Synovial fluid analysis and bacterial findings in arthritic joints of juvenile male camel (Camelus dromedarius) calves

Eighteen synovial fluid samples from 11 male dromedarian calves, 9-12 month old, were analysed cytologically and bacteriologically. Calves were lame and all joints were grossly swollen. The mean +/- SD of total nucleated cell count was 7970 +/- 5000 cells/microl (range 2800-20,000 cells/microl). Polymorphonuclear (PMN) leucocytes were the predominant cell type. The mean +/- SD of absolute and percentages of each cell type were as follows: PMN leucocytes 5518 +/- 3600 cells/microl and 68 +/- 19%, monocytes/macrophages 1600 +/- 1120 cells/microl and 26 +/- 17%, lymphocytes 830 +/- 140 cells/microl and 8 +/- 7%, and red blood cell 350 +/- 130 cells/microl. The mean +/- SD of total protein concentration was 3.5 +/- 1 g/dl (range 2.5-5 g/dl). The most commonly isolated bacteria were non-haemolytic streptococci spp., followed by Arcanobacterium pyogenes and Staphylococcus aureus. No bacterial growth was obtained in eight samples and non-revealed Mycoplasma spp.     

Cytologic analysis of synovial fluid in clinically normal tarsal joints of young camels (Camelus dromedarius)

BACKGROUND: Camels are important in the racing industry and for milk, meat, and hair production in the Middle East. Evaluation of synovial fluid is an important part of the assessment of musculoskeletal injuries in this species. Information in the literature regarding synovial fluid in camels is limited. OBJECTIVES: The objective of this study was to determine the protein and cellular composition of synovial fluid from the tarsal joints of clinically normal, young camels (Camelus dromedarius). METHODS: Thirty clinically healthy, male camels, aged 9 to 12 months, were used in the study. Synovial fluid samples were collected from the right and left tarsal joints. Samples were processed within 60 minutes after collection. Total nucleated cell counts (TNCC) were assessed using a hemacytometer. Total protein concentration was determined using a refractometer. RESULTS: Forty-six samples were analyzed. The TNCC (mean +/- SD) was 175.8 +/- 136.7 cells/microL (range 50-678 cells/microL). Differential cell percentages were obtained for lymphocytes (58.2 +/- 21.55%, range 15-90%), monocyte/macrophages (38.3 +/- 20.8%, range 10-85%), and neutrophils (3.5 +/- 5.1%, range 0-15%). Protein concentration was 2.1 +/- 0.6 g/dL (range 1-3 g/dL). Significant differences were not observed in any parameters between right and left tarsal joints. CONCLUSION: Synovial fluid reference values were established and may be useful in the clinical investigation of joint disease in young camels.     

Analysis of synovial fluid from clinically normal alpacas and llamas

OBJECTIVE: To establish reference range values for synovial fluid from clinically normal New World camelids. ANIMALS: 15 llamas and 15 alpacas. PROCEDURE: Llamas and alpacas were anesthetized with an IM injection of a xylazine hydrochloride, butorphanol tartrate, and ketamine hydrochloride combination. Synovial fluid (1 to 2 ml) was obtained by aseptic arthrocentesis from the radiocarpal and tarsocrural joints. Synovial fluid evaluation included determination of total nucleated cell count (NCC), absolute number and percentage of polymorphonuclear (PMN) and mononuclear leukocytes, total protein, and specific gravity. RESULTS: Synovial fluid evaluation revealed a total NCC of 100 to 1,400 cells/microl (mean +/- SD, 394.8+/-356.2 cells/microl; 95% confidence interval [CI], 295.2 to 494.6 cells/microl). Mononuclear leukocytes were the predominant cell type with lymphocytes, composing 50 to 90% (mean, 75.6+/-172%; 95% CI, 70.8 to 80.4%) of the mononuclear leukocytes. Approximately 0 to 12% (mean, 1.3+/-2.9%; 95% CI, 0.49 to 2.11%) of the cells were PMN leukocytes. Total protein concentrations ranged from 2.0 to 3.8 g/dl (mean, 2.54+/-0.29 g/dl; 95% CI, 2.46 to 2.62 g/dl); the specific gravity ranged between 1.010 and 1.026 (mean, 1.017+/-0.003; 95% CI, 1.016 to 1.018). CONCLUSION AND CLINICAL RELEVANCE: In llamas and alpacas, significant differences do not exist between species or between limbs (left vs right) or joints (radiocarpal vs tarsocrural) for synovial fluid values. Total NCC and absolute number and percentage of PMN and mononuclear leukocyte are similar to those of other ruminants and horses. However, synovial fluid total protein concentrations in New World camelids are high, compared with other domestic species.     

