Hind Limb amputations
What is a Hind Limb Amputation?
A hind limb of a dog or cat can be removed for a number of reasons; but the most common are neoplastic conditions, and fractures and/or other traumas that are not readily manageable otherwise. Irreversible nerve damage to the limb and congenital malformations may also be managed with an amputation.
Situational Awareness
In small animal general practice it is not uncommon to amputate hind limb because of a fracture. The truth is that most fractures are readily reparable but often require specialized training and instrumentation in order to do so. This type of advanced surgical treatment may not be available to all clients for a variety of reasons. Therefore, in this type of scenario, the amputation can be a life saving procedure.
A hind limb can be amputated at one of 3 levels. (1) The mid femoral is the most common and easiest of the 3 hind limb amputation procedures. A patient with a tibial fracture that can not be surgically repaired, should still undergo a mid- femoral amputation; as this is more esthetically pleasing and is associated with much fewer stump complications. (2) The disarticulation amputation involves removing the hind limb at the level of the coxofemoral joint. This surgery is exponentially more difficult than the mid femoral amputation. (3) The hemi or semi pelvectomy is the most difficult of the three surgeries.
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Get ready to Perform a Hind Limb amputation
All the information you need.
Fully narrated surgical videos.
In depth guide and more.
Pre-Surgical Considerations
Pick the appropriate level of amputation:
- A mid femoral amputation is appropriate for most hind limb conditions
- Fractures of the proximal third femur and distal
- Neoplasms that are at/or distal to the stifle (tumour dependent)
A disarticulation amputation is appropriate for
- Fractures of the femoral neck or coxofemoral joint
- Neoplasms located in the mid to distal femur or the stifle (tumour dependent)
A hemi/semi pelvectomy is appropriate for:
- Neoplasms in the proximal femur including the coxofemoral joint (tumour dependent)
- If the patient is using the limb well (perhaps the amputation is for an aggressive subcutaneous soft tissue sarcoma), consider placing them in an Ehmer sling for 3-4 days prior to the surgery so that they can learn to ambulate on 3 limbs prior to the surgery
What the client needs to know:
- Dogs and cats can get around quite well with a hind limb amputation; even the large breeds.
- The cost of the procedure isaThey may want to make changes to their home to accommodate their pet, especially in the early days as the pet is adjusting proportional to the amount of tissue damage.
- Have non-slippery surfaces for the pet to ambulate on
- Lower the bed/couch/favorite chair by removing the legs (on the furniture, of course)
- Have a harness to assist the pet in the first days (especially the bigger dogs) when handling stairs
- Consider unplugging the doorbell if the dog reacts excitedly when it rings (at least for the early days)
Step by Step Mid femoral Amputation:
- Figure 1
Make a clam shaped incision on the medial and lateral sides of the distal thigh (if possible depending on reason/level of problem).
- Figure 2
Isolate the Biceps femoris muscle and divide in the distal third of the limb (if possible, as above).
- Figure 3
Isolate and divide the quadriceps muscles in the distal third of the limb. Often easiest to isolate the Vastus lateralis and Rectus femoris together and then the Vastus medialis and intermedius together.
- Figure 4
The Semitendinosus and then the Semimembranosus are isolated and divided.
- Figure 5
The adductor is elevated off the mid to proximal third of the femur and then isolated and transected. Once this is done, the femur is cut at the desired location (mid to proximal third).
- Figure 6
The femoral artery and vein are located just medial to the femur, they are isolated, ligated (double or triple depending on size of patient) and divided.
- Figure 7
The medially located Gracilis muscle is now isolated and transected. Note that some of the smaller muscles (Sartorius, Pectineus) were not shown here; but suffice it to say that all muscles must be isolated and transected.
- Figure 8
Close by apposing opposing muscles using large mattress sutures ensuring that the bone end is well covered. Follow with the subcutaneous and skin layers. A drain is rarely needed.
Get ready to Perform to Hind Limb amputations
Preferred instrumentation:
- Have an abundance of small mosquito hemostats.
- The larger the patient, the more hemostats you should have.
- A patellar saw, hobby saw or a gigli wire can be used to cut the femur.
Post-op expectations:
- Drains are rarely necessary with this procedure.
- Manage their pain, especially for the first 24-48 hours. It diminishes rapidly after that time frame.
- Help with support (belly towel or chest harness) for the first few walks.
- Have non-slippery surfaces for them move on especially in the early days.
- Use antibiotics as indicated by the conditions and/or length of the procedure.
What you get when you register:
- The best way to be more confident when doing this procedure is to have an experienced surgeon looking over your shoulder guiding you and encouraging you.
- The information in this virtual workshop is the next best thing. Surgery is more than following a step-by-step pictorial description. It is important to be comfortable with the anatomy of the area. We will help you understand the relevant anatomy from a surgical perspective.
- There are fully narrated videos; (1) is a narrated presentation that explains when and how to do the surgery, how to select your cases and managing the patient post-operatively. There are narrated videos of mid-femoral amputations performed on a cadaver, so it is easy to see the details; and on a patient, so you can appreciate how it really looks. There are also videos on the disarticulation surgery as well.
- If you do plan on doing this surgery; have an anatomy book close at hand! When you watch the video, listen carefully to my words, I give a lot of little details that will help make the surgery easier for you. You will see how to handle the instruments and the tissues. Watch/listen to the video several times so that when you are in surgery you will continue to hear my voice.
Q & A
How well can a dog or cat get around with a hind limb amputation?
Cats and dogs can do extremely well with a hind limb amputation. They will continue to be active and go on walks with their owners.
Can I still exercise my dog after a hind limb amputation?
Yes of course and the owners should. They may have to mitigate the level of activity to accommodate their pet, especially in the beginning but at the pet becomes better adjusted and has developed appropriate musculature in the supporting limbs then they can explore what the new limits may be (or not!).
Workshop Content
Informational Session: Indications, Levels, Post-op Care
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Informational Session: The Mid-Femoral Amputation
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Surgical Procedure: Right Mid-Femoral Amputation on a Canine Cadaver
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Surgical Procedure: Left Mid-Femoral Amputation on a Feline Patient
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Informational Session: Disarticulation
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RIGHT Coxofemoral Disarticulation Amputation in a Cat
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LEFT Coxofemoral Disarticulation Amputation in a Cat
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Cadaver Disarticulation
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Reference Material
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Hind Limb Amputations – Quiz.
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