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  Discussion on Infected Stifle Joint/ Joint Injection
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Member:
1roper

Posted on Thursday, Jun 5, 2008 - 11:53 am:

On the 19th I took my futurity horse (barrel racing) in to have her hocks re-injected and we decided to do her stifles too. She is a 5yo with just at a year's worth of rides, and she's exceptionally talented. So much so, that when she's sore, she'll still find a way to get the job done.

He said 4 days of stall rest, and bute 2g/2x daily for four days. I did as he said, and on Friday I got her out and did some slow work with her because he said she was in shape enough to do so and I had a big barrel race that weekend anyway.

Saturday morning I pulled her out of her stall and she was lame on her right back hind- which was her good side.

I called my doctor (who is one of the best in the country when it comes to lameness) and he said that he felt like with no heat, that it was a collateral ligament tear and to put her back on bute 2g/2x day. He said if I find heat, or she isn't wanting to walk on it, or use it or she begins to hold it up, he wants to see her IMMEDIATELY.

Sunday she started showing those signs and I was 30 miles from his clinic at a barrel race, so he came to see her. He began to wonder if there was an infection in the joint. But then said that it was a 1 in about 200,000 chance that a horse would get an infection. He said it isn't so much from the injection itself as it is from something in her system reacting with the cortisone. I believe he has been practicing for about 40 years and has only had 2 other horses that got infections shortly after the injections.

He gave her a shot of banamine, bute and 20g of Baytrill just in case. He said there was fluid on the joint and he wanted to x-ray and ultrasound her so I took her to his clinic that afternoon and left her. On Monday she was at 85% sound- and he said to the layman they'd think she was sound. He gave her another shot of baytrill for good measure and said he really felt sure it was a tearing of her ligaments from the short ride on Friday. So I was instructed to put her on another 4 days of stall rest- and bute for 4 days and then another 4 days of stall rest sans bute.

I did as instructed and she was feeling great. No heat, no swelling in the joint. I took her off the bute and the first day she was great. Day 2 she was not as sound as she had been. So I decided we'd go back to the bute, as there was no heat, and she was simply short on it. Then the heat returned and she started not wanting to use it.

I hauled her to the vet as soon as possible the next day- which was yesterday and he pulled joint fluid that was an orange in color as she really does have an infection. He kept her there as he is giving her a mixture of rompum and ketamine everyday to lay her on his table and flush the joint. He flushed it today and I believe he said that he gave her 10cc of genocin (he may have even left it in the joint) and she'll stay on baytrill at 20cc a day.

I guess my question is, what is the prognosis for this sort of thing? She's just a 5yo and has so much promise. I would hate to have to put her in the broodmare pasture at this point.

Thanks, Dr. O.
Member:
1roper

Posted on Thursday, Jun 5, 2008 - 3:25 pm:

Oh I should add- she did tear her MCL.
Moderator:
DrO

Posted on Friday, Jun 6, 2008 - 7:55 am:

I am so sorry Jennifer. The article describes proper treatment and prognosis so the question is was treatment begun before the joint was permanently damaged? Really the only way to know this is response to treatment so we will have to wait and see.

The incidence of joint infection/serious complications depends on what is injected. In the case of steroids and hyaluronate the incidence found in the largest study to date is 1 in 10,000. In the case of PSGAG injection the incidence is significantly lower but I cannot remember it off the top of my head. Currently it is unknown if injecting a joint not clearly inflamed is of any benefit or if it may be detrimental. In spite of this it is a common accepted practice in performance horses.

I do wonder since all the history and clinical signs can be explained by the joint reaction to injection why is it still believed there was a collateral ligament tear?
DrO
Member:
1roper

Posted on Friday, Jun 6, 2008 - 8:10 am:

We saw the tear of the MCL on the ultrasound. That was my concern too, was did we catch it soon enough to battle this before the damage was done. It's hard to treat something you can't see. She really had full range of motion on it for the first 5 days, and on day 6 she came up lame- with no heat- that was probably when the MCL tear showed up. With the bute/banamine/baytril injection the doctor gave her on Sunday (5/26) all the swelling left and she was at 85% and then continued to improve through that week. It wasn't until around Saturday the 31 that she started to show lame again and that was after 2 days off of bute. There was no heat (such as what we found on Tuesday). The heat really didn't show up until Tuesday (6/3).

