Use of intra-articular administration of ethyl alcohol for arthrodesis of the tarsometatarsal joint in healthy horses

OBJECTIVE: To evaluate the efficacy and safety of intra-articular administration of ethyl alcohol for arthrodesis of tarsometatarsal joints in horses. ANIMALS: 8 healthy female horses without lameness or radiographic evidence of tarsal joint osteoarthritis. PROCEDURE: In each horse, 1 tarsometatarsal joint was treated with 4 mL of 70% ethyl alcohol and the opposite joint was treated with 4 mL of 95% ethyl alcohol. Lameness examinations were performed daily for 2 weeks, followed by monthly evaluations for the duration of the 12-month study. Radiographic evaluations of both tarsi were performed 1 month after injection and every 3 months thereafter. Gross and histologic examinations of the tarsi were undertaken at completion of the study. RESULTS: Horses had minimal to no lameness associated with the treatments. Radiography revealed that 8 of 16 joints were fused by 4 months after treatment, with significantly more joints fused in the 70% ethyl alcohol group. Fifteen of 16 joints were considered fused at postmortem examination at 12 months. Gross and histologic examinations revealed foci of dense mature osteonal bone spanning the joint spaces. Bony fusion appeared to be concentrated on the dorsolateral, centrolateral, and plantarolateral aspects of the joints. Significant differences were not detected between treatment groups for lameness or pathologic findings. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of ethyl alcohol into the tarsometatarsal joint of healthy horses appeared to facilitate arthrodesis of the joint in a pain-free manner. Results warrant further investigation into the potential use of ethyl alcohol in horses clinically affected with osteoarthritis of the tarsometatarsal and distal intertarsal joints.     

Surgical arthrodesis of distal tarsal joints in 17 horses clinically affected with osteoarthritis

Objective To evaluate the outcome of 17 horses that underwent surgical arthrodesis of the tarsometatarsal and distal intertarsal joints for treatment of lameness due to osteoarthritis.
Design Retrospective clinical study using client-owned animals.
Procedure Horses with hindlimb lameness were diagnosed with osteoarthritis of the distal tarsal joints following relief of lameness after intra-articular anaesthesia or intra-articular corticosteroid injection. Surgery to stimulate ankylosis was performed on 27 hocks by placing 3 diverging 3.2 mm drill holes approximately 3 cm through the tarsometatarsal and distal intertarsal joints from the medial aspect of the limb. The results of surgery were assessed by postoperative examinations, telephone communication with clients and analysis of race results.
Results In 71% of horses, surgery was considered to be successful as determined by clinical examination or telephone communication with clients: six of these horses had unilateral surgery and six had bilateral surgery. This represented 85% (6/7) of horses undergoing unilateral surgery and 60% (6/10) of horses having bilateral surgery. All (8/8) racing Standardbreds and 67% (4/6) of racing Thoroughbreds were considered a success. The average time between surgery and a return to racing was 9.5 months.
Conclusions The surgical technique used here can provide resolution of lameness from osteoarthritis of distal tarsal joints with a success rate similar to other reported surgical arthrodesis techniques that are more invasive and have a greater morbidity.     

Treatment of Carpometacarpal Osteoarthritis by Arthrodesis in 12 Horses

Objective— To evaluate arthrodesis as a treatment for carpometacarpal joint osteoarthritis (CMC‐OA). Study Design— Case series. Animals— Horses (n=12) with CMC‐OA. Methods— Arthrodesis was facilitated by insertion and fanning of a drill bit into the CMC joint at several (3–5) locations in 15 limbs. Follow‐up radiographs were obtained for 7 horses (9 limbs). Outcome was determined by telephone survey of owners based on postoperative pain, return to use, appearance of the limb, and success of treatment. Results— Postoperative pain was slight or moderate in 10 of 12 (83%) horses during the first 30 days, and 11 of 12 (92%) horses were markedly improved by 6 months and capable of returning to work. Radiographically 6 CMC joints had a bony ankylosis at follow‐up whereas 3 did not (mean 8.7 months). On long‐term follow‐up (mean 28.6 months) all horses had reduced severity of lameness, 10 of 12 (83%) were considered “sound,” 8 (67%) returned to their original activity, and all owners considered arthrodesis highly successful as a treatment. Conclusion— A drilling technique that produced CMC arthrodesis, allowed most horses to return to their original activity and was considered successful by all clients. Clinical Relevance— Arthrodesis of the CMC joint should be considered a treatment option for CMC‐OA.     