Absolute and relative cell counts for synovial fluid from clinically normal shoulder and stifle joints in cats

OBJECTIVE: To determine absolute and relative cell counts for synovial fluid from grossly, radiographically, and histologically normal shoulder and stifle joints in healthy cats. DESIGN: Clinical study. ANIMALS: 52 cats scheduled to be euthanatized for unrelated reasons. PROCEDURE: Arthrocentesis of the shoulder and stifle joints was performed bilaterally, and synovial fluid was analyzed for absolute WBC count, WBC morphology, and percentages of neutrophils and mononuclear cells. Joints were examined grossly and radiographically, and synovial membrane specimens were submitted for histologic examination. Synovial fluid samples that were contaminated with blood and samples from joints with any gross, radiographic, or histologic abnormalities were excluded. RESULTS: 82 of the 208 synovial fluid samples were excluded because abnormalities were identified during physical examination; the volume of fluid obtained was insufficient for analysis; there was evidence of blood contamination; or the joint had gross, radiographic, or histologic abnormalities. Median WBC count for the remaining 126 synovial fluid samples was 91 cells/microL (96.4% mononuclear cells and 3.6% neutrophils); WBC count was not significantly different between left and right joint samples or between shoulder and stifle joint samples. Body weight was associated with synovial fluid WBC count, with WBC count increasing as body weight increased. Sixteen of the 52 (30%) cats had radiographic evidence of osteoarthritis involving at least 1 joint. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that synovial fluid can be obtained reliably from shoulder and stifle joints in cats.     

Prospective study of blackthorn injury and synovitis in 35 horses

The objective of this prospective clinical study was to investigate the cause and describe the presentation, diagnosis, treatment techniques and outcome of Prunus spinosa (blackthorn) injury and synovitis in the horse. In all cases presented with blackthorn injury and synovitis, surgical treatment was performed within 24 h, using a two-stage procedure: 1-Perisynovial technique using ultrasound guided electrosurgical dissection; 2-Endoscopic technique. The diagnosis was confirmed by retrieval of black plant material from or close to the affected synovial structure. Mean lameness score on presentation was 4/5 (range 1–5). The most commonly affected structures were extensor tendon sheaths (12/35) and fetlock joints (11/35). All cases had thorn material removed, 80% had thorn material removed at surgery and in 49% it was intra-synovial. On presentation, the mean synovial fluid total protein level (TP) was 47.6 g/L (range 18–66); mean total nucleated cell count (TNCC) was 176 × 10⁹ cells/L (range 12–312). Two days post-surgery, mean total protein levels were 33 g/L (range 16–52), mean TNCC was 13 × 10⁹ cells/L (range 1–35). At 5 days post-surgery, the mean total protein was 23 g/L (range 12–28) and TNCC was 5 × 10⁹ cells/L (range 1–12). All synovial fluid cultures were negative. Twenty-eight (80%) horses were sound 5 days post-operatively, seven (20%) were not lame in walk; they all returned to full work in an average time of 8 weeks (range 3–48 weeks). Surgery achieved accurate identification and removal of thorn material. In contrast to previous studies of synovial sepsis, these cases had a positive outcome despite high pre- and post-operative synovial fluid TP and TNCC. These findings suggest that Prunus spinosus (blackthorn) synovitis has a different aetiology to synovitis originating from sepsis or other types of contamination.     

