal support was necessary. 

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Mocha gains confidence in her wheels on the grass.

The device that OrthoPets designed for Mocha is a fairly standard Wheelie Vest, though it was designed with the central axel a little bit to the left to accommodate Mocha’s habit of adducting her right forelimb in motion. Mocha’s device also came with an integrated D-ring leash attachment at the front in order to help teach Mocha how to turn her wheels, which can be one of the more challenging aspects for patients learning to use a Wheelie Vest.

When Mocha first got her vest, she was clearly nervous about it. Her owners worked hard with her to associate it with positive events (like treats) and in the beginning they started by just putting Mocha in it and letting her have treats for sitting calmly in the Wheelie Vest instead of trying to wriggle out. Once Mocha got comfortable with lying quietly in the device, she was able to move on to short sessions walking straight ahead on a smooth, easy surface in a controlled environment. 

Eventually, Mocha started gaining confidence in her wheels and going faster, as well as learning to turn herself to avoid obstacles. Once she started picking up speed (literally and figuratively!) it became clear that her right forelimb was sometimes hitting the axel of the cart when she moved any faster than a walk. It was determined that it was partially a result of Mocha’s habitual adducting of that limb to bear weight on from before she had her wheels. Mocha’s device was sent back to OrthoPets for an adjustment to move the axel forward giving her more space for that front paw. Even with the adjustment, it was important that Mocha continued rehabilitation exercises to help learn appropriate posture and more even weight distribution with her trunk.  

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Mocha jumps her first curb!

Mocha’s device came back to OrthoPets for one more adjustment to strengthen one of the bars of her device. Once the adjustment was completed and the Wheelie Vest was sent back home, Mocha’s owners reported that Mocha was excited just to see them come out of the box! Her owners also report that since using her wheels regularly, not only is Mocha more mobile, but she has less overall pain to the point that she hasn’t needed any pain medication for her legs or back. Wow!

Great job Mocha and family! You’re an inspirational little pup and we love seeing your success with your wheels!

Duke

Duke

Our American Mastiff, Duke, suffered a serious spinal cord injury that left him paralyzed initially on his left side. As he recovered he began to overuse his right carpus (wrist) and began to injure it. Our vet recommended a custom orthotic from OrthoPets. From our initial contact with them, they were extremely helpful, knowledgeable, and professional. They truly cared about Duke’s situation. Martin and his team of specialists thoroughly explained our options and developed a plan, and an Orthotic, that would allow Duke maximum use of his leg. OrthoPets fantastic staff and customer service are some of the best I have seen, and have worked closely with us through numerous fittings and adjustments. Today Duke is doing great and is able to walk, run at a full sprint, and enjoy a great life thanks to OrthoPets!

Duke

April 2017 OrthoPets Case Study for the Canine Rehabilitation Institute

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OrthoPets Case Study: Shia

Shia is a 6-year-old female spayed mixed breed dog who lives in North Carolina. She presented in January 2017 with a partially torn CCL in her right hind leg. Shia’s owner wanted to pursue a conservative course of rehabilitation with an orthotic instead of surgery. Shia’s case was relatively straightforward, with a good possibility for a “curative outcome” which means we have provided a stable environment to allow the body to lay down functional scar tissue. After reviewing her media, additional componentry was not deemed necessary for suspension or control. However, due to her thin fur and prominent malleoli, it was decided that additional modifications would be made to the device to alleviate additional pressure on those prominent anatomical landmarks. Relief channels were ground into the foam of the distal tarsus lateral, medial and cranial. Then, a thin black, non-friction material called “glide” was added to this area.

Shia received her device in mid-January and used it in conjunction with a formal rehab program at Vanguard Veterinary Hospital in West End, North Carolina. Her rehab program included use of a gait analysis mat, so we wanted to share some of her GLS numbers. Initially, her owner was concerned because in her first week with the device, Shia actually showed more weight bearing out of the device than in it. She had a GLS score on her right hind of 77 with the device and 83 without it (higher number shows more weight bearing). This favoring of the leg can be common upon first receiving a device; patients do not yet trust the device to support them and experience muscle fatigue from starting to use muscles again that have atrophied due to the injury.

Shia’s orthotic did return to OrthoPets for an adjustment about one month into her time in her device because she developed an irritation at her achilles due to her distal migration of the device. The adjustment involved grinding the top of the shell to decrease the overall height as her flank/groin was pushing the device down and adding non-friction glide material to the achilles strap to help alleviate the rubbing. By this time, thanks also to her fantastic rehab work with Vanguard, she was at a GLS score of 100 on her right hind both with and without the brace, so her owner felt comfortable letting her go without the brace for a few days for the adjustments to be completed.

