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  Discussion on Subchondral Bone Cyst in Coffin bone
Author Message
New Member:
cervelo

Posted on Friday, May 30, 2008 - 11:48 am:

Hello,

I have a 2yr old Warmblood gelding that has had surgery on a Subchondral Bone Cyst that was found on the front right pedal bone at the coffin joint. This has been a nightmare year to say the least.

His surgery was last December, 5 months ago, and his limp is decreasing slowly but steadily. I'm told that this is an uncommon location for a bone cyst. They x-rayed the other foot and did not find another one, thank God.

Can anyone give me any advice on what I should do at this point while I'm waiting for him to go sound again? His limp is almost unnoticable to someone who's not looking for it and when he's excited and trotting even I don't notice it.

Questions:

Should I be doing any rehab with him?

When should I know if the surgery was a success?

What kind of long term problems should I watch out for? (x-rays 3 months post surgery showed no inflamation and no signs of arthritis)

He had 3 months of stall and small paddock rest after his surgery. Personally speaking...anyone who's kept a long yearling colt on stall rest knows what a challenge it is to keep him on all four feet.

Any and all advice would be greatly appreciated. And if there's anyone out there who's been through this I would love to hear from you.

Thank you!
New Member:
cervelo

Posted on Sunday, Jun 1, 2008 - 6:14 am:

Dr. O, anyone?
Member:
frances

Posted on Sunday, Jun 1, 2008 - 9:02 am:

Hi Kimberly and welcome!

I expect DrO will reply to you soon - sometimes he is away from his computer on a Sunday and, unless his administration informs him that there's an emergency, he responds when he gets back, on Sunday evening or Monday morning.

Good luck with your horse!
Moderator:
DrO

Posted on Sunday, Jun 1, 2008 - 11:27 am:

Hello Kimberly,
There are several retrospective studies on the results of surgery for subchondral lesions of the distal(or third) phalanx. With surgery the outcome is usually very good with 80 to 90% returning to work which is a much better outcome than with conservative therapy.

However without examination of your horse we really cannot answer specific questions and they would best be answered by the surgeon who actually did the work on the cyst or your regular veterinarian who is intimately involved with the cause. They will know better than anyone what to expect post op and when the horse is ready for rehab.

We would be interested in having the pre and post surgical radiographs posted and we might be able to add some helpful information. Also following along with the progress of your case may help other members who have this problem in the future. Certainly the number one complication to be expected would be coffin joint arthritis but it may be very slow to develop. Is seems fairly common for these horses to develop some extra calcification around the margins of the joint.
DrO
New Member:
cervelo

Posted on Sunday, Jun 1, 2008 - 7:58 pm:

Thank you Dr. O and LL! The surgery was done at NC State and the surgeon was very happy with how the proceedure went and also how the radiographs looked 3 months later. I guess the hardest part for me at this stage is that no one can give me a time line as to when I can finally breathe a sigh of relief. I guess I was being too hopeful in thinking he would completely stop limping by now.

I have a lot of confidence in my vet but she's not seen many (if any) cases in this particular location. Even the surgeon only sees about one like this per year.

I have emailed the surgeon and left a phone message. When he responds back I will let you know what he says. Is it common for surgeons and Vets to allow a client to have copies of the x-rays to send to you? If so I'll try to get a copy. They even filmed the surgery! That was pretty cool to see.

This young horse has so much potential. He was a fantastic mover before all this happened and every now and then I'll get a glimps of that beautiful uphill trot and it just makes me smile and reminds me it's all going to be worth it. And too, having been through all this together we've developed quite a bond. He follows me all around the pasture like a puppy.

Thank you again and I'll keep you posted.
New Member:
cervelo

Posted on Thursday, Jun 12, 2008 - 2:28 pm:

My surgeon looked at a recent video of my horse's trot and was not happy with what he saw. This is the email he sent me.

"I was obviously disappointed to see that he is still significantly lame. I think we have to assume that after this amount of time the chances of him becoming sound are become more remote. At this stage I would be careful about further joint injections as they might compromise the health of the surrounding cartilage.

I would like to suggest that he is injected with Tildren, a bisphosphonate that inhibits bone resorption. I is a bit of a long shot as we have not used this for cysts before, but there is a logical basis for its use and an outside chance that we may still be able to turn this around."

So...what do you think? And how much does this cost? I've read that it is administered in 10 iv injections.
Moderator:
DrO

Posted on Friday, Jun 13, 2008 - 6:28 am:

Hello Kimberly,
I am uncertain what particular condition of the foot the surgeon finds a logical candidate for Tildren therapy. We have several other posts on Tildren Kimberly, if you run a search you will find them. I have not used this product so don't know the wholesale cost and even if I did pricing schemes vary widely between practices, maybe some of the other members who have used the product will comment.
DrO
Member:
cervelo

Posted on Friday, Jun 13, 2008 - 9:43 am:

From what little I have learned from the posts here and from my own vet (who is currently looking into this for me) it's expensive and it's not approved in the US yet so getting my hands on some is not going to be easy. My vet is also going to make a phone call to where trials are being conducted but unless his condition is specific to their study he would not likely be a candidate for a clinical trial.

His breeder has graciously offer me the choice of another youngster from her farm, and I have very thankfully accepted the offer. I'm going up this month to pick one out and they will hold it for a year to give my guy more time to see if things turn around for him.

I could never say enough wonderful things about his breeder. I have kept her informed every step of the way so she knows the horrors we've been through since last August when he first went lame and 15 months of age. She told me she was not going to leave me with a lame horse and she's making good on her word. People like that are hard to come by these days.
Moderator:
DrO

Posted on Saturday, Jun 14, 2008 - 8:40 am:

Good to hear things will work out for you. I just hope the filly goes on to soundness.
DrO
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