OrthoPets Blog

Is an orthosis the right solution for you and your pet?

Is an orthosis the right solution for you and your pet?

OrthoPets offers both orthotic and prosthetic devices to help with your pet’s unique case. But what is the difference between the two? Orthotic devices are used to help stabilize an injury or instability. Prosthetic devices are used to replace a partial limb segment and make up a limb length discrepancy for congenital defects or for partial subtotal amputation. Below you will find common orthopedic injuries and instabilities as well as how a device may benefit your pet. All of our devices are designed to assist your pet pre-operatively, post-operatively or in lieu of surgery. Please reach out to one of our Case Managers for more information regarding our prosthetic devices and your pet’s specific case.

Carpal and Tarsal Injuries

Injury to the carpus (wrist) can be complex because it is composed of 3 joints, 6 carpal
bones, 2 antebrachial bones (radius and ulna), and 4 or 5 metacarpal bones. There are multiple ligaments holding this structure together and injuries can occur at any of the joint levels (antebrachiocarpal, middle carpal, or carpometacarpal).

Injury to the tarsus (hock) can be complex because it is composed of 6 joints arranged in 3 levels, 6 tarsal bones, 2 antebrachial bones (tibia and fibula), and 4 (rarely 5) metacarpal bones. There are multiple ligaments holding this structure together and injuries can occur at any of the joint levels (tarsocrural, talocalcaneal, talocalcaneocentral, calcaneoquartal, cetrodistal, and tarsometatarsal).

Clinical signs of carpal and tarsal injuries include lameness, swelling, and mal-alignment. Mal-alignment can include hyperextension and/or increased angling of the paw toward the midline (varus) or away from the midline (valgus). Minor injuries will resolve with rest and a temporary splint, however more severe injuries may require surgery or an orthosis. Additionally, any of the associated bones can be displaced (luxated) or fractured. Injuries to the Achilles complex is covered in another document. Common surgical approaches include repair of large ligament injuries when possible, screw fixation of fractures of the larger bones, partial or complete fusing of the carpus or tarsus so that it no longer bends (articulates). Device design is paramount to success and depends on the type and severity of injury.

Careful consideration is taken in prescribing a device and its specific components. Important clinical variables surround use of a paw segment and whether articulation by way of hinges is possible.

  1. The paw segment is required in the following circumstances: short metacarpal bones, fracture of metacarpal bones, severe hyperextension, middle or distal jointhyperextension, subluxation, more than one plane of instability, excessive dewclaws, deranged digits, flexor tendon failure or shortening at the digits and wounds associated with the paw.
  2. Articulation (hinging) is ideal whenever possible in order to provide as close to normal limb use as possible. With this design, the carpus or tarsus can flex if appropriate and yet be limited to flexion within safe parameters only; this is called an arthrodesis-on- demand. Articulation cannot be provided under the following circumstances: severe carpal or tarsal malalignment, bone tumors near the carpus or tarsus, metacarpal or metatarsal fractures, and non-reducible bone luxations. When articulation is not possible, patients may experience an altered gait in the device.

Stifle Injuries

Injury to the cranial cruciate ligament (CCL, also called the ACL) is the most common
orthopedic injury in the dog. This injury is due to a partial or complete tear of a ligament inside the stifle (knee). The resulting instability leads to pain and arthritis. There is no published study directly comparing use of a custom stifle orthosis to surgical stabilization for CCL injury in the dog.

Stabilization is recommended for best short and long-term function, quality of life, and
comfort. Stabilization is traditionally done surgically either with a joint realignment surgery (TPLO or TTA) or with a pseudo-ligament surgically placed outside the joint (tight rope or lateral suture). These procedures are considered the standard of care. In the past 7 years, the use of a custom orthosis (brace) has become available as an alternative to surgery when surgery is not appropriate for any reason. These reasons may include other health issues, unacceptable surgical or anesthesia risk, advanced age, and financial constraints, among others.