Now, not even four months after receiving her device, Shia is completely weight-bearing again and uses her orthotic just as a sports brace to help prevent re-injuring the ligament when she does high-impact activities like playing at the beach with her owner!

OrthoPets Patient Feature: Morgan

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Meet Morgan! Morgan is a shepherd mix pup who received her below tarsus prosthetic device through Dr. Kern at our fantastic Michigan Partner Clinic, Pawsitive Steps Rehabilitation. Morgan’s initial consult was at only 10 weeks of age, not long after she was adopted by a pair of veterinarians. Morgan was born without her distal left hind limb, below her tarsus. She would to try to walk on her stump when moving slowly, but would hold it up and hop on three legs when she wanted to go faster. Sometimes, she had a hard time getting traction with her stump, which was challenging for her. She would also to extend the tarsus/hock joint of that limb very straight, possibly in an effort to “reach” for the ground with the stump. 

Everyone agreed that Morgan would be a great candidate for a prosthesis, but because of her young age and likelihood of needing multiple devices as she outgrew them, her owners opted to wait to start the prosthetic process until Morgan was closer to full grown. In the meantime, Morgan did a lot of rehabilitation at Pawsitive Steps to work on improving her core strength, balance and especially focused on flexing the tarsal joint of her residual limb. It was also very important to get her comfortable with that limb being handled to prepare her for donning and doffing of the device. 

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When Morgan was close to full grown, Dr. Kern did her fiberglass impression and measurements for her prosthetic device. Because of the amount of limb remaining, Morgan was borderline between making a prosthetic with a non-articulating tarsus (no motion) and an articulating one (motion allowed). Since Morgan is young and preserving as much range of motion in her tarsal joint as possible was priority, Dr. Kern and Silver (Morgan’s OrthoPets Case Manager) decided on the articulating version, with motion limiting straps available in case Morgan did not handle the articulation well. 

Morgan received her device in August of 2016. Her device not only helps protect her stump and gives her good traction, but makes up the limb length discrepancy she has so that her hips can be level and her spine can stay neutral, which is very important for long-term health and comfort. Slow acclimation to the device is important to ensure the patient is using the device properly. Otherwise, they may form “bad habits” such as lifting their prosthetic limb during faster gaits, improper sitting, etc. Rehabilitation and supervised, structured, slow and steady work upon receipt of a device is important so that patients can learn good habits and become accustomed to using the device as if their prosthetic limb had been there the entire time and eventually they can tear around and play. 

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Great job, Morgan and family! We love your pirate style!

 

OrthoPets March 2017 Case Study for the Canine Rehabilitation Institute

When 10 months old, Bianca was rescued in Italy after she had become stuck in an illegal trap. It was estimated she had been in the trap for 3 days causing such severe damage to her hindlimbs that sub-total amputations proximal to the tarsi were necessary. The rescue began working with our OrthoPets Europe Distributor to provide prosthetic devices to her.
Current recommendations for a functional outcome with prosthetics with our devices include the following: Patients must have a functional stifle as well as at least 40% of the tibia/fibula remaining. Retaining the tarsus is ideal for a prosthesis to aid in suspension, however it is not always plausible for our patients as seen in Bianca. Due to her amputation levels, she was not a candidate for our standard prosthetic design. Patients with amputation levels proximal to the tarsi may be candidates for a specialized prosthesis called a “Chevy” Prosthesis, named after the first patient this design was fabricated for. While we highly recommend each of our devices be accompanied by a formal rehabilitation program, it is definitely required for Chevy Prosthetic patients. These patients will have an extensive learning curve and will need at least 1 year of rehabilitation to provide them the best opportunity to be fully functional in the device.
Bianca received bilateral “Chevy” prostheses which are connected together by a pelvic plate. The “Chevy” design provides a prosthetic solution for patients who otherwise may require a full limb amputation and/or wheelchair.
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Bianca has been doing exceptionally well! Here is a video of Bianca 11 days after her initial fitting: Bianca: 11 Days Post Initial Prosthetic Fitting

OrthoPets is currently working with Colorado State University to determine outcomes in patients with partial limb amputations and the use of a prosthesis. Here is a link to more information regarding this study: Clinical Trial: Evaluation of Partial Amputation in Dogs.
OrthoPets February 2017 Case Study for the Canine Rehabilitation Institute

OrthoPets February 2017 Case Study for the Canine Rehabilitation Institute

 

4c0318c8-4bd3-4c56-9548-1a7b567ab3fa.jpgGibson is a 5-year-old MC Border Collie that lives in Mexico. His veterinarian is Dr. Gabriel Ramirez who has a long working relationship with OrthoPets. Dr. Ramirez frequently sees cases that have had complications elsewhere and is known to “think outside of the box” with the goal to his patients to gain their mobility back as quickly as possible. In Gibson’s case, he had a pancarpal arthrodesis. Unfortunately, the post-operative bandage was placed too tightly and caused tissue necrosis. The medical team tried to save the limb but eventually the “only” established option for him was a full-limb amputation. However, since the affected area was distal on the limb, the owner elected a sub-total amputation and prosthetic.

