OrthoPets Case Study: Kaia
Any prosthetic case can be tricky to work with. There are many factors in play that can determine the failure or success of a prosthesis. To determine some of these factors and get a more objective assessment of this novel treatment option for dogs we have been working closely with Dr. Felix Duerr from Colorado State University (CSU). CSU is conducting a prospective study evaluating prosthetic devices for dogs with lower limb pathology. More information about the study can be found here – there are still a few spots for enrollment that may benefit your patient!
Choosing to avoid a full limb amputation and pursuing a partial limb amputation requires life-long dedication from the owner and the need for a team of dedicated individuals (frequently including a surgeon, veterinarian, and rehabilitation specialist). We at OrthoPets are happy to aid with the fabrication of the device as well as supporting the animal health professionals, the pet, and the client for the life of the patient.
The main challenges we face in veterinary prosthetic patients is device suspension, device rotation and of course the possibility of pressure sores or friction. Compared to people, we cannot use suction devices/techniques to aid with the suspension in our furry patients. Therefore, we require a minimum limb length that facilitates suspension of the device and avoids rotational problem. In our experience, the required length in order for us to fabricate a functional prosthesis for a patient is approximately mid-way of the radius/tibia. This is a general guideline, however, success depends on many individual patient factors particularly the anatomy and presence of bony prominences.
Limb shortening due to osseous defects/discrepancy can be addressed with the use of a procedure called Distraction Osteogenesis. This process involves cutting of the bone and slowly separating the two bone ends allowing the gap to fill in and essentially lengthen the bone. This procedure is used in canine patients for the treatment of angular limb deformities with limb length discrepancy, however, it has not been reported in the veterinary literature to facilitate the attachment of a prosthetic device. One of our Partner Clinics, Port City Veterinary Referral, in New England, had been working with a young pit bull named Kaia that unfortunately did not meet the minimum limb length requirements for the prosthesis. Luckily, Kaia’s owner is a veterinarian and was up for any sort of challenge! He worked alongside a surgeon, our Partner Clinic and Martin here at OrthoPets. Together they developed the idea of using Distraction Osteogenesis in the hopes of lengthening her limb enough so that we would be able to suspend a prosthesis for her.
Kaia’s surgery was performed in September 2016, and by January 2017 she had 2.5 cm of bone growth based on radiographs. By April 2017 the external fixator was removed, and Kaia had enough limb length for the suspension of a prosthesis. Though there was a slight curvature to the limb and bone healing was not complete, Kaia’s team decided to move forward and get her into the prosthesis. Kaia did wonderfully at her first fitting and is using the limb well. Kaia continues to spend time working on her gait re-education and functional integration of the residuum into a quadruped gait.
Kaia is a great example of how thinking outside the box by her owner as well as her veterinary and VOP team can help solve problems that seem impossible to solve!
Dudley is a 2-year old, 64-pound mixed breed dog. Dudley initially presented to his veterinarian December 2016 for a Grade 2 patellar luxation secondary to patella alta on the left pelvic limb. When his patella luxated, he was in immense pain. Surgical correction was performed that same month. The trochlear groove was noted to be normal depth and a trochleoplasty was performed. Dudley did very well post-operatively and was using his limb with no apparent lameness within 3 days following surgery. In January, Dudley presented on emergency with severe pain of his left stifle. Radiographs revealed an avulsion of the left tibial tuberosity, just proximal to the previously placed pins.
A second surgical repair was performed. Dudley was then placed in a lateral splint and remained hospitalized to reduce his post-operative activity. Three days later, Dudley was noted to be acutely painful on his left hind limb again. He had another surgery where it was noted that the tibial tuberosity had fractured vertically through the two previously placed pins. Another repair was performed. Unfortunately, radiographs performed 3 weeks later revealed a failure to the repair. Dudley remained in a splint at the point and his veterinary team reached out to OrthoPets for potential support via orthosis.