Even with an orthosis, surgery may be required. When the cranial cruciate ligament is
torn sometimes the meniscus is also torn. The middle or medial meniscus is most commonly injured and injury may occur at the time of the initial cranial cruciate injury or any time later due to too much activity on an unstable joint. A torn meniscus is very painful and if not treated it will cause continued lameness despite stabilizing the joint with surgery or an orthosis. If this occurs, a surgical procedure called a partial medial meniscectomy is required.

Because an orthosis is not the correct therapy for all patients, before choosing an orthosis the following points are important to keep in mind:

  1. The device MUST be put on and removed daily. The device is to be used all day every day, but must be removed at night. The orthosis stabilizes the stifle, tarsus or carpus from the outside only when ON, while surgery does so from the inside. The device is not used at night and your dog must not be allowed to move about (jump on or off bed, wander the house, go outside through a dog door, etc.). Wearing schedules vary based on the type of injury.
  2. Adjustments are expected and are a normal part of the custom orthosis process. The device is custom-made for your dog, and every effort is made to accurately fit the device. Two complimentary adjustments are included to help meet the requirements for an appropriate fit; your veterinarian will coordinate these adjustments. Increased activity and activity intensity can expose fit issues requiring further adjustments. Please follow all instructions with on how to monitor your pet, contact OrthoPets as well as your veterinarian promptly if you have concerns. If adjustments are required, it will be necessary to ship the device to OrthoPets with a turnaround time of 1-3 business days excluding shipping time.
  3. Follow-up is critical to success. An orthosis is considered a “durable medical device.” This means that proper use of the device is necessary to meet therapeutic goals and to ensure its safe application over the lifetime of your dog. In the first few months of fitting, your veterinary team, with the help of your OrthoPets case manager, will help coach you with regards to device use and rehabilitation. Annual to twice annual appointments are advised depending on age and activity of your dog. At these appointments, your doctor will thoroughly assess your dog’s orthopedic condition and evaluate the condition and fit of the device.
  4. The role of Rehabilitation. Most dogs adapt quickly to wearing an orthosis, however, behavioral techniques can facilitate this. Your dog will need to learn basic skills while wearing the device, which include: transitions (sitting, lying down, getting upstairs), and moving around on different types of surfaces (ground, carpet, hardwood floor, etc.). Orthopedic injury leads to compensatory abnormal movement and associated muscle strain and weakness. The best way to ensure the highest level of success is to follow recommended rehabilitation schedule and techniques. Each patient’s condition and abilities are unique and as such an individualized rehabilitation program is needed. Your veterinarian can help find a certified rehabilitation professional (CCRT or CCRP) in your area.
  5. A proactive approach to arthritis management is the second key to long-term success. If the joint itself is injured rather than a ligament alone, osteoarthritis may develop. Steps taken early and continued throughout your dog’s lifetime will make a difference in terms of regaining and maintaining comfort and an active life-style well into the senior years. Consult with your doctors for a comprehensive pain management plan.

OrthoPets’ Past and Future

OrthoPets is like nothing you have ever seen in veterinary medicine. OrthoPets
offers custom orthotics (braces) and prosthetics manufactured to the same
standards and with the same bioengineering skill used for human patients in a
full-time on site and virtual clinic with a human orthotist and veterinary specialist
collaborating on every case.

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Recognizing a need

The concept of OrthoPets originated in 2003 when Martin Kaufmann, a certified
human ped-orthotist and prosthetist, first applied his training and experience to
the animal healthcare industry. His first patient, Walt, suffered a neurologic injury
and amputation was recommended. Using knowledge of human patients with
similar functional deficits, Martin created an orthotic device to reposition the limb
allowing Walt to walk on four legs again.
This rewarding challenge soon became a full-time pursuit and OrthoPets was
launched as the first dedicated Veterinary Orthotics and Prosthetics (VOP) Clinic
in the world. One by one, Martin helped animals regain the lifestyle they once
enjoyed. OrthoPets grew rapidly and in 2006 moved from the Kaufmann’s
garage to a small manufacturing facility in north Denver. Martin’s wife, Amy,
joined the endeavor as head of sales and marketing. From 2003 OrthoPets
provided mobility solutions to more than 15,000 animals, in all 50 states and on 3
continents.