Evaluation of ethyl alcohol for use in a minimally invasive technique for equine proximal interphalangeal joint arthrodesis

Objective: To determine whether intra‐articular 70% ethyl alcohol alone (IAEA) or in combination with 2 percutaneously placed transarticular lag screws (EA‐TLS) would result in arthrodesis of the equine proximal interphalangeal (PIP) joint. Study Design: Experimental. Animals: Healthy horses (n=6), aged 1.5–3 years, free of lameness, diagonally paired front and hind PIP joints. Methods: Six milliliters 70% ethyl alcohol was injected into randomly selected diagonally paired front and hind PIP joints. Thirty days later, 2 parallel 5.5 mm cortical screws were inserted in lag fashion across the hind PIP joints and the limbs were cast. Horses were confined for 60 days after surgery before free exercise was permitted. Serial lameness examinations were performed at 1, 6, and 10 months. Radiographs of the PIP joints were obtained before injection with alcohol (front, hind PIP joints), at 6 and 10 months (front PIP joints) and 1, 3, 6, and 10 months (hind PIP joints). At 10 months, horses were euthanatized and gross and histopathologic examination of the treated joints was performed. Results: Horses had variable cartilage thinning (more severe in hind PIP joints) and dorsal bone proliferation. One front and 1 hind PIP joint were fused 10 months after alcohol injection. Conclusions: Ethyl alcohol injected alone or in combination with percutaneously placed transarticular lag screws failed to reliably produce fusion of the PIP joint.     

Use of a three-drill-tract technique for arthrodesis of the distal tarsal joints in horses with distal tarsal osteoarthritis: 54 cases (1990-1999)

OBJECTIVE: To assess the long-term clinical outcome of horses with distal tarsal osteoarthritis (OA) in which a 3-drill-tract technique was used to induce arthrodesis of the affected joints, identify any preoperative or operative factors associated with outcome, and describe any complications associated with the technique. DESIGN: Retrospective study. ANIMALS: 54 horses. PROCEDURE: Medical records were reviewed for information on signalment, use, history, physical and lameness examination findings, surgical technique, and postoperative care. Radiographs were examined, and severity of OA was graded. Follow-up information was obtained through telephone interviews with owners at least 13 months after the procedure. RESULTS: 32 (59%) horses had a successful outcome, 6 (11%) improved but were not sound after surgery, and 16 (30%) did not improve following surgery. Outcome was negatively associated with the previous use of intra-articular injections. Few postoperative complications were evident. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that distal tarsal OA in horses can be successfully treated by means of distal tarsal arthrodesis with a 3-drill-tract technique. Horses with advanced distal tarsal OA are likely to have poorer outcomes, and the procedure will likely be of minimal benefit in horses with concomitant causes of hind limb lameness prior to surgery and in horses with preexisting proximal intertarsal joint disease.     

Chemical arthrodesis of the distal tarsal joints using sodium monoiodoacetate in 104 horses

OBJECTIVE: To evaluate chemical arthrodesis using sodium monoiodoacetate for treatment of degenerative joint disease of the tarsometatarsal and distal intertarsal joints. DESIGN: Retrospective clinical study. METHOD: Horses were diagnosed with degenerative joint disease of one or more of the tarsometatarsal or distal intertarsal joints based on history, lameness examination, radiographic findings and, in some cases, response to intra-articular anaesthesia or medication. Intra-articular injections of sodium monoiodoacetate were performed using 23 gauge needles in the sedated, standing horse. Positive contrast arthrography of the distal intertarsal joint was performed in all horses to evaluate needle placement and the presence or absence of communication with other synovial structures. The mean intra-articular dose of sodium monoiodoacetate was 192 mg. Horses were subject to a graded exercise program commencing 7 to 10 days after treatment. Where possible, follow up lameness examination and radiography was performed at 3, 6, 12 and 24 months after treatment. RESULTS: At 3, 6, 12 and 24 months after treatment, respectively, 0/57, 14/55, 41/50, and 29/34 of horses were sound. At 3, 6, 12 and 24 months after treatment, respectively, 5/55, 24/38, 26/30 and 18/18 of horses had radiographic evidence of ankylosis of treated joints. Post injection pain was marked in 6.7% of horses and significant complications requiring further treatment occurred in 3.8% of horses. CONCLUSIONS: Chemical arthrodesis using sodium monoiodoacetate was an effective treatment method for degenerative joint disease of the distal tarsal joints. The technique was performed in the sedated standing horse and required minimal equipment. Results were comparable to those achieved following surgical arthrodesis. The risk of significant complications was minimised through good technique using an appropriate injection volume and concentration.     