Peritoneal fluid analysis in adult, nonpregnant Awassi sheep

BACKGROUND: To the authors' knowledge, there is no information in the literature about normal peritoneal fluid values in ovine species. OBJECTIVES: The purpose of the study reported here was to establish reference intervals for peritoneal fluid from clinically normal Awassi sheep and to compare the values to those in blood. METHODS: Peritoneal fluid and blood samples were collected into tubes containing EDTA, from 40 clinically healthy, nonpregnant, female Awassi sheep, aged 2 to 7 years. Total nucleated cell count (TNCC) was determined using an electronic cell counter. Total protein, albumin, urea, creatinine, and glucose concentrations and aspartate transaminase activity were analyzed using commercially available kits. RESULTS: TNCC (mean +/- SD) of peritoneal fluid was 1.1 +/- 0.87 X 10(3)/microl, with neutrophils (3.9%), lymphocytes (33.5%), macrophages/monocytes (61.2%), and eosinophils (1.4%). Biochemical results in peritoneal fluid were: total protein, 1.7 +/- 0.74 g/dL; albumin, 1.0 +/- 0.04 g/dL; urea, 12.6 +/- 3.95 mg/dL; creatinine, 0.6 +/- 0.19 mg/dL; glucose, 54.8 +/- 6.11 mg/dL; and aspartate transaminase, 23.5 +/- 8.82 U/L. Eosinophil percentage and creatinine concentration did not differ significantly from blood values. CONCLUSION: Baseline values for cytologic and biochemical parameters in peritoneal fluid of Awassi sheep, with comparison to blood, have been generated. Such data may be applicable to other ovine species and can be used in the clinical investigation of ovine abdominal disorders.     

Synovial fluid analysis in cattle: a review of 130 cases

OBJECTIVE: To compare synovial fluid characteristics of cattle with infectious and noninfectious arthritis. STUDY DESIGN: Retrospective cohort study. ANIMAL OR SAMPLE POPULATION: 130 cattle. METHODS: Synovial fluid was analyzed for total nucleated cell count (NCC), absolute number and percentages of polymorphonuclear (PMN) and mononuclear cells, total protein (TP) concentration, and specific gravity. Cattle were categorized as having infectious or noninfectious arthritis based on physical and lameness examinations, joint radiographs, and microbial culture results. Kruskal-Wallis 1-way analysis of variance was used to compare synovial fluid analysis data from different categories. Selection of cut-off values for the calculation of likelihood ratios, sensitivity, specificity, and positive and negative predictive values was based on examination of the distribution of the data using histograms. RESULTS: Cattle with infectious arthritis had significantly higher numbers of total NNC, PMN cells, TP concentration, and specific gravity (P = .0001) and a significantly higher percentage of PMN cells compared with cattle with noninfectious arthritis (P = .0001). The percentage of mononuclear cells was significantly higher in cattle with noninfectious arthritis (P = .0001). CONCLUSIONS: Synovial fluid analysis is useful for differentiation of infectious and noninfectious causes of joint disease in cattle. CLINICAL RELEVANCE: Cattle with a synovial fluid total NCC > 25,000 cells/microL, a PMN cell count > 20,000 cells/microL or more than 80% PMN cells, and TP > 4.5 g/dL should be considered to have infectious arthritis.     

Regional limb perfusion for antibiotic treatment of experimentally induced septic arthritis.

Septic arthritis was induced in one antebrachiocarpal joint of seven horses by the intra-articular injection of 1 mL Staphylococcus aureus suspension containing a mean of 10(5) colony-forming units. Twenty-four hours after inoculation, four horses were treated by regional perfusion with 1 g of gentamicin sulfate, and three horses received 2.2 mg/kg gentamicin sulfate intravenously (IV) every 6 hours. Synovial fluid was collected for culture and cytology at regular intervals, and the synovial membranes were collected for culture and histologic examination at euthanasia 24 hours after the first treatment. Gentamicin concentration in the septic synovial fluid after three successful perfusions was 221.2 +/- 71.4 (SD) micrograms/mL; after gentamicin IV, it was 7.6 +/- 1.6 (SD) micrograms/mL. The mean leukocyte count in the inoculated joints decreased significantly by hour 24 in the successfully perfused joints. Terminal bacterial cultures of synovial fluid and synovial membranes were negative in two horses with successfully perfused joints. S. aureus was isolated from the infected joints in all three horses treated with gentamicin IV.     