After reviewing the case with our surgical and sports medicine team at Colorado State University, it was determined that even though this was a complicated situation no matter what approach was taken and no guarantees could be made, this may have been the best chance to return comfort and mobility to Dudley.
Essentially, what OrthoPets was able to offer was similar to an orthotic design used to support post-operative patellar tendon avulsion cases. The stifle, tarsus and paw are incorporated in the device and “locked out” or non-articulating at first. As healing progresses, range of motion is slowly returned. These device configurations are very complex and require a lot of commitment from not only the clients, but also the veterinary team.
In February 2017, OrthoPets received Dudley’s case including fiberglass impression, measurements and radiographs. Due to Dudley’s multiple injuries and therapeutic goals, a special hinge called a “Camber Axis Hinge” was determined best for his device as they allow for variable ranges of flexion and/or extension to be given. The hinges were metal adding additional frontal and transverse control as well. Also, given that the entire device would be non-articulating at first, and the weight of all the componentry required, suspension would be a challenge so the device was fabricated with a neoprene suspension sleeve to increase purchase of the device to limb.
The owners and veterinary team continued to implement rehabilitation in Dudley’s treatment plan. By the end of March 2017, Dudley had full range of motion of this stifle and tarsus. By April 2017, no instabilities were present. Since Dudley had progressed so well, the additional componentry such as the special hinges, paw segment and tarsal cuff were not necessary. Dudley’s owners and veterinary team decided that it would be best to continue to provide support to his stifle and had a standard stifle orthosis fabricated to use as a “sports brace.”
When our 10 year old Siberian Husky, Sterling, started limping on her hind leg, we were devastated and saddened knowing she was in terrible pain. After spending $1,000 on veterinary bills while trying to get answers, we reached out to OrthoPets to see if they could help. Sterling was diagnosed with a CCL injury at her stifle joint.
Due to Sterling’s age and the expense associated with surgery, we decided to pursue bracing to help support her leg and allow her to walk & run in comfort again. Within a week after casting Sterling’s leg for a new custom brace, it arrived with detailed installation, break-in, and maintenance instructions.
After installing her custom OrthoPets brace, we could immediately tell that Sterling’s hind leg was being supported properly. It fits her PERFECTLY and doesn’t slide out of place. Sterling is now able to walk, run, and navigate stairs like she could before her CCL injury and understands that the brace is helping her to do so.
Thank you so much for your compassion and for getting Sterling back on her feet so she can enjoy her retirement years with her family & friends!
Jason, Kelly, and Sterling
Minneapolis, MN USA
Shine’s owner found him injured after being bit by a dog. This injury left him with irreversible damage from his pastern to his hoof. Colorado State University performed a rare hind limb amputation at the level of the pastern. They then placed him in a specialized cast that would allow him to bear weight, but not directly put weight on the amputation site while his prosthesis was being fabricated. OrthoPets owner/founder Martin Kaufmann was present at CSU during the amputation to create the fiberglass impression immediately post-operatively.
Large animal prosthetic patients have special considerations due to their size. The skin can be friable when using a prosthesis due to the pressure from the weight of the patient. Large animal patients also require a 24-hour wearing schedule since they are often turned out to pasture. Due to the continuous wearing schedule and the outdoor living conditions, the prostheses utilize a removable foam liner that can be replaced as needed without returning the device to OrthoPets. The prosthesis allows the patient to return to their normal life style. At the initial fitting, Shine took to the prosthesis quickly.
Shine has now returned to his normal lifestyle. The prosthesis has allowed Shine to keep up with his family whether out in the pasture, trotting, or even galloping. The prosthesis was fabricated with his lifestyle in mind. It has special modifications to manage the constant exposure of being outdoors. The prosthesis will last his lifetime as the removable foam liners can be replaced as needed. Shine has overcome the odds and will live out the rest of his life happy and healthy. The fun video here tells Shine’s story.
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.
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.
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.
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
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.
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.
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!
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!
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!