Use of sodium monoiodoacetate to fuse the distal hock joints in horses

SUMMARY Intra-articular injection of sodium monoiodoacetate (MIA) was investigated as an agent for chemical arthrodesis of the distal hock joints in the horse. Five horses diagnosed with either spavin (three horses), a small tarsal bone fracture or a failed surgical arthrodesis, had 150 mg of MIA injected into the tarsometatarsal (TMT) joint of the affected hock(s). Eight joints were treated in the five horses. Follow-up evaluation by clinical and radiological examination took place over 9 to 14 months. Two of the five horses were sound at the conclusion of the study and one horse, although lame after flexion, was considered by the owner to have been treated successfully. One of eight TMT joints showed complete radiographic fusion. Complications after treatment included pain, chronic lameness and swelling. It was concluded that chemical arthrodesis using this technique can not be recommended as being a superior treatment as compared with surgical arthrodesis at this time but is deserving of further clinical evaluation.     

Proximal interphalangeal joint arthrodesis in 34 horses using two parallel 5.5-mm cortical bone screws

OBJECTIVE: To report clinical experience with arthrodesis of the proximal interphalangeal joint in horses using two parallel 5.5-mm cortical bone screws placed in lag fashion. STUDY DESIGN: Retrospective, clinical study. ANIMALS: Thirty-four horses, aged 1 to 19 years. METHODS: Medical records for all horses admitted (1991-1997) for pastern arthrodesis using two 5.5-mm ASIF cortical bone screws, in parallel orientation, and placed in lag fashion by use of a combined aiming device to facilitate accuracy were reviewed. Signalment, lameness diagnosis, duration of lameness, limb(s) involved, and outcome were recorded. Criteria for successful outcome were determined as return to previous level of function or future intended athletic use. RESULTS: Thirty-nine proximal interphalangeal joint arthrodeses were performed on 34 horses. One horse was euthanatized in the recovery room and was excluded from data analysis. Successful outcome occurred in 85% of frontlimbs and 89% of hindlimbs. Failure occurred in 5 joints; 1 horse had lameness directly associated with surgery, whereas 4 horses had unrelated lameness. CONCLUSION AND CLINICAL RELEVANCE: Age, breed, and initial disease did not affect outcome. Arthrodesis of the proximal interphalangeal joint by use of two 5.5-mm ASIF cortical bone screws, in parallel orientation, placed in lag fashion by use of a combined aiming device, resulted in sound use of the limb in >85% of the joints with shortened postoperative coaptation.     

A Modified Cloward''s Technique for Arthrodesis of the Normal Metacarpophalangeal Joint in the Horse

A modified Cloward's technique was performed for arthrodesis of one metacarpophalangeal (MCP) joint in eight horses. Dorsal arthrotomies were performed medial and lateral to the common digital extensor tendon and two 16 mm holes were drilled through the joint. A perforated cylindrical stainless steel basket filled with cancellous bone was impacted into each hole. The limbs were supported in casts for 8 weeks. The joints were examined and radiographed at 4 weeks, 8 weeks, 6 months, and 10 months. One horse was euthanatized at week 14 to assess the progress of the arthrodesis. In the other seven horses, there was clinical fusion at month 6. Dynamographic evaluations were performed 11 months after surgery at the walk and trot. The maximum vertical forces exerted during weight bearing by treated and control limbs were compared. No difference was detected at the walk; however, a significant difference was present at the trot (p less than 0.05). It was calculated that at the trot the horses placed 90% as much force on the treated limb as on the control limb. Eleven months after surgery, the baskets contained compact and cancellous bone. Ingrowth of bone occurred through all openings, completely filling the baskets and fusing the joints.     