OrthoPets is currently gathering retrospective and prospective data on canine prosthetics, however, based on our current experience a few things are important when considering a prosthetic device: Prosthetic candidates should be amenable to handling of the residual limb and a long enough limb to allow appropriate suspension of the device and proprioception to properly use the device in a functional manner is necessary.

The combination of these two factors will translate into the functionality of the device and ultimately serve as a predictor for the success of the case. The total length of residuum is currently unknown, and it varies depending on the anatomy of the remaining limb. For example, we have some cases that show appropriate suspension with a mid-radius amputation while others don’t have prominent enough humeral epicondyles to allow successful suspension. In general, the more distal the better the chances to have a successful outcome. As such, Gibson is a perfect case for this treatment.

Regarding the surgical approach to a sub-total amputation with the goal of utilizing a prosthesis, it is important to consider the following:

  • Skin suture line location to avoid scar tissue formation on the weight bearing surface of the limb
  • Remaining soft tissue placement to encourage comfortable weight bearing
  • Identification of nerves to avoid placement over the residuum

Gibson’s amputation was performed so that the accessory carpal bone remained which created a bulbous distal end aiding with the suspension. The device was fabricated with a removable liner for replacements to be sent as needed rather than requiring the device to be sent to us. A traditional style prosthesis has a “fixed” liner that is connected to the shell requiring the entire device and additional steps to replace or change the liner. The removable liner approach allows us to replace, duplicate and adjust the foam liner without needing the entire device.

Gibson was fit with his prosthesis and immediately took very well to it! So far, Gibson’s device has not needed any adjustments aside from tread replacement which can easily be done by his owner. The entire team at OrthoPets as well as his medical team was pleased with the fit of the device and how quickly Gibson adapted to his old activities such as playing with a Frisbee. Gibson will need regular rechecks to ensure that the device is not only fitting well but that the device is still providing appropriate function to his affected limb.

For additional information: Colorado State University is conducting an ongoing study evaluating partial amputation in dogs. Read more here.

OrthoPets ACORN Stifle Study- University of Louisville Stifle Brace Study

Bertocci, Gina E., and Nathan P. Brown, “Biomechanics of an orthosis-managed cranial cruciate ligament-deficient canine stifle joint predicted by use of a computer model.” American Journal of Veterinary Research 78.1 (2017): 27-35.

http://avmajournals.avma.org/doi/abs/10.2460/ajvr.78.1.27


Picture2.pngOBJECTIVE

To evaluate effects of an orthosis on biomechanics of a cranial cruciate ligament (CrCL)–deficient canine stifle joint by use of a 3-D quasistatic rigid-body pelvic limb computer model simulating the stance phase of gait and to investigate influences of orthosis hinge stiffness (durometer).

SAMPLE

A previously developed computer simulation model for a healthy 33-kg 5-year-old neutered Golden Retriever.

PROCEDURES

A custom stifle joint orthosis was implemented in the CrCL-deficient pelvic limb computer simulation model. Ligament loads, relative tibial translation, and relative tibial rotation in the orthosis-stabilized stifle joint (baseline scenario; high-durometer hinge) were determined and compared with values for CrCL-intact and CrCL-deficient stifle joints. Sensitivity analysis was conducted to evaluate the influence of orthosis hinge stiffness on model outcome measures.

RESULTS

The orthosis decreased loads placed on the caudal cruciate and lateral collateral ligaments and increased load placed on the medial collateral ligament, compared with loads for the CrCL-intact stifle joint. Ligament loads were decreased in the orthosis-managed CrCL-deficient stifle joint, compared with loads for the CrCL-deficient stifle joint. Relative tibial translation and rotation decreased but were not eliminated after orthosis management. Increased orthosis hinge stiffness reduced tibial translation and rotation, whereas decreased hinge stiffness increased internal tibial rotation, compared with values for the baseline scenario.

