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IRAP or alcohol fusion of lower hock joint, long term effects?

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  • IRAP or alcohol fusion of lower hock joint, long term effects?

    Does anyone have any experience with using ethyl alcohol injections into the lower hock space to fuse the joint? I'm specificlly looking for long term health effects.

    Will this create more of a problem in the upper hock joint in the future?

    What about IRAP therapy on the hock? Any experience?

    Loong story short, horse coming back from RF low Suspens injury done in Sept 09. Horse steadily coming back into work shows grade 1-2 lameness in LH. Last week the vet did lameness exam and blocked pasturn, suspen area then hock and then x-rayed hock. Feels the issue in in the hock. Shows lower joints loosing space. Vet recommends 1) joint injections every 3 months with HA/Steroid OR 2) IRAP therapy OR 3) alcohol fusion of the lower hock joint OR 4) put horse on Equioxx daily and see how he goes.

    We got soo tied up in the LH that we ran out of time for the RF. But so far ultrasounds show that's ehaling well. I'll have th evt out again to u/s the RF tomorrow to see if that gives me any nudge towards a particular therapy for the LH.

    Horse is 15yo QH gelding. We did a hock inject in March with moderate success for this same issue. the hock issues are not completely out of the blue, I have xrays from 2006 on both hocks (b/c they were of concern) that show no changes. FWIW

    i'm rambling. Any info on the 2 therapies is appreciated.

  • #2
    Fusion is a good option once all conventional therapy fails. I would not jump into fusion until nothing else works as it in is always an option down the road. I did surgical pastern arthrodesis surgery August 2009 and it has not been a smooth recovery as expected. They still say he has a good chance at soundness but he is still quite lame and it has been really really hard what was sposed to take six months to a year will now take over a year and my horse is still in pain. I would use the hock injections or IRAP as long as you can keep the horse sound. Equioxx or previcox is a good option legend adequan whatever you can do to keep them confortable. When therapy is no longer effective then consider fusion. Talk to your vet for sure that is just my feeling.


    • #3
      My horse had the alcohol injections in his hocks last year.
      Background: 10 yo QH that has bad arthritis. He was about 90% fused in both hocks but the last bit wouldn't fuse. Previcox would sometimes mask the pain but not always. Hock injections (steroid and HA) would only last 2 weeks. My horse then lost the ability to canter under rider both directions and then lost the trot. I opted for the ethanol injections at UC Davis. The vet assured me that there were no long term problems so long as the ethanol did not leak out of the joint. The injections were done under xray with a contrast agent first to make sure no leakage would occur.
      He improved for about 4 months and then went back to showing all his original symptoms. At 6 months post injection, I had new xrays taken and they showed 0% new fusion. Yes, I mean NO changes in his hocks compared to the preinjection xrays.
      I took him to another vet clinic for a second opinion and opted to have his hocks drilled. We are 9 weeks post surgery and beginning rehab so it will be a long time before I know if it worked. The vet there said he never sees the hock drilling fail but he's seen a lot of failures to fuse from the ethanol injections and the old caustic iodine injections.
      I went with the alcohol injections because it sounded a lost less painful and your horse doesn't have to be put completely under. But I think most vets will tell you that you have the best chance of inducing fusion with the hock drilling.
      I would ask your vet what his/her success rate is with the alcohol injections. Not what the general success rate of 70% that is quoted from the one paper that's been published but what his/her personal success rate is. Good luck.


      • Original Poster

        Thanks all for the replies. i posted a ? about Tildren in this forum tonite. More info there.

        Horse is 15, has had NQR issues with hind end for 9 yrs. Has been on Legend and Adaquan since 2005. Doing an injection every 2.5 weeks. Adaquan then Legend and etc. has had hocks injected as well as stifles. Chiro, Accupuncture, massage and myofascia work done. We have been treating for long time so I am not jumping to Alcohol injections as the first treatment option.

        Today the vet recomended trying the Equioxx for 3 weeks and see how he goes on that. Then to try Tildren next and use that again if we get 6-8 months of happy horse. Then when that no longer gives good results to go to the Alcohol injections.

        RAyers on this BB pointed out the - side effects of using Tildren in posts he made in 2007 but i ahven't dug up any recent posts to see if he's still opposed.

        Still researching. Started first syringe of Equioxx today.


        • Original Poster

          Originally posted by Fharoah View Post
          Fusion is a good option once all conventional therapy fails. When therapy is no longer effective then consider fusion. Talk to your vet for sure that is just my feeling.
          I'm not considering doing a surgical fusion. Ethyl alcohol fusion is a procedure done at the vet clinic, a dye is injected into the lower joint to make sure that the upper joint isn;t involved. Then the alcohol is injected into the a 2 week time off then back to work. There should be no pain involved as the alcohol deadens/kills the nerves in the lower hock joint.

          Hock injections just don't seem to be a good option at all. I mean all we get is about 3 months of grade 1 over a grade 2 soundness. So it's really not worth it to stick a needle into the joint so frequently.