Limb Amputation

Limb amputations are performed for various reasons. The most common method for removing a damaged or diseased limb in dogs and cats is where the limb meets the body. This is to prevent any remaining portion of the leg from becoming a problem for the pet. Any portion of a limb that remains may become traumatized during daily activities or interfere with movement. 

Partial limb amputations and prosthetic (artificial limb) use in pets are a new treatment option for some patients. As with other procedures, this is not a good option for all pets and all owners. Stump management and prosthetic use require diligent daily care and attention. Some animals may need several prosthetics over their lifetime. 

Amputation may be recommended because of cancer, severe trauma, or a birth defect that has resulted in a non-functional leg. Other indications for amputation are a painful leg not responding to treatment, a limb not being used, or a limb with a wound or fracture that cannot be fixed. 

Your primary care veterinarian and/or an ACVS board-certified surgeon may recommend additional diagnostics before a limb amputation. It will depend on the reason for the amputation and the age and overall health condition of your pet.

• Blood work—complete blood count, chemistry, and urinalysis. Used to evaluate the overall health of your pet before surgery.
• X-rays—of the limb to be removed, the one on the other side to make sure it can support the extra weight, chest or abdominal films to make sure there are no signs of cancer.
• Advanced imaging– such as a CT scan or MRI may be needed to evaluate the underlying issue and ensure that amputation is the best recommendation.

Further consultation with your veterinarian may result in a referral to a ACVS board-certified surgeon to fully explore your options.

For the front leg, the most successful and cosmetic amputation is by “scapulothoracic disarticulation”—the entire limb is removed from the toes to the scapula (shoulder blade). Since the normal anatomy of the front leg only has muscles that attach the front leg to the chest wall, it is straightforward to remove the limb by cutting these muscles and sewing the area closed. This complete removal creates a smooth, well-padded amputation site on the side of the chest that will not get pressure sores or interfere with movement in anyway.

For the rear leg, there are two main techniques that are commonly used. The first is a “high femur” amputation that results in a short, well-padded stump at the level of the rump/thigh. The muscles of the mid-thigh are cut and the femur (thighbone) is cut close to the hip. When the tissues are sewn together, this provides good padding for the pelvis when the pet is lying down and offers a cosmetic appearance by maintaining symmetry of the rump area. The second technique is often used when the disease of the rear leg is in the thigh area; the leg is removed at the hip joint, only the pelvis and the surrounding muscles remain. This amputation technique is very successful as well, with slightly less padding over the amputation site and a less symmetrical appearance.

A third, less commonly, used procedure for hindlimb amputation (typically used for tumors in the upper part of the thigh, hip or pelvis) is a limb amputation with hemipelvectomy, in which part of the pelvis is removed as well.  This procedure does change the symmetry of the rump more than other procedures but is well-tolerated.

Most pets are discharged within one to two days after amputation, depending on their comfort and ability to walk after surgery.

Your pet will come home with oral pain relievers. Adhesive fentanyl patches are used for some patients as well. Some patients may also receive antibiotics after surgery at home. Your pet may be discharged with a bandage at the discretion of your surgeon. An Elizabethan Collar is used in the first 10–14 days to prevent licking or chewing of the incision.

Exercise restrictions following surgery are recommended to protect pets from injury while they gain strength and coordination after amputation:

• Your pet should be kept in a comfortable, safe indoor location for 24–48 hours until they are very steady on their feet. Do not allow free access to stairs or slippery floors.
• Sling support can be helpful to assist your pet to rise and balance, especially on slippery or uneven surfaces. For front leg amputees, a sling is placed under the chest. For back leg amputees, a sling is placed under the belly.
• Avoid any rigorous activity for four weeks. Short, leashed walks are fine.
• Cats may have trouble getting into litter boxes with high sides while they are recovering. It is recommended to provide a litter box with low sides until they are more comfortable navigating after an amputation.
• Cats with hind limb amputations may not be able to jump as well immediately after surgery, so they should be supervised around areas that they normally would have jumped to ensure they don’t injure themselves
• It is important to encourage your pet to stand and walk for increasing amounts of time. They will have to build confidence in their mobility over time.

Complications:

• Incisional bruising is common but should improve after several days
• Seroma, or fluid under the skin, may develop near the bottom of the incision in the first two weeks
• Infection
• Neuroma formation:  Very rarely, nerves that have been cut for amputation will form little masses of nerve tissue that can be painful.  This may require additional surgery or pain medication
• Hernia formation (rare with hemipelvectomy)
• Bleeding

Human amputees report phantom pain after amputation. Pain at an amputation site is not common in animals. 

The functional prognosis for animals after amputation is considered very good. The majority of animals return to a high level of activity and endurance for their age. Following the recovery period, there are no recommended limitations to their lifestyle. 

Rear limb amputees tend to return to near normal mobility; forelimb amputees need to adjust their gait more significantly. For the older pet, learning to move after an amputation may take more time. 

Ideally, keep your pet on the thin side of normal their whole life. Any minor orthopedic condition can progress with arthritis over time with excessive wear and tear; carrying less body weight will reduce the energy they must use and will relieve some of this stress on the joints of the remaining three limbs.