Growing into the Future

In 2014 Dr. Felix Duerr, a board-certified orthopedic surgeon and board-certified
canine sports medicine and rehabilitation joined the OrthoPets team. The
mission envisioned by the Kaufmanns and Dr. Duerr was to positively impact the
quality of life of animal patients and their human companions through innovative
solutions for animal pain and mobility issues. Their purpose was to pioneer the
specialty of VOP as a compliment to existing standards of care through custom
engineered external coaptation (CEEC). Their goal became setting the bar as the
world leader in VOP through creative design, integrity, and service.
With his knowledge of primary veterinary healthcare and his specialized training
in orthopedics and sports medicine is the driving force behind research and
testing. Using the human process as a model, patients at this center will enjoy
the expertise and collaboration of specialists in the fields of modern, integrative
veterinary pain medicine, VOP, and veterinary rehabilitation under one roof. No
such facility exists anywhere in the world.

In response to increased demand and a rapidly developing industry, OrthoPets
moved into their new Westminster Colorado facility in October 2014. More than 4
times larger than the previous facility, the new OrthoPets location houses a full-
time VOP clinic in which cases are collaboratively managed by Martin and a
virtual clinic in which technology (email, skype, video conferencing) allows
national and international patients to receive the services provided in the Denver
clinic, and OrthoPets fabrication lab where custom devices are designed,
manufactured, and refurbished. OrthoPets is available to help you throughout
your journey.

New Tools and Partnership for Veterinarians

VOP is truly a new tool in the veterinarian’s therapeutic repertoire. All devices
are custom manufactured using the same adaptive technologies and materials
developed on the human side. Common devices for the forelimbs include
prosthetics for issues mid antebrachium and below; carpus devices include
solutions for hyperextension, premature physeal closure, collateral ligament
injury, and distal radial neoplasia. Devices for the hindlimbs include prosthetics
for issues at or below the hock; hock injuries amenable to bracing include
hyperextension, achilles tendon injuries (surgical or nonsurgical), collateral
ligament injury, and luxation; stifle braces include solutions for cranial cruciate
injury, luxating patella, and osteoarthritis. Devices are adaptable for use pre-op,
post op, or no op as primary external coaptation, dynamic support, sports
bracing, and limb replacement.

A crucial aspect of the OrthoPets vision and mission is to give each patient a
second chance to enjoy a normal life. By partnering with various animal
healthcare professionals (family veterinarians, veterinary surgeons, veterinary
neurologists, veterinary rehabilitation therapists), OrthoPets has successfully
provided solutions to old problems and created new options never before
possible.

Knowledge and Experience Provide Adaptability

Since 2003, OrthoPets has found great success in applying the same adaptive
technologies developed for human orthotics and prosthetics to the care for
animal patients. Use of these devices in animals requires a new way of thinking
because of differences in movement (e.g. 4 legs, wings, hooves, paws), activity
(e.g. agility, sporting, flying, swinging through trees, guarding sheep, sleeping on
the couch!), size (e.g. 5 lb Chihuahua, 800 lb calf), and environment (e.g. carpeted
house, snow, barnyard, zoo enclosure). Understanding biomechanics of
movement and the forces applied to a limb as an animal goes about normal
activity is paramount. Through years of experience and knowledge the
engineers and veterinarians at OrthoPets are able to customize a mobility
solution for each individual.