Effect of storage time on automated cell count and cytological interpretation of body cavity effusions

The effect of 24- and 48-hour storage at room temperature on automated total nucleated cell count (TNCC), differential cell count (DCC) and cell morphology was assessed, and the effect of initial total protein concentration on canine and feline body cavity effusion samples (2 to 5 ml) was evaluated. At 24 and 48 hours, TNCC and absolute numbers of neutrophils, macrophages and small lymphocytes were significantly decreased and numbers of unrecognisable cells were significantly increased. Neoplastic cells and intracellular bacteria identified in fresh samples were missed at 24 and 48 hours. The initial total protein concentration was associated with an effect on percentage of unrecognisable cells and small lymphocytes over time. Change in TNCC over time would have resulted in misclassification of the effusion type in four of 47 samples.     

Use of a fetlock support brace to manage lacerations of equine flexor tendons

A retrospective analysis of 15 cases of flexor tendon lacerations managed with a fetlock support brace between 2004 and 2008 was performed. Information was gathered concerning exact nature of the injury, treatment details and outcome. Limbs involved included 2 forelimbs and 13 hindlimbs. Eight of fifteen horses (53%) presented with a dropped fetlock, elevated toe or both when bearing weight on the affected limb. General anaesthesia was performed on 7/15 cases to further evaluate and treat the wound, 8/15 cases were managed with local anaesthesia and/or sedation only. The brace was applied within 14 days of presentation and maintained for a mean of 106 days. Sixty percent of cases were sound and used as intended and an additional 20% were sound but at a lesser level of work. Horses with flexor tendon lacerations can be managed with a fetlock support brace alone and have a similar outcome with shorter hospitalisation than horses managed by other methods.     

Scintigraphic evaluation of metacarpophalangeal and metatarsophalangeal joints in clinically sound horses.

The purpose of this study was to describe the pattern of radiopharmaceutical uptake in the metacarpophalangeal (MCP) and metatarsophalangeal (MTP) (fetlock) joints in clinically sound horses. Scintigraphic images from 29 clinically normal horses were evaluated. All the images were assessed subjectively. The lateral views were assessed quantitatively using vertical line profiles through the center of the joint, and mean ratios of radiopharmaceutical uptake were calculated from regions of interest around the third metacarpal or metatarsal bones, and the proximal phalanx and proximal sesamoid bones. From the vertical line profiles, in the majority of forelimbs (65%) the peak activity of radiopharmaceutical distribution was at the proximal region of the proximal phalanx, with a significantly lower activity within the condyles of the third metacarpal bone. However, in 84% of hindlimbs there was a broader profile peak incorporating the condyles of the third metatarsal bone and the proximal aspect of the proximal phalanx, indicating a more generalized even uptake of radiopharmaceutical across the MTP joint. When the regions of interest were compared between front and hindlimbs, there was no significant difference between proximal phalanx and proximal sesamoid bones, but the distal condyles of the third metacarpal bone of the forelimb had significantly lower radiopharmaceutical activity than hindlimbs (P < 0.04). In lateral images, the mean forelimb ratios tended to be higher in the left MCP joint compared with the right (P = 0.069). In hindlimbs, the mean ratios tended to be higher in the right MTP joint than the left (P = 0.052). There was no significant effect of age.     