Comparison of Three Drilling Techniques for Carpometacarpal Joint Arthrodesis in Horses

Objective: To evaluate 3 drilling techniques for arthrodesis of the equine carpometacarpal (CMC) joint. Study Design: Experimental study. Sample Population: Cadaveric equine forelimbs (n=15). Methods: Limbs were divided into 3 groups (5 limbs each) to evaluate 3 drilling techniques: (1) use of a 4.5 mm drill bit inserted into the joint through 4 entry points and moved in a fanning motion; (2) a 5.5 mm drill bit inserted through 2 entry points to create 3 nonfanned drill tracts (3 drill technique); and (3) a 4.5 mm drill bit used in a 3 drill technique. The CMC joint was disarticulated after drilling, and cartilage and subchondral bone damage evaluated visually and by gross and microradiographic examination using planimetry. Results: Technique 1 produced significantly more damage of the proximal surface, but significantly less to the subchondral bone of the distal surface. Technique 1 produced the most damage to both the articular cartilage and subchondral bone of the total CMC joint than either of the 3 drill tract techniques; however, the difference between techniques 1 and 2 was not significant. Damage from technique 3 was significantly less than that with techniques 1 or 2. Conclusions: Techniques 1 and 2 produced the most cartilage and subchondral bone damage with technique 2 changes more equally distributed between proximal and distal joint surfaces. Clinical Relevance: Technique 1 (fanning) and 2 (5.5 mm 3 drill tracts) may be preferable to achieve arthrodesis of the CMC joint. Morbidity and efficacy of these arthrodesis techniques need to be evaluated in vivo.     

A Technique for Laser‐Facilitated Equine Pastern Arthrodesis Using Parallel Screws Inserted in Lag Fashion

Objective— To report a technique for laser‐facilitated, minimally invasive proximal interphalangeal joint (PIJ) arthrodesis in horses. Study Design— Case series. Animals— Horses (n=6); 5 thoracic and 2 pelvic limb PIJ. Methods— PIJ osteoarthritis (OA) diagnosis was confirmed by radiography. A diode laser was used to apply 2000 J of energy to the joint followed by insertion of 3 parallel 5.5 mm screws in lag fashion through stab incisions to achieve PIJ arthrodesis. After anesthetic recovery, limbs were maintained in bandages (n=2) or bandage casts (5) for 3 weeks. Horses were allowed exercise or turnout by 3 months. Results— Three horses (4 limbs) were sound throughout follow‐up (6–18 months). One horse remained lame the 1st month, another had mild lameness at pasture at 6 weeks, and another had persistent low‐grade lameness and delayed joint fusion (1 year). Within 6 months, 5 horses were sound, 4 had radiographic evidence of successful joint fusion, and 5 had returned to intended use. Conclusion— Diode laser‐facilitated, 3 parallel screw arthrodesis for PIJ OA costs less and is associated with less pain compared with standard, open PIJ arthrodesis using 3 parallel screws inserted in lag fashion. Clinical Relevance— In horses with advanced PIJ OA, this technique appears to be a viable alternative for PIJ arthrodesis. Further study including characterization of the effects of the laser, ideal case selection indications, and optimal laser dose is indicated before this technique is recommended for routine PIJ arthrodesis.     

Surgical arthrodesis for the treatment of osteoarthrosis of the proximal intertarsal, distal intertarsal and tarsometatarsal joints in 30 horses: a comparison of four different techniques

Over a period of seven years, 30 horses were treated by surgical arthrodesis for lameness resulting from osteoarthrosis of the proximal intertarsal, distal intertarsal and tarsometatarsal joints (bone and occult spavin). Twenty-five horses were affected in one hock only and five were affected bilaterally. Four different techniques for achieving arthrodesis were used. Fourteen out of 18 horses (78 per cent) with involvement of the distal intertarsal and tarsometatarsal joints only and six out of 11 horses (55 per cent) in which the proximal intertarsal joint was also involved became sound following surgery. The status of one other horse, with involvement of the proximal intertarsal joint, is not known.     