October 2017 OrthoPets Case Study for the Canine Rehabilitation Institute: Duke

Duke is a 12-year-old mixed breed who presented to his primary veterinarian for right hind limb lameness in March of 2016. There, he was diagnosed with a right cranial cruciate ligament tear and chronic joint effusion, which is a common injury in dogs. An ACL, also known as a CCL or CrCL tear, is the same injury as seen in humans. When surgery isn’t an option due to age, health, financial reasons, or any other reason, OrthoPets can offer an alternative solution via a custom made orthosis. In Duke’s case, his owner chose an orthotic solution due to his age and opted to not put him under anesthesia for the corrective surgery most commonly known as TPLO (tibial plateau leveling osteotomy) or TTA (tibial tuberosity advancement). After we reviewed his case, it was decided that a standard stifle orthosis would be the best option for him at this time. Due to his age and therapeutic goals, a lower durometer (more flexible) hinge was installed on the lateral side along with a standard resistance hinge on the medial side to still provide stability and control but allow an easier range of motion. OrthoPets utilizes a number of different types of hinges and chooses the appropriate one for each patient based on a number of factors.

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Left: Duke’s fiberglass impression. Right: Duke’s stifle orthosis.

Once the device was fabricated, it was shipped to the clinic where the referring veterinarian was able to fit it properly and discuss with Duke’s owners the recommended break-in schedule. Duke had been wearing the device for a few weeks and had been going on longer walks and even playing catch with a Frisbee, but unfortunately he reinjured his right stifle likely due to high levels of activity. Our stifle orthosis when properly donned will control tibial thrust, but patient activity in and out of the device as well as environmental factors may play a role in progressive tears. For partial tears, an orthosis is just a portion of the patient’s overall treatment plan for achieving a “curative outcome.” Most partial CCL tear patients are receiving accompanying therapies in addition to the use of an orthosis, including laser therapy, PRP injections, shock wave, and a few others. The patient’s body requirements for healing are not changed with application of an orthosis.

After reviewing additional media and discussing an adjustment plan with the owner, we decided it would be beneficial to Duke for us to switch out his lower resistance hinge on the lateral side for a standard resistance hinge. The owners were weary of Duke being without his device, so they decided to order a “back-up” device for him. Sometime after completing the adjustments for the original device and sending out the back-up device, we followed up with the owner and received a reply email with an amazing update as stated below:

“Thank you so much for checking in! Duke is doing great – he loves the brace and it enables him to do all the things he loves to do! Hiking, Frisbee, ball, and just enjoying life. I am so grateful for your company creating such a wonderful alternative for dogs so they don’t have to go through surgery.”

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Duke, post-orthosis.

A year had passed after Duke had been using his device, and his mom reached out to us for a complete refurbishment of his devices, which is recommended every 1-2 years depending on environment and activity level in the device. We stripped the device down to the shell and added new foam, straps, and hardware to his device. After shipping them back out, his mom sent us another great email giving us kudos and letting us know how big of a difference we had made in Duke’s life. Her response was as follows:

“We just received Duke’s adjusted brace (actually yesterday) and it looks great!! Really wonderful – thanks so much!! I will be in the office on Tuesday and will send the other brace to you overnight (you will have it on Wed) for the refurb! Can’t wait – it’s really worn looking so it will be great to have it look nice again! We are so reliant on the brace for Duke – it’s really made it so he can do all the things he loves! 🙂 Thanks again!”

We here at OrthoPets are so happy to be able to offer an alternative solution to help so many people and their pets. We wish you all the best and enjoy hearing of the success your pet has with their devices!

Tiger the CCF Cheetah Scat Dog

Our Partner Vet, Dr. Ilana Strubel (who runs our OrthoPets Partner Clinic in San Francisco, A Well Adjusted Pet) recently took a safari trip in Africa. While she was in Namibia, she helped fit an OrthoPets elbow orthotic for Tiger, a Cheetah Scat detection dog for the Cheetah Conservation Fund. Dr. Strubel writes:

One of the most exciting parts of the visit to CCF for me personally was bringing a custom-made Elbow Orthotic (Brace) donated by my custom orthotics partner Ortho Pets in Colorado! I had pre-ordered the device for “Tiger” who is a Cheetah Scat Detection dog who had been injured and unable to perform his important work.