Cytologic interpretation of canine cerebrospinal fluid samples with low total nucleated cell concentration,with and without blood contamination

Background: Cerebrospinal fluid (CSF) is potentially altered by iatrogenic blood contamination at the time of sampling due to the addition of blood‐associated leukocytes and protein. Objectives: The objective of this study was to assess whether protein concentration, neutrophil percentage, and the presence of activated macrophages, reactive lymphocytes, or eosinophils in CSF samples with low total nucleated cell concentration (TNCC) are affected by blood contamination or associated with central nervous system (CNS) disease. Methods: Case records from the Royal Veterinary College Diagnostic Laboratory were searched retrospectively for dogs with CSF having ≤5 TNCC/μL. TNCC, RBC, and protein concentrations; neutrophil percentage; and the presence of activated macrophages, reactive lymphocytes, and eosinophils were recorded. Results of magnetic resonance imaging (MRI) also were recorded as a marker of CNS disease. Results: Of 906 cases evaluated, 106 (12%) had blood contamination (>500 RBCs/μL) in CSF. Protein concentration and neutrophil percentage were significantly higher and the presence of eosinophils was more likely in blood contaminated vs noncontaminated samples. Non‐blood‐contaminated samples with activated macrophages or reactive lymphocytes had higher protein concentrations and neutrophil percentages, and those with activated macrophages were more likely to have a positive finding on MRI. Conclusions: Protein concentration, neutrophil percentage, and the presence of eosinophils are significantly affected by blood contamination in canine CSF having low TNCC. Activated macrophages and reactive lymphocytes are not affected by blood contamination, however, and may be useful in identifying dogs with CNS abnormalities.     

Effect of intrathecal amikacin administration and repeated centesis on digital flexor tendon sheath synovial fluid in horses

OBJECTIVE: To determine the effect of intrathecal amikacin administration and repeated tenovaginocentesis on the total nucleated cell count (TNCC), total protein (TP) concentration and cytologic characteristics of synovial fluid of the equine digital flexor tendon sheath (DFTS). STUDY DESIGN: Randomized, cross-over experimental design. ANIMALS: Adult horses (n=8). METHODS: Synovial fluid was aseptically collected from the DFTS and either 1 mL amikacin sulfate (250 mg/mL) or lactated Ringer's solution (LRS) was injected into the DFTS. Serial synovial fluid samples were obtained at 0, 12, 24, 48, and 72 hours. The opposite treatment was administered to the contralateral DFTS after a washout period of 2 weeks. RESULTS: Treatment increased TP concentration, TNCC, percentage of neutrophils, and neutrophil counts from baseline levels. There was no difference between treatment of the DFTS with amikacin or LRS. Values peaked at 12-24 hours after the initial centesis and then declined toward baseline levels. CONCLUSIONS: Injection and repeat centesis of the normal DFTS with 250 mg amikacin or an equivalent volume of LRS resulted in mild increases in synovial fluid analytes from baseline. Synovial inflammation in this study was not accompanied by lameness at the walk and measured analytes returned toward baseline levels within 12-24 hours of first injection. CLINICAL RELEVANCE: The effect of tenovaginocentesis and intrathecal administration of amikacin or LRS on DFTS synovial fluid values are modest in most horses; however, some horses can develop marked increases in synovial fluid values that may be interpreted as sepsis.     

Net joint kinetics in the limbs of pigs walking on concrete floor in dry and contaminated conditions