CONCLUSIONS AND CLINICAL RELEVANCE

Stifle joint biomechanics were improved following orthosis implementation, compared with biomechanics of the CrCL-deficient stifle joint. Orthosis hinge stiffness influenced stifle joint biomechanics. An orthosis may be a viable option to stabilize a CrCL-deficient canine stifle joint.


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Introduction:

  • Orthoses for CCLD have been reported. Their efficacy is dependent on device, owner, care-provider (adjustment, fitting of device and rehabilitation) and animal factors.
  • Orthosis allows limited functional movement (rather than complete immobilization) according to 4-point force application system used in humans with ACL-tears with the following cranial constraints (quads, tibial tuberosity, distal tibia) and caudal constraints (semimembranosus and semitendinosus, gastrocnemius muscles and calcanean tendon)
  • However, stabilizing effect of canine stifle orthosis has not been investigated

Materials and Methods:

  • Previously developed and validated computer model (3-D quasi-static based on 33kg Golden Retriever) utilized to test Orthopets CCLD-orthosis (with 2 Tamarack hinges at stifle) that was molded specifically for the dog that the computer model was based on
  • A 3-D scan of the orthosis was then performed to import the orthosis into the previously developed stifle model and loads on the ligaments (caudal CL, MCL, LCL) and tibial rotation and translation (drawer) through stance phase were compared between CrCL-intact, CrCL-deficient and CrCl-intact and -deficient with Orthopets orthosis
  • Different hinge stiffness (Tamarack 740-L [high] and Vet-L-65 [low stiffness]) were also evaluated

Results:

  • CrCL-deficient stifle compared to orthosis-managed CrCL-deficient stifle showed reduced tibial translation (91%) and rotation (61%)
  • CrCL-intact stifle compared to orthosis (with CrCL-intact stifle) showed significantly different peak loads (i.e. orthosis changes the loads compared to an intact stifle):
    • Loads on the caudal cruciate (38%) and lateral collateral ligament (53%) were reduced while MCL increased (50%)
  • CrCL-deficient stifle compared to orthosis-managed CrCL-deficient stifle showed significantly decreased peak loads for all ligaments tested:
    • Caudal cruciate (90%), lateral collateral ligament (93%) and MCL (59%)
  • Hinge stiffness significantly impacted tibial rotation (decreasing rotation with increasing hinge stiffness)

Discussion:

  • Stifle orthosis for CrCL-deficient stifle reduced translational instability by 90% in this computer-model
    • The tested device (Orthopets stifle orthosis) significantly improved biomechanical stifle stability in the stifle with cranial cruciate ligament deficiency
  • Stifle orthosis for CrCL-deficient stifle decreased loads on the collateral ligaments and caudal cruciate ligaments in this computer-model
    • The tested device (Orthopets stifle orthosis) may prevent subsequent injury to ligamentous structures
    • The tested design appears to reduce loading of the lateral collateral ligament to a greater degree than medial collateral ligament
  • Hinge stiffness had the greatest impact on tibial rotation
    • If greater control of internal tibial rotation is required (such as pivot-shift cases) a stiffer hinge should be considered
  • While computer models have been previously validated and appear highly predictive some variables are introduced when using a ‘real’ patient that may change these results (such as the cuffs were ‘modeled’ as a straight line, the foam may compress over time etc.) – in other words the result of this model are likely superior to what can be accomplished in a clinical patient
  • Modeling limited because it was based on one patient at one time-point only
Levi

Levi

Hello LiLen and all of the wonderful OrthoPets team,

I spoke to Lilen this morning about my dog Levi who two years ago was suffering from a cruciate tear in his left rear leg. OrthoPets fitted him with a stifle brace and the whole process was so positive. At that time he was just 14 and I was uncertain about his ability to bounce back from such an injury at his age. I am very proud to say that this spring he will turn 17 years old!!! He no longer needs his OrthoPets stifle brace but he took to wearing it almost immediately.

The stifle brace gave his leg the stability to heal while keeping him active – this to me is the genius of these braces. At his age mobility is EVERYTHING!!!

When he was 12 he tore his right leg cruciate and I opted to have surgery. It took a full 6 months for him to be able to walk and move freely again and consequently he lost much of his muscle tone and mobility. While I don’t regret my decision (and recognize that surgery is the best course of action in some cases) the process was so arduous and tentative. It was so amazing to have the option to use the OrthoPets brace and be a lot more proactive in the healing process – and to be able to keep him moving!

I am so grateful everyday that somehow I connected with OrthoPets. Without their help, I would not be enjoying each and everyday with my happy and healthy pup! Thank you a million times over!!!

Sincerely,
Courtney and Levi