Laser-Facilitated arthrodesis of the distal tarsal joints

Arthritis of the distal tarsal joints is a common cause of lameness in performance horses. Clinical signs of distal tarsal arthritis are variable and may include gait abnormalities typical for tarsal lameness, including accentuated elevation of the affected limb, shortened cranial phase of the stride, and decreased arc of the foot. Affected horses frequently resent palpation of the lumbar and gluteal musculature. The lameness is usually increased after a hind limb flexion test. This condition is most commonly treated with intra-articular injections of sodium hyaluronate and corticosteroids in conjunction with controlled exercise and systemic nonsteroidal anti-inflammatory medication. Horses that are refractory to this form of treatment have traditionally been treated by cunean tenectomy with inconsistent results. Various surgical techniques have been used to achieve arthrodesis of these joints in an effort to eliminate the lameness associated with arthritic changes in these joints. Laser-assisted arthrodesis offers a minimally invasive surgical procedure with a relatively short convalescent period that eliminates the clinical signs of lameness in a high number of cases.     

Arthrodesis of the Distal Intertarsal and Tarsometatarsal Joints in the Horse

Arthrodesis created by destruction of the articular surfaces of the distal intertarsal and tarsometatarsal joints by repeated insertion of a drill was studied in one limb of each of nine horses. Postoperatively, the horses were housed in box stalls for 8 weeks and then confined to a paddock for 19 weeks. Clinical and radiographic evaluations were performed prior to surgery, immediately following surgery, and at 2,4, 6, 8,10,12,16, 20, and 27 weeks following surgery. There was a statistically significant positive correlation between decreasing degree of lameness and increasing radiographic evidence of bony fusion; fusion of the distal intertarsal and tarsometatarsal joints was present in five horses 27 weeks after surgery. The horses lost weight during the first 8 weeks after surgery. Flexion of the treated tarsal joints was decreased significantly at the end of the experiment.
Complications encountered included fracture of the third tarsal bone (five horses), instability of the tarsus (four horses), septic arthritis (three horses), and diarrhea (four horses).
Arthrodesis, with this method of surgical drilling of the distal intertarsal and tarsometatarsal joints, is not recommended because of severe pain, prolonged convalescence, and high incidence of complications.     

Use of a bone plate for treatment of middle phalangeal fractures in horses: seven cases (1979-1984)

Four adult horses and 3 foals with middle phalangeal fractures were treated by arthrodesis of the proximal interphalangeal joint, using a bone plate. Six of the 7 horses survived greater than 2 years; 2 of the 6 horses had intermittent lameness after hard work, and 4 horses didn't have evidence of lameness. The use of a bone plate for arthrodesis of the proximal interphalangeal joint was a successful treatment alternative for middle phalangeal fractures in horses.     

Arthrodesis of the Distal Interphalangeal Joint in Two Horses Using Three Parallel 5.5-mm Cortical Screws

The distal interphalangeal joint was successfully arthrodesed in two horses using three parallel 5.5-mm cortical screws and an autogenous cancellous bone graft. The screws were directed from the palmar proximal border of the second phalanx dorso-distally across the joint space and into the third phalanx. The technique was first developed on a normal horse. The second horse, a clinical case, ruptured its deep digital flexor tendon with complete luxation of the distal interphalangeal joint. Bony fusion of the distal interphalangeal joint occurred in both horses, but both also had residual lameness at a walk. Twenty-one months after the arthrodesis procedure, the clinical patient died from complications related to a subsolar abscess in the operated limb.     