In pigs (Sus scrofa), joint disorders are frequent leg problems, and inappropriate pigpen floors and slippery floor conditions may contribute to these problems. Therefore, this study first aimed to quantify the net joint kinetics (net joint moments and net joint reaction forces) in the forelimbs and hindlimbs of healthy pigs walking on solid concrete floors. Second, this study aimed to examine the effect of floor condition on the net joint kinetics. Kinematic (50-Hz video recordings) and kinetic (1-kHz force plate measurements) data were collected from 30 pigs and combined with body segment parameters from a cadaver study. Net joint kinetics was calculated by using a 2-dimensional inverse dynamic solution. Inverse dynamics have, to our knowledge, not been applied in pigs before. Dry, greasy, and wet floor conditions were tested with 10 pigs each. In the forelimbs, peak joint moment was less (P < 0.01) on greasy (0.184 +/- 0.012 Nm/kg, moment of force per kg of BW) than on dry (0.232 +/- 0.012 Nm/kg) or wet (0.230 +/- 0.012 Nm/kg) conditions. Additionally, the minimum forelimb joint moment was more negative (P < 0.05) on greasy (-0.119 +/- 0.009 Nm/kg) than on dry or wet (both -0.091 +/- 0.009 Nm/kg) conditions. The forelimb joint reaction forces and the hindlimb joint kinetics were unaffected by floor condition. The greatest (P < 0.001) joint moments occurred in the shoulder (-0.376 +/- 0.007 Nm/kg), elbow (0.345 +/- 0.009 Nm/kg), hip (0.252 +/- 0.009 Nm/kg), and tarsal (0.329 +/- 0.009 Nm/kg) joints, which may be related to the greater incidence of joint diseases in some of these joints. In conclusion, the forelimb joints of the pigs responded more markedly to floor condition than did their hindlimb joints, probably because the forelimbs carry more weight. In particular, between the dry and greasy floor conditions, the joint loading differed, most likely because the pigs adapted to a potentially slippery surface.     

Automated flow cytometric cell count and differentiation of canine cerebrospinal fluid cells using the ADVIA 2120

Background: Microscopic cell counts in cerebrospinal fluid (CSF) are time-consuming and prone to imprecision. The recently introduced automated hematology analyzer ADVIA 2120 offers an automated cell count and differential for CSF in the veterinary software mode based on laser light scatter and absorbance measurements. Objectives: The purpose of this study was to evaluate the precision, linearity, and accuracy of the ADVIA 2120 CSF assay. Methods: Sixty-seven CSF samples were analyzed on the ADVIA 2120 and total nucleated cell counts (TNCC) and RBC counts were compared with the hemocytometer results. In 21 samples with TNCC >5/muL, ADVIA 2120 results were compared with 100-300 cell manual differentials performed on cytocentrifuged preparations. Statistical analysis included Spearman's rank correlation, Passing-Bablok regression, and Bland-Altman analysis. Results: Repeatability (intra-assay) coefficients of variation (CVs) ranged from 4.19% to 25.94%. Interassay CVs ranged from 2.56% to 28.67%. Accurate results within 30% were achieved for TNCC up to 4000/muL. Except for low TNCC, deviation from the expected value was higher (TNCC of 8/muL instead of 4/muL). The following correlation coefficients (r) and biases were achieved compared with the reference method: r=.90 and bias 2.3/muL for TNCC; r=.88 and bias 32.0/muL for RBC counts; r=.86 and bias +/-13.4% for mononuclear and polymorphonuclear cell percentages; r=.88 and bias -6.1% for lymphocyte percentage; r=.56 and bias 19.4% for monocyte percentage; and r=.75 and bias -9.7% for neutrophil percentage. Conclusion: Our results demonstrated that the automated ADVIA 2120 CSF assay generally compares well with reference methods although there are some limitations for the automated monocyte count and for samples with only mild pleocytosis.     

Associations between hoof shape and the position of the frontal plane ground reaction force vector in walking horses

AIMS: To determine the frontal plane position of the ground reaction force vector at its centre of pressure under the hoof of walking horses, and its projection through the distal limb joints, and to relate this to hoof geometric measurements.

METHODS: Reflective markers were glued to the forelimb hooves and skin of 26 horses, over palpable landmarks representing centres of the coffin, fetlock and carpal joints, and the dorsal toe at its most distal point. A 4-camera kinematic system recorded the position of these markers as the horse walked in hand across a force platform, to generate a frontal plane representation of the ground reaction force vector passing between the markers at the joints. The position of the vector was calculated as the relative distance between the lateral (0%) and medial (100%) markers at each joint. Digital photos were taken of the hoof in frontal and sagittal views to determine hoof geometric measurements. Associations between these and the position of the force vector at each joint were examined using Pearson correlation coefficients.