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Dr. Strubel places Tiger’s orthotic.

I first learned about “Tiger” (the best ‘Cheetah Scat Detection Dog’ in all of Namibia) at a lecture given by CCF Director, Dr. Laurie Marker at the Wildlife Conservation Network Expo last April. She mentioned that “Tiger” had broken his left front leg and that despite the best veterinary care available in Namibia, he was still too painful on the leg and he was no longer able to do his important work of detecting “black gold” = Cheetah Scat (fecal matter)!

 

 

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Handsome Tiger models his orthotic.

The Cheetah Conservation Fund (CCF) runs the scat sampling project through its Applied Biosystems Conservation Genetics Laboratory, with the aim to provide a non-invasive method of collecting DNA from animals. The genetics lab collects scat samples to help obtain genetic ID of individual cheetahs around CCF and it also helps determine the number of different cheetah represented in the samples. The samples are mostly collected with the aid of the scat-detecting dogs!

 

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Tiger with his caregivers and Dr. Strubel.

So far “Tiger” is acclimating well to his new elbow orthotic (Brace). The most recent progress report from his caregivers, William and Stephanie, is that he is adjusting to using the orthotic well, putting more weight on that leg again, and having less pain and lameness after he’s been in his brace. Our goal is to hopefully get him back out in the field doing what he loves most- sniffing for and finding wild Cheetah scat, and just being a sweet and goofy dog (playing fetch with his favorite object, lemons) without pain!!

 

To read more about why dogs are trained to find wild Cheetah Scat (fecal matter) click here: https://cheetah.org/blog/news-scat-dog-program/

 

You can get involved and help support the work of CCF here:
https://cheetah.org/you-can-help/

 

Overall, visiting southern Africa was simply AMAZING and helping Cheetah conservation in action by sharing my rehab skills in helping “Tiger” with his custom orthotic was equally exciting.

Thanks for the update, Dr. Strubel!

 

September 2017 OrthoPets Case Study for the Canine Rehabilitation Institute: Pirate

unnamed.jpgPirate, a Landrace cross pig, was rescued by a sanctuary in Canada. He had suffered either an unknown trauma or birth defect resulting in his tarsus being fused in a flexed position. Landrace pigs can grow to an estimated weight of 450-600 pounds for sows and 500-700 pounds for males. Pirate began his journey with us when he was 4 months old and still had a considerable amount of growing to do.

There are considerations in pursuing V-OP (veterinary orthotic and prosthetic devices) for patients who are not yet fully grown. Typically, the younger the patient, the smoother the transition to a device will be. This is due to less compensatory time. Many times, a supportive device can help reduce or prevent compensatory changes prior to them developing. However, the younger you begin a patient, the more likely it is for a patient to outgrow their device increasing the likelihood of multiple devices.

Pirate’s device required special consideration due to his size, age and the environment that he lives in. As he’s grown, his tarsus has also become more flexed. He received an accommodative tarsal orthosis that was designed to cradle his tarsus, metatarsals and hoof. The device utilizes a “runner” for him to easily maneuver whether on grass or while wallowing. His device was also designed to accommodate some circumferential growth and featured extra foam liners that can be removed as he grows. Pirate took to the device right away.

Now on his third device due to growth, Pirate continues to do well. The sanctuary plans to continue use of the orthosis for the rest of his life. He has regained his quality of life and is able to spend his days wallowing with the other pigs on the sanctuary.

August 2017 OrthoPets Case Study for the Canine Rehabilitation Institute

OrthoPets Case Study: Kaia 

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Fitting Kaia’s prosthetic.

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.

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Pre-procedure radiographs.

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.

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Post-procedure radiographs.

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!

July 2017 OrthoPets Case Study for the Canine Rehabilitation Institute

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.

Initial radiographs prior to the initial device

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.

Initial Device

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.”

 

Recheck radiograph prior to sports brace conversion.