leg amputation - options?

Re: leg amputation - options?

Evelyn Barbour-Hill — Fri, 13 Mar 2015 20:58:05 GMT

[quote user="Henry L'Eplattenier"]the head of the femur is in contact with the body of the ilium and even small movements are likely to cause erosion of the articular cartilage and exposure of the subchondral bone where there are pain receptors.[/quote]

Thank you.

Re: leg amputation - options?

Henry L'Eplattenier — Fri, 13 Mar 2015 16:52:17 GMT

My thought process was the following: After craniolateral coxofemoral luxation, the head of the femur is in contact with the body of the ilium and even small movements are likely to cause erosion of the articular cartilage and exposure of the subchondral bone where there are pain receptors. I do not know how significant this is clinically after a mid-femoral amputation, but why take any chances when the hip luxation can quite easily be resolved in the same surgical procedure?

Re: leg amputation - options?

Martin Atkinson — Thu, 05 Mar 2015 11:33:29 GMT

[quote user="Rob Davis"]why would there be ongoing pain from the hip post-amputation? I am happy to be corrected if this is wrong, but does anybody have experience of this?[/quote]I presume that that animal will instinctively attempt to move the limb when it walks and therefore this may cause pain. However given that many animals seem to settle down after a while with a dislocated hip forming a false joint and coping quite well this could equally be presumed to be temporary. Nonetheless I would stick to my original assertion that total limb amputation is actually no more technically demanding that partial amputation and will result in a better cosmetic appearance with less risk of post-op complications.

Re: leg amputation - options?

Hannah Wynne Richards — Thu, 05 Mar 2015 10:04:29 GMT

Thanks for starting this thread. I now know that in this scenario, I should ligate the femoral artery just above the fracture site (where I'm experienced at doing so) then shell out the femur. Useful thread.

Wynne

Re: leg amputation - options?

Rob Davis — Thu, 05 Mar 2015 08:34:20 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Henry L'Eplattenier"]I would expect the luxated hip to be painful[/quote]

Why? By the time the pain from the amputation has gone, will not also the pain from the hip joint? It's not being required to bear weight, or even to move at all.

This is not a rhetorical question, it's a genuine request for knowledge, as you can see since I have already supported Utlendigur's recommendation.

[/quote]

I agree with Evelyn - why would there be ongoing pain from the hip post-amputation? I am happy to be corrected if this is wrong, but does anybody have experience of this?

Re: leg amputation - options?

Kerry Peak — Wed, 04 Mar 2015 18:50:51 GMT

Thank you to everyone for the replies.

In the end we decided to remove the entire limb. We thought that the luxated hip would probably cause a certain amount of discomfort (just because it's not in the right place really!) so thought this was the best option for the cat. He is doing really well and was immediately more comfortable post op :)

Thanks again

Re: leg amputation - options?

Evelyn Barbour-Hill — Wed, 04 Mar 2015 18:28:52 GMT

[quote user="Henry L'Eplattenier"]I would expect the luxated hip to be painful[/quote]

Why? By the time the pain from the amputation has gone, will not also the pain from the hip joint? It's not being required to bear weight, or even to move at all.

This is not a rhetorical question, it's a genuine request for knowledge, as you can see since I have already supported Utlendigur's recommendation.

Re: leg amputation - options?

Martin Atkinson — Wed, 04 Mar 2015 16:20:36 GMT

I have found that total limb amputation is a lot less technically demanding that partial amputation and I am no orthopaedic surgeon. There is a still a bloody big artery to avoid whichever way you do it. Just go carefully and apply surgical first principles. It is a lot easier to close the wound with less risk of post op complications as well.

Re: leg amputation - options?

Henry L'Eplattenier — Wed, 04 Mar 2015 12:19:49 GMT

Sorry, coming in a bit late on this one. You may have already done the operation.

I would expect the luxated hip to be painful even if the limb has been amputated and would therefore disarticulate the hip joint as Utlendigur suggests, since it is only slightly more time consuming than a mid-femoral amputation. The dissection on the medial side of the joint is similar to a mid-femoral amputation (including the ligation of the femoral artery), but on the lateral side, you will not need to cut through most of the quadriceps as it has its origin on the femur, but you will need to cut through all muscles attached to the greater trochanter (the gluteus group) and the trochanteric fossa (the rotator muscles), as well as the minor trochanter (iliopsoas) staying close to the bone as Utlendigur mentioned.

I hope this helps. Good luck with the case!

Re: leg amputation - options?

Evelyn Barbour-Hill — Sat, 28 Feb 2015 15:56:37 GMT

I'm sure Utlendigur's suggestion is best (I wonder if it would give the best cosmetic result too?); but, my first thought on the original post was....... if you do a normal careful mid-femoral amputation just above the fracture, does the continued existence of the luxated hip actually matter?

Re: leg amputation - options?

Hannah Wynne Richards — Sat, 28 Feb 2015 11:20:09 GMT

I get what you mean now. I was thinking about the difficulty of ligating the artery at the top. Your method sounds much better.

Arlo Is it possible for you to give CPD certs?

Wynne

Re: leg amputation - options?

Gillian Mostyn — Sat, 28 Feb 2015 11:06:53 GMT

Agree with Utlendigur. That method, where a lot of the proximal soft tissues are preserved but the whole femur is removed, will lead to a better aesthetic result and some 'padding' around that side of the pelvis.

Re: leg amputation - options?

Utlendigur — Sat, 28 Feb 2015 10:18:17 GMT

I would ligate the femoral artery as you would for a normal amputation - blunt dissection on medial side to expose it where it lies subcut proximally. Then incise through the muscles as you would for a normal proximal femoral amputation but "fillet out" the whole length of the proximal femur keeping close to the bone all the way. It isn't that difficult, especially if the femoral head is already luxated.

Re: leg amputation - options?

Hannah Wynne Richards — Sat, 28 Feb 2015 09:47:03 GMT

I'd be worried about ligating the femoral artery at that level. I think I'd sooner amputate the femur, above the fracture, and then remove the femorsl head. Not ideal, as I'd worry about blood supply to the remaining femur. Where are the surgical bods?

Wynne

Re: leg amputation - options?

Anthony Dennison — Sat, 28 Feb 2015 09:10:37 GMT

So all the injuries are on the same leg? Could you just amputate the leg including the femoral head?