This is an archived Horseadvice.com Discussion. The parent article and menus are available on the navigation menu below:
HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Upper Rear Limb » Overview of Diseases of the Hock (Tarsus) »
  Discussion on Lower Distal Joint Fusion: bone injury risk and exercise
Author Message
New Member:
Gabin

Posted on Monday, Nov 6, 2006 - 10:43 am:

Dr. O:

My 12 year old selle francais was diagnosed two months ago with arthritis in the lower distal joint of the hock. Since we are in France, I unfortunately only know the brand names of the medicines used here to treat him. His lameness started suddenly from a trauma to the bones while cantering due to the result of loss of cartilage in the joint. He received an immediate IV of a calcium building product called Tildren. This medication is so strong that he causes immediate fatigue and may cause colic. Luckily, my horse, Gabin, had a good reaction - though he was tired for 2 days. Ten days later, the vet administered an injection of Hyonate (4 ml) - a thick gel-like substance to help lubricate all his joints. This injection was not made directly into the hock since the vet explained that there was not enough space between the bones to make the injection. He was walked for 2 and a half weeks, first by hand then ridden, after which we were told to begin riding with a progressive increase in the work. He started the work while on a strong anti-inflamatory called Equipalazone and showed no pain or hesitance to work. His work continued to improve for 2 weeks (though he showed stiffness in the hock) without any anti-inflamatory until he suddenly went lame again. After an x-ray, the vet found a tiny fracture (1 mm) near the site of where the original bone trauma was, while at the same time he found that the latter problem showed noticeable improvement as a result of the treatments and activity during the first month. With this fracture, he must stay in his stall for one month after which the vet will check with x-rays. He might be able to begin walking by hand for one month then possibly starting to be ridden again in early January.

My question is: Since the vet recommended the natural fusion of the joint, what is your opinion on activity level? I do not want to risk any more bone injury but to get the joint fused, he must be active. Also, how do we balance the risk of additional bone injury with enough activity to promote joint fusion? The vet indicated that Tildren strengthens the bones. How long does it take for the joint to fuse? What kind and amount of exercise is good and what is potentially dangerous?

I would appreciate your thoughts.

Regards,

Lisa
Moderator:
DrO

Posted on Tuesday, Nov 7, 2006 - 6:14 am:

Hello Lisa,
We have an article on arthritis at Diseases of Horses » Lameness » Joint, Bone, Ligament Diseases » Arthritis and DJD: An Overview that discusses arthritis and arthrodesis (fusion). Be sure to follow the link from that article to the complete article on arthrodesis.

A fracture is a unusual complication of arthritis in the hock so though the articles gives general answers to your questions on exercise and timing the specifics of your case can be most accurately answered by those who can examine your horse.
DrO
New Member:
Gabin

Posted on Sunday, Dec 17, 2006 - 1:18 pm:

Dear Dr. O:

Thank you for your response. I was put in touch with another vet who examined my horse's hock more closely. According to the numerous x-rays he took, the horse does not have a fracture and as his left hock is completely normal, he does not think that the problem with the right hock is DJD. He calls the problem: osteonecrose mediale of the tarsal joint. From what I understand, the actual bone is fragile causing partial fusion of the joint. The part of the joint that is not yet fused is still has cartilage which is preventing full fusion. The vet believes that this problem may have occurred when the horse was still growing and experienced some sort of trauma to the hock. Because of the bone weakness, he feels that steroid injections will only worsen the condition. He advises surgery involving the removal of the remaining cartilage, introduction of small holes and grafting stem cells from bone marrow in his sternum. Without the surgery, he is worried that the disk may collapse under the pressure of a canter. He is in touch with Dean Richardson at U of PA to understand the latest techniques and eventual prognosis.

We have been hand walking the horse for the last month and a half. After his shoes are changed tomorrow, we will ride him for half an hour everyday, but only walking and trotting.

Verbally, the vet feels that the horse should recover most of his normal movement and should eventually be able to compete in jumping. For dressage he is more reserved, stating that Gabin will not be able to do high level dressage since his movements will not be regular. I would like to continue low level dressage with some competition.

Do you have any experience with this sort of a problem, this surgery and the most likely prognosis? He is a very talented, athletic and sweet horse and it breaks my heart to think that he may not be able to continue using his talents.

Regards,

Lisa
Moderator:
DrO

Posted on Monday, Dec 18, 2006 - 9:42 am:

Not in a 12 year old horse and strongly recommend you have the radiographs sent to the equine surgeons and radiologist at U of Penn veterinary college for a second opinion on this before beginning an extensive surgical procedure.
DrO
New Member:
Gabin

Posted on Monday, Jan 8, 2007 - 10:35 am:

Dr. O:

Happy New Year! Let's hope for Gabin as well!

He has a steroid injection today into the diseased hock joint and an IV of Tildren. He is back in his stall resting as I write. U of PA opted to try the injections over surgery and does not feel that this will worsen the osteonecrosis, which appears to be more severe than he believed for a 12 year old horse.

Thank you again for your advise. I will keep you posted . . .

Lisa
Moderator:
DrO

Posted on Sunday, Jan 14, 2007 - 10:16 am:

Thanks for the update Lisa,
DrO
New Member:
gabin

Posted on Monday, Apr 30, 2007 - 9:08 am:

Dr. O:

Just an update on Gabin. After his hock injection, he was reworked for a month and a half but on the fourth day after starting to canter, he went lame. I recontacted Dean Richardson at Penn who suggested surgery.

Gabin was operated on March 27th by one of the leading specialists in France (recommended by Dr. Richardson). He spent one month in rehab and was moved last Friday to a small paddock where he will stay for one week after which he will have the freedom to roam and play in a very large paddock. Last week, he was not lame trotting in a circle on the right side and slightly lame on the left side. The vet confirmed that this was normal and will sort itself out as Gabin uses his leg naturally over the next three months. After being on and off depressed while remaining very cooperative and gentle with the vets and trainers, Gabin is visibly happy!

So far it has been almost 8 months since Gabin first went lame last September. I will keep you posted hoping Gabin's experience will help others.

Regards,

Lisa
Moderator:
DrO

Posted on Tuesday, May 1, 2007 - 7:28 am:

Delighted to hear things are heading in the right direction Lisa. Please continue to keep us informed.
DrO
Home Page | Top of Page | Join Us!
Horseadvice.com is a BBB Accredited Business. Click for the BBB Business Review of this Horse Training in Stokesdale NC