Comparison of intra-articular drilling and diode laser treatment for arthrodesis of the distal tarsal joints in normal horses

REASONS FOR PERFORMING STUDY: Anecdotal reports suggest that laser-facilitated arthrodesis of the distal tarsal joints improves the prognosis compared with intra-articular drilling but no objective comparisons have been performed. OBJECTIVES: To evaluate intra-articular drilling and laser-facilitated arthrodesis using in situ and in vivo techniques. METHODS: Fourteen cadaver limbs were evaluated in situ for chondrocyte viability after both surgical techniques. In vivo, one randomly selected limb was subjected to laser-facilitated arthrodesis and the other underwent intra-articular drilling in 6 normal horses. Clinical examinations were performed at 1, 3 and 5 months. Two horses were subjected to euthanasia at 1, 3 and 5 months. RESULTS: Significantly more chondrocyte death was observed with laser-facilitated arthrodesis compared to drilling, but the overall degree suggested only a focal effect. In vivo, both groups demonstrated minimal post operative morbidity. There was more evidence of arthrodesis seen at all time points with intra-articular drilling. CONCLUSIONS: This study demonstrated that changes associated with ultimate arthrodesis occur earlier after intra-articular drilling of the distal tarsal joints than laser-facilitated arthrodesis, although clinically affected horses may respond differently. POTENTIAL RELEVANCE: Intra-articular drilling may provide earlier arthrodesis of the distal tarsal joints, but not necessarily a better long-term result.     

Carpometacarpal Osteoarthritis in Thirty‐Three Horses

Objective— To describe signalment, clinical, and radiographic changes associated with carpometacarpal osteoarthritis (CMC‐OA) and to report long‐term outcome. Study Design— Case series. Animals— Horses (n=33) with CMC‐OA. Methods— Medical records (1992–2007) of horses diagnosed with CMC‐OA were reviewed and signalment, clinical, and radiographic findings retrieved. Owners were contacted for information on the impact of lameness on intended use, response to treatment, progression of lameness, outcome, and owner satisfaction with response to treatment. Results— CMC‐OA identified in 39 limbs, occurred predominantly in middle‐aged and older Quarter Horses and Arabians, and caused severe lameness that prevented normal use. Characteristic swelling was centered over the 2nd metacarpal bone/2nd carpal bone articulation. Radiographic changes consisted of proliferative new bone, narrowed joint space, and subchondral lysis. Of 20 horses with follow‐up, 7 of 14 treated horses were euthanatized within 4 years and 4 of 5 nontreated horses within 3 years. Response to treatment was short lived and considered very poor by most owners. Conclusion— CMC‐OA seemingly occurs primarily in Quarter Horses and Arabians in our region. Response to conservative treatment is very poor and short‐lived with most horses being euthanatized. Clinical Relevance— Conventional treatment methods are unsuccessful for treating CMC‐OA.     

Scapulohumeral arthrodesis in miniature horses

OBJECTIVES: To describe surgical arthrodesis of the scapulohumeral joint and to evaluate its efficacy in reducing morbidity associated with severe shoulder dysfunction in miniature horses. STUDY DESIGN: Retrospective study. ANIMALS: Four miniature horses. METHODS: Medical records and radiographs were reviewed for history, physical examination findings, lameness evaluation, radiographic evaluation, surgical techniques, postoperative complications, and outcome. A 10- or 11-hole, 4.5-mm narrow dynamic compression plate and 4.5-mm cortical screws were applied to the cranial surface of the scapula and cranial surface of the humerus after osteotomy of the intermediate tubercle. In most horses, 1 or 2 screws were inserted in lag fashion across the joint, through holes in the plate. RESULTS: Scapulohumeral osteoarthritis was diagnosed radiographically in 4 horses, and 3 horses had concurrent shoulder luxation or subluxation. All horses had grade 3 or 4 lameness before surgery, and most improved by 1 to 2 grades after surgery. Despite complications of implant failure (2 horses), infection (2 horses), scapular fracture (1 horse), and atrophy of the shoulder muscles (1 horse), functional arthrodesis reduced morbidity in all horses. CONCLUSIONS: Scapulohumeral arthrodesis facilitates early return to weight bearing in miniature horses with severe scapulohumeral joint osteoarthrosis. Despite functional gait abnormality, the horses ambulated quite well after surgery. CLINICAL RELEVANCE: Scapulohumeral arthrodesis should be considered for debilitating conditions of the shoulder joint in miniature horses, especially when the intended outcome is breeding or pasture soundness.