[kickyjz]

Hi all,

My horse is a twenty year old gelding who was retired 2-3 years ago (mostly) due to arthritic ankles.

Last Monday he became very sore, and we thought perhaps it was an abscess. He had been walking a bit foot-sore a few days earlier but (as mentioned) he hasn't been sound-sound for years. The vet came out and agreed that perhaps it was an abscess (although the horse did not react to the hoof tester) and we poulticed it. The vet also mentioned that perhaps it was his ankles bugging him but we were crossing our fingers for an abscess.

In the past, we have injected this horse with hyaluronic acid and two out of the three times he had an allergic reaction - his ankles swelled up and for the next month he was very, very sore. As a result, we won't be giving him any more HA injections.

On Saturday, we noticed some oozing around his coronet/ankle on the foot that we had poulticed. We were hoping this was the abscess bursting, however the oozing wasn't really consistent with a draining abscess - and he wasn't getting any sounder.

On Sunday, he was still very lame in the front end but now was moving strange in his hind end. He also seemed to have trouble moving in a straight line when walking, which was worrisome. We thought perhaps it was a nuerological problem and immediately called the vet out.

The vet did some tests (having the horse walk in tight circles, mainly), and determined it was not a neurological problem and was due to the pain in his right ankle. The vet did xrays on the spot and they showed that the horse no longer has synovial fluid in his right ankle. We're talking bone on bone.

As a side note: The oozing/rain rot-looking spot is likely from a lot of heat in his ankle

For the next week, we are trying him on (I believe it's called) Polyglycan (it's generally used for dogs with hip dysplasia, but the vet has had some pain relief success with horses who have foundered). After that, if there isn't much improvement... I guess a big decision needs to be made

I'm just curious to know if anyone has any treatment ideas to keep this boy comfortable as long as possible, or what your experiences have been.

[Simkie]

IRAP, maybe? It is very effective at reducing inflammation within the joint, and he should not react to it, as it is derived from his own blood. It is pretty costly.

Alternatively, you could use some steroid in the joint. Much cheaper than IRAP and should at least provide some short-term pain relief.

Although, 20 years old, hasn't been sound in a couple years and is now acutely painful and bone on bone? I'm afraid I would be seriously considering putting him down before it gets cold

[SCMSL]

The best thing you can do is infiltrate with eather steroids or PRP's, which are more expensive but also have a higher success rate and last longer than steroids.

Anything you may give orally or IM will only prevent an issue from getting worse, it won't help with an already arthritic horse.

Jingles for your boy

[Laurierace]

Not sure I buy the oozing from inflammation but in either case I would go to pentosan and a course of bute or previcox.

[joiedevie99]

I'd try some combination of Pentosan, Legend, Previcox and Steroid-only injections in the joint. Sadly, none are likely to be long-term solutions.

I also don't buy that the rain rot/oozing is from heat. I'd be looking at/treating that as if it wasn't.

I know pasterns can be fused, but I don't believe that would work on a fetlock.

[Laurierace]

My gut feeling is you are dealing with cellulitis and the bone on bone is secondary.

[morganpony86]

The vet did xrays on the spot and they showed that the horse no longer has synovial fluid in his right ankle. We're talking bone on bone.

Sigh. You can't tell that from radiographs. You can tell that the joint space has closed significantly (the "bone on bone" you mentioned), but synovial fluid isn't radiopaque. Just like cartilage isn't radiopaque either. So the horse has severe osteoarthritis in the joint, I assume based on your description? Are there large osteophytes (bone spurs) present as well? All classic radiographic evidence of OA?

If that's the case, then there isn't much you can do. In humans, when OA gets to that advanced stage, a total joint replacement is performed. Obviously you can't do that in a horse. You can't replace the synovial fluid or the cartilage lost, so the only option is palliative care until the horse tell you it's time to give up.

[abbasi]

“A sticky or squeaking hinge can be “cured” with a drop of oil, so it makes sense that a hinge joint, like the knee, would also benefit from a little lubrication. At least that’s the premise behind one new form of treatment for arthritis of the knee.

The procedure, called viscosupplementation or synovial fluid replacement injects a preparation of hyaluronic acid into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial (joint) fluid. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads”

Obtaining Synovial Fluid Replacement.

Synovial fluid replacement is a prescription only product administered by a qualified doctor. Many hospital doctors perform this procedure as well as General Practitioners. The injection procedure is covered by the VHI, BUPA and VIVAS and the product is on the General Medical Scheme (GMS) and the Drugs Payment Scheme.

[RAyers]

“A sticky or squeaking hinge can be “cured” with a drop of oil, so it makes sense that a hinge joint, like the knee, would also benefit from a little lubrication. At least that’s the premise behind one new form of treatment for arthritis of the knee.

The procedure, called viscosupplementation or synovial fluid replacement injects a preparation of hyaluronic acid into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial (joint) fluid. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads”

Obtaining Synovial Fluid Replacement.

Synovial fluid replacement is a prescription only product administered by a qualified doctor. Many hospital doctors perform this procedure as well as General Practitioners. The injection procedure is covered by the VHI, BUPA and VIVAS and the product is on the General Medical Scheme (GMS) and the Drugs Payment Scheme.

Yeah, no. A swing and a miss in this case. And NO, simple supplementation does NOT do what is claimed. Plenty of clinical studies over the past 10 years show that.

As morganpony said, the joint is gone. Period. There is no making new cartilage, there is no synovial supplementation when the synovium is gone.

The only option is ankyosis (fusion) of the joint. It can be done surgically. Sure, crank on IRAP and 'roids to make the bone fuse. But the function will continue to diminish, regardless.

[kickyjz]

Thanks for your replies everyone, it's such a crappy situation to be in.
Ugh, horses.

[Fharoah]

Coffin joint or pastern? If it was the pastern wonder if a chemical fusion could be considered. You can try injections into the joint, if you can still get a needle in there.