RESULTS: Mean vector position for both forelimbs at the toe, coffin, fetlock and carpal joint was 50.1 (SD 8.9), 53.0 (SD 9.2), 54.6 (SD 11.4) and 50.5 (SD17.3)%, respectively, of the distance between the lateral and medial sides of the joint in the frontal plane. Across all four joints, the vector position was slightly more medial (2–4%) for the right than left limb (p>0.05). Medial hoof wall angle was correlated (p<0.05) with force vector position at the fetlock (r=?0.402) and carpal (r=?0.317) joints; lateral hoof wall angle with vector position at the toe (r=0.288) and carpal (r=?0.34) joint, and medial hoof wall height with vector position at the fetlock (r=?0.306) and carpal (r=?0.303) joints.

CONCLUSION: The position of the two-dimensional frontal plane ground reaction force vector at the toe, and at the fetlock and carpal joints was associated with hoof shape. Mediolateral hoof balance has been shown in vitro to affect articular forces, which may be a factor in development of joint disease. The effect of hoof shape needs to be evaluated at faster gaits to determine the potential for joint injury in the presence of larger forces.     

The effect of implanting gentamicin-impregnated polymethylmethacrylate beads in the tarsocrural joint of the horse

OBJECTIVE: To determine the effect of intra-articular gentamicin-impregnated polymethylmethacrylate (PMMA) beads inserted in the equine tarsocrural joint on the synovial fluid, synovial lining, and cartilage, and to determine the peak and sustainable gentamicin concentrations in synovial fluid and plasma. STUDY DESIGN: Pharmacokinetic, cytologic, and histologic study of the effect of gentamicin-impregnated PMMA on normal equine tarsocrural joints. ANIMALS: Five healthy adult horses. METHODS: Gentamicin-impregnated PMMA bead strands (3 strands each of 40 beads, with each strand containing 100 mg gentamicin) were surgically inserted into one radiographically normal tarsocrural joint in 5 horses. Each horse had both joints flushed with 1 L of lactated Ringer's solution before bead administration. Synovial fluid total protein concentration, white blood cell (WBC) count, gentamicin concentration, synovial histology, cartilage integrity, and cartilage glycosaminoglycan (GAG) concentrations were determined. RESULTS: Gentamicin concentration (mean +/- SEM peak concentration, 27.9 +/- 2.27 microg/mL) occurred in the first 24 hours and remained above 2 microg/mL for 9 days. Gentamicin concentrations in control joints and the plasma remained below detectable levels. The synovial fluid WBC count for treated joints was increased compared with control joints for 72 hours, but was similar at day 6. The synovial protein concentration in gentamicin-treated joints remained increased for 21 days. Synovium in treated joints had diffuse synovitis, whereas control joints had less fibrovascular proliferation. Superficial cartilage erosion was present in all treated joints. There was no difference in the GAG content of treated and control joint cartilage. CONCLUSIONS: Short-term implantation of gentamicin (300 mg)-impregnated PMMA beads can provide therapeutic levels of gentamicin (>2 microg/mL) in the normal tarsocrural joint for 9 days; however, gentamicin-impregnated PMMA beads induce synovitis and superficial cartilage erosion. CLINICAL RELEVANCE: Temporary intra-articular administration of antibiotic-impregnated PMMA may be an effective way to treat septic joints that require constant high concentrations of antibiotics.     

Gentamicin concentrations in synovial fluid and joint tissues during intravenous administration or continuous intra-articular infusion of the tarsocrural joint of clinically normal horses

