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  Discussion on Arthrodesis of the hock
Author Message
New Member:
Wendyp

Posted on Sunday, Dec 7, 2003 - 3:01 pm:

Hi,
In March 2001 my 8 year Irish cob was diagnosed with a spavin in his right hind in the tarso metatarsal joint. He received 2 cortisone injections three months apart and but failed to stay sound. He was then found to also have arthritis in the distal intertarsal joint. In November 2002 he under went arthrodesis in both affected joints. By June this year he was still lame and was re-Xrayed. The tarsometarsal joint has fused but the distal intersal joint has not.
My vet then injected more cortisone into that joint but he has not improved.
He has 2 sachets of bute a day and is usually stiff rather than lame when ridden. He does sometime warm up and go very well but on other occasions the best he can manage is slow trot.

My vet has now informed me that he thinks we should re-operate and drill out the joint again.
I am concerned that another operation may do nothing or even worse make the situation worse.
Surely if cartilege has already been drilled out, it doesn't grow back, so the vet will be drilling more cartilege out. Is there more chance of it fusing? Or will we have the situation where there is very little cartilege, considerable pain and no hope for my horse?
What other things could go wrong?
Does anyone have any experience of arthrodesis being carried out twice in a joint?

The surgeon, who is well renowned in the UK, has never drilled one out twice and I am concerned that my vets do not really know what will happen.

I have asked my vet if we should give up trying to get the joint to fuse and instead put him on supplements such as cortaflex. It is more conservative approach but I feel it is less risky and I would like to know if there is much success with this approach.

Thanks
Wendy
Moderator:
DrO

Posted on Monday, Dec 8, 2003 - 5:59 am:

Hello MrsWP,
The prognosis for arthrodesis is not excellent. Large studies usually indicate about a 25% failure rate. With two joints involved the prognosis worsens. Though not well studied it seems logical that failure occurs for 2 reasons:
  • Failure for the joint to fuse effectively
  • Pain from other areas than the drilled out joint


If it can be well demonstrated that the pain is from the DI joint and you want the horse back as soon as possible redrilling may be the best choice. But I agree with you that the prognosis for the second operation is not clear for anyone as I do not know any studies that have looked at this.
DrO
Member:
Wendyp

Posted on Tuesday, Dec 9, 2003 - 10:52 am:

Thank you for your prompt reply.
My vet wants to try and establish that it is the DI joint too. So he came today to nerveblock it. However my horse came out his stable completely sound, we even lunged him and he was sound. He hasn't moved like that for 18 months. So the vet couldn't do the nerveblock. So we are going to stop the bute and try again later in the week.

The vet is concerned about a suspensory ligament problem but thinks that he wouldn't have come out sound today if it was.

Wendy
Member:
Wendyp

Posted on Saturday, Dec 13, 2003 - 2:05 pm:

The vet came yesterday and did the nerveblock and it is definitely the DI joint.
The vet did give me a choice of treatments. The op or a new drug which has just been trialled in the UK and has had very successful results on spavins. It is supposed to stop the bony growth altogether. The treatment consists of 3 intravenous injections over 6 months and represents, to me anyway, a much lower risk than re-operating. Unfortunately I haven't got the name of the drug, but the trial was covered in the horse press over here recently and I am trying to track down a copy of the article.
Once I have it, I will post some more information where others on the site are more likely to see it.
Wendy
Member:
Wendyp

Posted on Saturday, Aug 28, 2004 - 11:26 am:

Unfortunately the drug did not work and we decided to redo the arthrodesis 2 weeks ago.
Moderator:
DrO

Posted on Saturday, Aug 28, 2004 - 5:10 pm:

Hello MrsP,
Thank you so much for the update. Did you ever find the name of the medication. Please keep us appraised of how the arthrodesis goes.
DrO
Member:
Wendyp

Posted on Monday, May 30, 2005 - 8:31 am:

I haven't posted for a long time I know. I ended up divorced. The drug was tildren. The last I heard it was still being trialled here.

We've had 9 months now since the last arthrodesis. Unfortunately he was very naughty about the box rest and being ridden, so he had to be turned out after 2 months. He then threw a splint galloping around so all that set him back a couple of months. We have had a horrendous wet winter in the UK, reducing our hacking to a quagmire we couldn't use and the arenas to bogs. We were confined to the arena which is not ideal for him and he struggled in the surface. So for a long time we appeared to make no progress. In the last 2 months he has started to improve. He is now down to 1 bute a day, looks sound some of the time and only slightly unlevel the rest. He is still struggling a bit when he comes out of the stable.
He is being worked a lot harder now, much harder than he has worked in the last 3 years in an attempt to slim him down and to get the fusion completed. I'm fortunate that he lives at a riding school so the staff have been using him to escort hacks and to do the occasional lesson. So he has been doing up to 2.5 hours a day compared with struggling with 45 minutes in the past. He has never been able to sustain the extra work before without getting very stiff. He also no longer stiffens up as badly when he stands for a break.
We are definitely getting there but it is slow progress.
Moderator:
DrO

Posted on Tuesday, May 31, 2005 - 8:21 am:

Thanks for the update. Since our last postings I have seen some work on Tildren and if I remember correctly it had a higher failure rate than drilling but like you said they are still working on it and they may find a better protocol. Hope things continue to improve with your Irish Cob.
DrO
Member:
Wendyp

Posted on Sunday, Jun 5, 2005 - 12:06 pm:

Tildren is the first treatment used in the Netherlands - my vets has a dutch vet and he has said he has had good results with it in the Netherlands. However bute is banned there so perhaps it is the best option going.
It was expensive - 1 dose of the drug was £500 and that was at cost.
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