amputate or fix?

Re: amputate or fix?

CatherineThomas — Wed, 19 Sep 2012 21:27:16 GMT

Sorry I didn't fully explain the case it was more of a musing rather than asking for advice about the case.

We anaesthetised the cat yesterday and took x-rays which were emailed to our local orthopaedic referral centre for their opinion. She was also given plenty of pain relief. The luxation is between the distal tarsal bones and the metatarsal bones. The opinion given was that arthrodesis was the only viable thing to do, or amputation if the owner couldn't afford the referral fees. After discussing these options with the owner they decided that they would take her to the referral centre for surgery. There was never any intention to treat this case medically apart from the immediate first aid until surgical treatment can be arranged.

I've never had to refer a paient for arthrodesis before but most other cases which I have referred for orthopaedic proceedures have had instructions for cage rest on discharge so I was assuming that this would be the same for an arthrodesis. I was also thinking that there would be some post operative pain even if pain relief was given. I have had orthopaedic surgery before and I was given plenty of pain relief but it was still painful for a good while after the surgery.

Re: amputate or fix?

Hannah Wynne Richards — Wed, 19 Sep 2012 08:53:06 GMT

Thanks Malcolm

Wynne

Re: amputate or fix?

Malcolm Ness — Wed, 19 Sep 2012 08:29:06 GMT

[quote user="CatherineThomas"]We had a cat in today with a very unstable hock joint with luxation of the tarsal and metatarsal bones. So the options I gave to the owner were referral for arthrodesis or amputation.[/quote]

I am confused by this and much of the subsequent thread.

Both amputation and arthrodesis are salvage procedures yet the implication here is that they are being advised before accurate diagnosis and specifically the consideration of either primary repair or the passage of time and pain control.

Hock luxation implies luxation of the tibio-tarsal joint and almost always occurs without significant involvement /damage of the tarsal or metatarsals or their joints. Furthermore, many hock luxations in cats are associated with malleolar fractures that can be repaired effectively and inexpensively. Hock arthrodesis (pan-tarsal arthrodesis) is a major, though effective bit of surgery in cats - pain control will be profound and limb function, though impaired is acceptable - certainly better than the tripod gait. However, pan-tarsal arthrodesis is not something that we need to do very often in cats and most "other" luxations around the hock (inter-tarsal or tarso-metatarsal) can be effectively treated by localised, relatively minor arthrodesis and in those cases, pain control is complete and the limb function will be normal or very near normal.

I very rarely "cage rest" patients after orthopaedic surgery for more than a day or two. Any arthrodesis that results in "[activity] restriction and pain" for the cat has, by definition, failed.

[quote user="CatherineThomas"]Are we really doing things like this in the cat's best interest or are we allowing human emotion to cloud our judgement?[/quote]

Things like what?? I would venture that very, very much more suffering is caused to those patients whose vet perseveres with medical management of joint chronic disease without considering/discussing/offering surgical options.

Re: amputate or fix?

Luciano Nebiante PGCertSAS — Tue, 18 Sep 2012 23:13:53 GMT

Regardless of human emotion, and acting in the best interest of the cat, then the two options are both salvage procedures, so I would help the owner taking an informed decision, once I know more about the cat itsef, like age, other health problems, life style, indor\outdoor and so on.

Also the onset of DJD will be earlier in life in either procedure I think. But are you aware of any difference between amputation and arthrodesis regarding the DJD in the controlateral limb (spare one)?

Re: amputate or fix?

Michael Woodhouse — Tue, 18 Sep 2012 13:29:10 GMT

[quote user="Hannah Wynne Richards"]

Sorry Micheal I interpreted your post as not offering referral Please accept my apologies

Wynne

[/quote]

No bother

Re: amputate or fix?

Hannah Wynne Richards — Tue, 18 Sep 2012 13:28:02 GMT

Sorry Micheal I interpreted your post as not offering referral Please accept my apologies

Wynne

Re: amputate or fix?

Michael Woodhouse — Tue, 18 Sep 2012 13:04:56 GMT

[quote user="Hannah Wynne Richards"]Micheal Give me one (I'm only asking for 1 ) sound CLINICAL reason for not arthrodesing[/quote]

If it was a client I would offer them referral, no question. I don't force my views onto clinets.

The OP asked:[quote user="CatherineThomas"] The owner then asked me if both operations cost the same amount of money which one would I go for if it was my cat.[/quote]

To me the cost is irrelevant - it is not something I would want to put a cat of mine through to preserve its leg. It is more painful and a much more prolonged recovery. After an amputation I'm happy letting most cats back outside at stitches out. I wouldn't want a house cat.

There's a lot of things we can do, but some of them don't sit very comfortably with me (I'd have euthanased the entire neuro ward @ college, £5000 later and we will still need to fit your dog with wheels..........).

Re: amputate or fix?

Hannah Wynne Richards — Tue, 18 Sep 2012 12:27:03 GMT

Micheal Give me one (I'm only asking for 1 ) sound CLINICAL reason for not arthrodesing Please,please, please don't say cost , because not all owners are cost concious-and you have no right to deny the best clinical treatment just because you think it's too expensive It's not your business, so don't try to make it your business

Wynne

Re: amputate or fix?

Rajat — Tue, 18 Sep 2012 12:02:10 GMT

I would arthrodese - cat will find it easier to deal with 4 legs one of which has a limited range of motion rather than 3 legs.

Cats do well with 3 legs, better yet with 4 !

Re: amputate or fix?

Michael Woodhouse — Tue, 18 Sep 2012 11:15:32 GMT

I'd amputate. If it was a simple fracture then fix it, but if it was my cat I'd not send it away from an arthrodesis.

Re: amputate or fix?

Hannah Wynne Richards — Tue, 18 Sep 2012 10:37:22 GMT

Definitely arthrodesis is best , as Roboxley wrote amputation leaves the cat with no spare

Wynne

Re: amputate or fix?

Rob Loxley — Tue, 18 Sep 2012 08:38:04 GMT

[quote user="CatherineThomas"]Considering the fact that cats do so well with 3 legs[/quote]

but then they've used up their spare...

Re: amputate or fix?

Glenn Hodgson — Tue, 18 Sep 2012 08:09:52 GMT

It would certainly be better for the cat to arthrodese if the other leg is due to suffer a similar problem.