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Veterinary Forum September 2008 (Vol 25, No 9)

Cutting-edge prosthesis gives canine amputee a leg up

by Liz Donovan

    Raleigh, N.C. A groundbreaking surgery performed at North Carolina State University will allow a dog with an amputated leg to once again walk on all fours.

    Denis Marcellin-Little, DEDV, CCRP, DACVS, DECVS, associate professor of orthopedics at NC State and founder of Animal Rehabilitation and Wellness Hospital in Raleigh, and Ola Harrysson, PhD, associate professor of industrial and systems engineering, implanted an osseointegrated prosthetic limb to replace the right hindlimb of Cassidy, a male German shepherd mix. The dog's leg had been partially amputated at the junction of the proximal and middle thirds of the tibia, Marcellin-Little told Veterinary Forum.

    This is not the first time that Marcellin-Little and Harrysson have used the osseointegration technique — a process in which a prosthetic limb is fused with bone . In 2005, the pair successfully performed the procedure on a cat that had been born without the lower half of its hindlimbs. Since that time, an additional cat has undergone the procedure.

    Cassidy was considered a candidate for this surgery after an attempt to build an external prosthesis was unsuccessful. The owner, however, still wanted Cassidy to have the opportunity to walk on all fours.

    "Owners of large three-legged dogs report that while their dogs appear to have an acceptable quality of life, their mobility is negatively impacted by the absence of a limb," said Marcellin-Little. "We also see orthopedic problems in the remaining forelimb or pelvic limb that are challenging to treat."

    To perform the procedure, Marcellin-Little and Harrysson made a custom implant based on a computed tomography scan of the patient. "A three-dimensional rendering of the bone and skin is made, and the prosthesis is built to match the surface of that bone, with separate porous portions for bone, fascia and subcutaneous and skin ingrowth," explained Marcellin-Little, who added that he rehearsed the procedure several times on a replica of the dog's tibia before performing it.

    Cassidy was released 24 hours after surgery, and the healing process is anticipated to take several weeks. During that time, the owner must keep the skin"implant interface clean and prevent Cassidy from licking his limb, Marcellin-Little said. In addition, it will be necessary to monitor Cassidy for signs of infection or indications that the prosthesis is failing to fixate.

    In approximately 3 months, a prosthetic foot will be connected to the prosthetic limb.

    The success of Cassidy's surgery makes Marcellin-Little confident that osseointegrated pet prosthetics could become a standard of care for dogs and cats in the future.

    "With advances in technology and implant design and fabrication, custom implants are becoming a more realistic option for patients with complex orthopedic problems, such as amputations of the distal portions of the limbs and bone defects after trauma or tumor removal," he said. "However, the fabrication of such complex custom implants continues to present challenges that we are overcoming."

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