OBJECTIVE: To compare gentamicin concentrations achieved in synovial fluid and joint tissues during IV administration and continuous intra-articular (IA) infusion of the tarsocrural joint in horses. ANIMALS: 18 horses with clinically normal tarsocrural joints. PROCEDURE: Horses were assigned to 3 groups (6 horses/group) and administered gentamicin (6.6 mg/kg, IV, q 24 h for 4 days; group 1), a continuous IA infusion of gentamicin into the tarsocrural joint (50 mg/h for 73 hours; group 2), or both treatments (group 3). Serum, synovial fluid, and joint tissue samples were collected for measurement of gentamicin at various time points during and 73 hours after initiation of treatment. Gentamicin concentrations were compared by use of a Kruskal-Wallis ANOVA. RESULTS: At 73 hours, mean +/- SE gentamicin concentrations in synovial fluid, synovial membrane, joint capsule, subchondral bone, and collateral ligament of group 1 horses were 11.5 +/- 1.5 microg/mL, 21.1 +/- 3.0 microg/g, 17.1 +/- 1.4 microg/g, 9.8 +/- 2.0 microg/g, and 5.9 +/- 0.7 microg/g, respectively. Corresponding concentrations in group 2 horses were 458.7 +/- 130.3 microg/mL, 496.8 +/- 126.5 microg/g, 128.5 +/- 74.2 microg/g, 99.4 +/- 47.3 microg/g, and 13.5 +/- 7.6 microg/g, respectively. Gentamicin concentrations in synovial fluid, synovial membrane, and joint capsule of group 1 horses were significantly lower than concentrations in those samples for horses in groups 2 and 3. CONCLUSIONS AND CLINICAL RELEVANCE: Continuous IA infusion of gentamicin achieves higher drug concentrations in joint tissues of normal tarsocrural joints of horses, compared with concentrations after IV administration.     

Detection of synovial macrophages in the joint capsule of dogs with naturally occurring rupture of the cranial cruciate ligament

OBJECTIVE: To test the hypotheses that the densities of macrophages in the synovial membranes and capsules of stifle joints in dogs with ruptured cranial cruciate ligaments are greater than those of normal joints and that those densities in affected joints are positively correlated with the chronicity and severity of the disease. ANIMALS: 17 dogs with naturally occurring rupture of the cranial cruciate ligament and 5 healthy control dogs. PROCEDURE: All dogs underwent orthopedic and radiographic evaluations. In affected dogs, duration of clinical signs was used as an indicator of disease chronicity and the severity of osteoarthritis in the stifle joint was determined radiographically. Joint capsule specimens were evaluated histologically; macrophages, interleukin-6, and tumor necrosis factor-alpha were identified by use of immunocytochemical techniques. RESULTS: Compared with unaffected joints, macrophage density was increased in all affected joints. Duration of disease was significantly associated with radiographic severity of osteoarthritis and synovial macrophage density. Synovial macrophage density was significantly associated with severity of osteoarthritis and with the presence of interleukin-6 and tumor necrosis factor-a. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that synovial macrophages may be involved in the development of pathologic changes (including osteophyte formation) in the stifle joints of dogs with osteoarthritis secondary to rupture of the cranial cruciate ligament. Determination of the importance of synovial macrophages in the development of changes in osteoarthritic joints may result in new treatment strategies that involve elimination of the deleterious effects of those cells.     

Clinical and low field magnetic resonance imaging features of osseous cyst‐like lesions of the proximal sesamoid bones in seven horses

Osseous cyst‐like lesions of the proximal sesamoid bones (PSBs) were diagnosed in 7 horses. The diagnosis was achieved radiographically prior to magnetic resonance imaging (MRI) in only one horse, and in the other 6 horses the diagnosis was made using low field MRI (retrospective evaluation of the radiographs after the MRI revealed ill‐defined radiolucencies of the PSBs in 4 of these horses). The horses ranged in age from 3 to 12 years, and the affected limbs included 3 forelimbs and 4 hindlimbs. The onset of lameness was reported to be sudden in 6 horses and insidious in one, and the duration of lameness at the time of MRI ranged from 0.3 to 11 months. The degree of lameness in the 6 horses with sudden‐onset lameness was moderate to severe. Pain on flexion of the affected metacarpo(tarso)phalangeal (fetlock) joint or exacerbation of the degree of lameness following fetlock flexion was recorded in 4 of the 7 horses. The MRI findings in all cases included a focal high signal intensity lesion (all magnetic resonance sequences) at various locations in one PSB. Both septic and nonseptic aetiologies were identified. Four of the 7 horses were subjected to euthanasia due to persistent lameness, one remained chronically lame and only 2 were able to return to their previous level of exercise.