How long should it take to see results if she is going to improve? And is this something that time can continue to heal after the infection is cleared up? Is it something that with time off and turn out will correct itself? I've heard of stranger things happening. This mare, while a QH believes she's a wild mustang, and part of the issue with her healing I believe is that she doesn't do well in confinement, without turn out or daily riding. She believes she was put on this planet to run. We all know that doing what we love is good for the soul. I don't believe a horse to be any different.
Member:
1roper

Posted on Saturday, Jun 7, 2008 - 12:41 pm:

Doc called today and said that the heat was very minimal so he feels like we are gaining ground. He said she still wasn't moving well on the affected limb, however.
Member:
1roper

Posted on Saturday, Jun 21, 2008 - 2:10 pm:

They have identified the organism as Staph. She has been moved to a surgical clinic and they scoped the joint on Wednesday. They flushed 5 liters of fluid through it. The last liter being a 5% DMSO solution.

They left Amikacin in the joint.

We have been at this since June 4th now, and there has been some improvement, but not a lot. She's on Baytril that they are giving intravenously.

I can't get anyone to tell me how long it should take to kill off this bacteria. So I might be a tad frustrated at this moment.
Member:
mrose

Posted on Saturday, Jun 21, 2008 - 2:54 pm:

Dr.O, when I read posts like this about infections in joints that are slow to respond to antibiotics, it makes me think of the anaerobic bacteria that infected Libby. If I understand right, it will not show up in a normally done culture. How difficult is it to culture for anaerobic bacteria? When antibiotics aren't working, should a culture be done for them? Or, will they eventually respond to an antibiotic anyway?
Member:
1roper

Posted on Saturday, Jun 21, 2008 - 3:15 pm:

Sarah-

This clinic has a hyperbaric chamber they are using as part of their therapy for my mare. Apparently, it works by adding additional oxygen to the bloodstream and that accomplishes three things as it has been explained to me:

1. Due to the increase in Oxygen it helps kill off bacteria because it makes the environment that it lives in undesireable.

2. It helps certain antibiotics work better, such as the Amikacin that they are using in this mare's joint.

3. It helps the white blood cells work more efficiently.
Moderator:
DrO

Posted on Sunday, Jun 22, 2008 - 6:21 pm:

Often aerobic and anaerobic cultures are run concurrently however these type infections are not usually anaerobic though this can become a secondary problem. Jennifer it is not good prognostically that there is still remarkable lameness, what does the clinic say about the small amount of response.
DrO
Member:
1roper

Posted on Sunday, Jun 22, 2008 - 7:44 pm:

They have said that it could take months for her to not be lame anymore. They put special shoes on her back feet this week, to help relieve the stress on her Digital Flexor Tendon, as they're worried about laminitis setting in.

The scoping showed the cartilage and bone edges to still be in good form.

This morning's update was that she's still not putting a lot of weight on her bad leg, and she's laying down a lot but she was walking better. I'm not sure how much better they want her walking, but I've talked to several people that had this same problem with coffin joints and hocks and they said that their horses weren't sound until around 6 months to a year after this sort of thing. So, I don't really know.

The head surgeon has been out of town all week, so I've got the vet that's four years out of school (who is doing his residency under Dr. Ray- who studied under that surgeon at CSU) and he can't answer a lot of my questions.

What I really need, is this infection gone. Getting her sound is secondary- because she can at least be a broodmare if nothing else.

You may find this a strange line of thinking, but I honestly believe that this mare will not get better in a 12 x 12. She needs to be at least outside in a 12 x 12 as she doesn't do well in confinement.
Member:
mrose

Posted on Sunday, Jun 22, 2008 - 11:47 pm:

Just my opinion, but I'd try to keep her confined if that is what the drs. advise. Is she getting any handwalking at this point? There were some posts on HA a while back about keeping horses content in confinement. Perhaps they'll be of help.

I know how frustrating it is to not know for sure what is going on and to worry about what her future will be.There is nothing worse than not knowing, imo. However, as was said before, it will take time and patience - a lot of each. And, don't give up on your mare. We had one show mare that tore her ACL and another a couple of years ago,Libby, that severed her DDFT. The first mare, Maarissa, eventually became sound enough to be riden on easy trails and to be a lesson horse. When her arthritis got bad in her knee, we retired her to pet status.

Libby has become sound enough to go out in pasture and to be a brood mare, which is all I could have hoped for after her ordeal.

Ann and some others have also had experience with tendon and joint injuries. Reading some posts on these horses, if you haven't already, may be of help.

A lot will depend on your mare and her attitude, also. I think Ann's post would really be helpful to you because her mare is young and high energy.
Moderator:
DrO

Posted on Monday, Jun 23, 2008 - 7:04 am:

While the distal intertarsal and tarso-metatarsal hock joints may have prolonged lameness then go sound do to fusion of the joints. A coffin (or stifle) joint lame from sepsis for 6 months is a very very unlikely candidate for soundness.
DrO
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