Amputation – post-operative care

There are a number of reasons which may necessitate the removal of an animal’s leg. The two most common of these are severe trauma, for example after a road traffic accident, or as management of a leg cancer.

As a general rule, cats cope far better with amputation than people imagine they will. Humans of course only have two legs, so losing one leg means a reduction to only one. Cats have four legs so losing one still leaves them with three.

©David Godfrey

Owners often assume that cats experience the same emotions as we do, this may not be true in all circumstances. However, we do know that cats are supremely good at adapting to new situations. Vets with the most experience of managing cats who have undergone amputation consistently report that these animals do not show any signs of an emotional disturbance. Most cats that have a leg amputated do so for relief of a severe, often life-threatening, illness. Almost invariably these patients have an extremely painful condition affecting the leg that is to be removed. In many cases the patient is immediately happier and more relaxed after amputation.

It is extraordinary how quickly most animals become mobile after amputation of a leg. Patients that have no other mobility issues, for example osteoarthritis, should be mobile within their kennel within 24 hours of the operation. Young cats can be expected to start walking on three legs after only 12 hours.

Following amputation your cat will usually stay in the hospital for a few days after surgery. The veterinary team will need to examine the patient regularly to ensure the wound is healing properly and to provide appropriate pain relief. During this time the patient will make their early adjustments to being three-legged. Within three days of surgery most cats would be able to jog for 5-10 meters.

For two weeks after surgery the cat’s exercise will need to be significantly restricted to allow the surgical wound to heal. During this time, patients should be allowed to potter about a garden or have lead exercise for a maximum of 5-10 minutes at a time for toilet purposes. The cat will begin to adjust and to train their muscles for moving in a different way.

Once your cat returns home after amputation they will have a large shaved area, with a line, or lines, of stitches or staples where the operation was performed. Often there is substantial bruising under the skin where blood may have trickled during surgery. This is not painful, like a normal bruise.

Surgery of course would be painful if appropriate pain-relief was not administered. Your veterinarian will probably prescribe a strong pain-killer, such as methadone, in combination with non-steroidal anti-inflammatory pain-killers. These drugs will normally be given before surgery to stop pain developing and then are continued after surgery. Typically the strong pain-killer is given for one to three days while the non-steroidal anti-inflammatory pain-killer is given for one to two weeks and therefore is continued at home once the patient has been discharged from the hospital. In some institutions additional pain relief is also provided using a local anesthetic in the surgery site before surgery and for one to three days afterwards. This adds even further to the comfort for the patient.

Patients whose pain relief strategy is well thought-out and well-managed are very comfortable throughout.

Phantom limb pain is a debilitating condition affecting some human amputees. They experience an extremely uncomfortable pain which their brain tells them affects the leg or arm that is no longer present. Importantly phantom limb pain has never been reported in animals. Clearly we could not rely on animals telling us that they are experiencing phantom leg pain for a diagnosis to be made, but if cats were in pain after the operation they would show some signs of this.

Owners should not expect to have to perform any significant wound management. You should check the wound every day to look for signs of inflammation or soreness. These include redness, swelling, heat, discharge and pain. This is because there is a risk of post-operative bleeding or infection with any operation and prompt recognition of the signs of either of these can mean that the consequences for the patient can be minimized. If you are concerned about the appearance of your cat’s wound you should make contact with your veterinary team. It is better to ask and to find that there was nothing to worry about than to leave something and then learn you should have acted sooner.

Some cats are far from active before amputation and this does not change after surgery. The only modifications that might be necessary for them to enjoy a perfectly good quality of life might be to simply ensure that their favorite bed is removed from the sofa and onto the floor so that they do not encounter difficulties getting into it. More active cats may require a little more imagination on the part of their owner to ensure that they can still enjoy a high perch in the house or garden. In the immediate short term, a few weeks after surgery, stools or boxes can be used as steps to assist the cat in climbing onto a favorite spot on the bed or the lounge furniture. Once they are more agile, some owners will construct imaginative wooden ramps that might provide a safe route from the ground to a favorite perch on the roof of a shed in the garden for example.

In most cats exercise is restricted for the first two weeks after surgery. During this time they adapt perfectly well to being three-legged and by the end of the two weeks they would be able to move satisfactorily about a single floor of the house. Slim cats without other complicating factors, such as other injuries, will be able to navigate up and down stairs after two weeks. Obese cats take longer to adjust; this may in part be a motivation issue. Both for their own emotional well-being and for the health of their remaining limbs, weight loss is a very important factor in their further management.

There is no doubt that once a patient has undergone amputation, the leg on the other side of the body has to do the work of two. Your cat will need to adjust the way it stands and moves and this results in a degree of redistribution of weight-bearing. Muscle or tendon injuries are exceptionally rare in amputees. Obese cats do have an increased risk of suffering other complicating medical complaints such as diabetes mellitus. Weight loss is a critical part of the post-operative management of obese feline amputees.

There are some patients who are simply not good candidates for amputation. In cats one should give consideration to the impact that amputation would have on their usual lifestyle and whether this would cause a significant emotional disturbance. Some cats derive their only pleasure from sitting on top of the shed roof. If they cannot realistically be expected to do this again, amputation might not be appropriate.

Osteoarthritis is frequently listed as a reason for not performing amputation but there are exceptionally good medications for arthritis and in the view of this author, arthritis alone does not constitute a valid reason for choosing not to perform amputation, particularly since the conditions we are treating by amputation are typically intractably painful and this pain can be cured by a single surgical procedure.

In order for a cat to cope well after amputation they do need to be able to adapt to life on three legs. Cats with spinal problems are usually unable to do this. Obese cats and cats that have diabetes mellitus are not good candidates for amputation but this does not mean they should not have surgery if it is required. However, it is critical that the veterinary team and the owners in such cases appreciate the importance of weight control or diabetes management.

It is sadly true that cancer is one of the reasons for considering amputation in cats. Some cancers of the bones do spread (metastasis) prior to the diagnosis of the lameness and many are actually spread from other body areas. Surgery must not therefore be regarded as a cancer cure.