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  Discussion on Silicone use in inter-articular injections/ stem cell in joints
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New Member:
7cents

Posted on Thursday, Aug 24, 2006 - 10:22 pm:

New here, joined to see what the concensus on this was....

Several years back there was quite a bit of hype in the racing world about a form of silicone used for joint injections. I never had reason then to explore it. I currently have a very talented, stakes winning gelding with progressing DJD in his front ankles. But, it seems like the silicone "solution" has disappeared. Why has it been abandoned? FDA? Infections? Poor long-term effects?

The horse has been on 2x month Adequan and oral joint supplement (MSM, chonDrOitin, HA, glucousamine, shark cartilage, devil's claw liq. compounded by a vet) for about 20 months. He gets HA inter-articularly at 35-60 day intervals with depo added every 3rd injection (180 days).

His natural speed is, I'm sure, exacerbating this condition. He is 5 yrs old. Xrays taken today show an alarming increase in the cartilage degeneration in his left fore ankle.

Any progress in stem cell therapy helping cartilage regeneration?

Any help, advice, thoughts would be greatly appreciated.
Member:
Hwood

Posted on Thursday, Aug 24, 2006 - 10:50 pm:

Kris, welcome.
Dr. O. posted about DJD earlier today. This isn't about silicone, but you might be interested. Check out this post dated today.
Horseadvice.com » Diseases of Horses » Lameness » Joint & Bone Diseases » Arthritis and DJD: An Overview
Moderator:
DrO

Posted on Friday, Aug 25, 2006 - 6:54 am:

Kris can you tell us how often your horse is racing, how often he is lame, and what your short and long term objectives are?

I have not heard about the intra-articular silicone injection thing but we do have a number of oral, IM, IV, and IA suggestions in the article Diseases of Horses » Lameness » Joint & Bone Diseases » Arthritis and DJD: An Overview and the medication links found in that article. Looking at the list of things you are currently giving and your implied long term objective of perserving this joint I would consider seeing if you could substitute triamcinolone acetonide for the methylprednisolone (Depo). The reasons are explained in the article on arthritis. Also I would DrOp the devil's claw, unlike NSAID's it might hide inflammation by relieving pain while allowing the inflammation to hasten the damage. Lastly I don't see any NSAID's in your regimen, these are important drugs in controlling the inflammation associated with arthritis that speed up cartilage destruction.

Stem cell therapy has been a bit disappointing. The current newest thing that seems to be working well is autologous cartilage grafts (only at Colorado State as far as I know) for resurfacing acutely injured joint surfaces. The results have truly been promising but I thing the million dollar question is will this technology be applicable to resurface chronic arthritis (OA) damage.
DrO
New Member:
7cents

Posted on Friday, Aug 25, 2006 - 10:33 pm:

Dr.Oglesby,

Thank you for your response. We do use some NSAIDs. He gets 2g Bute 12 hours prior to a breeze or fast gallop and 5 hrs post breeze/fast gallop. He gets Ketofen 30-40 hrs prerace and either Banamine OR Bute 24 hrs prerace (timing depends on state he is running in) and Banamine 2 hrs postrace, 2g Bute for 2-4 days following a race/breeze. He has had bleeding issues, so I seldom use aspirin and cannot incorporate swimming into his training regime. BTW, he is a TB. Until you mentioned it, I am not sure why we have seldom used triamcinolone (trade name Vetalog?) with him, and never interarticularly. The joint does not often carry much inflammation, except first day or 2 post race/fast breeze. He has not been markedly lame before until this Tuesday after a routine slow gallop. He last worked 10 days ago and went an easy 1/2 mile (1 ace pill slows him down). He last raced July 26th.

Topically, the horse is iced daily, upped to twice a day 14 days prior to and 3 days after a race.He is "done up" daily in Surpass and poultice, switching to HPQR 2-6 days prerace (he is thin skinned and does not handle DMSO mixes well) depending on testing statutes. He uses a Centurion electromagnetic blanket daily and has chiropractic work monthly. We have injected his hocks twice this year. Body soreness and hock soreness we attribute to compensating for his front end.

He has raced at 30-45 day intervals since I've had him (last 20 months). He ran 21 days apart once. He did not race from Nov 05 until March 06 (recovering from a bad bleeding episode). He has been "warm up out of it" stiff before, but never markedly lame until 3 days ago after a routine, slow gallop.

The long and short term goals are the same - to get and keep him sound and healthy for racing. While we are not aiming for the Breeder's Cup,he is a solid upper level horse at middle class racetracks. This is NOT a horse that is going to get run down to bottom claimers hobbling to the gates on bad wheels. I do not trust this guy to take care of himself, he has too much "want to" to stop if he gets in trouble physically. He has run 6 times this year, catching 2 track records and 2 stakes records and running 2 2nds and 2 close 3rds in those races.

I was in contact w/ Colorado State today and overnighted his recent radiographs to Dr. McIlwraith. Interesting you mentioned them. A vet I work with in Phoenix recommended them when I spoke with him by phone today.

Thank You again for your response.

Kris
New Member:
7cents

Posted on Friday, Aug 25, 2006 - 10:41 pm:

Sorry, 2 last questions...

1) Are there any articles/papers out on the autologous grafting?

2) I've only seen one old (2004) paper on the ACT procedure from a German researcher. My question is - where do they harvest the cartilage to graft into the affected joint from?

Thank You

Kris
Moderator:
DrO

Posted on Saturday, Aug 26, 2006 - 12:54 pm:

I think I first heard about the procedure at a AAEP meeting this past year where Dr McIlwraith gave a lecture on advances in joint disease and they recently did a short blurb in their newsletter they send out. But since you will be talking directly with CO I would get any information from the lions mouth so to speak. I believe they take it from the proximal anterior aspect of the tibia (the stifle).
DrO
Member:
7cents

Posted on Tuesday, Aug 29, 2006 - 5:15 pm:

Just an update. My vet here in Chicago has a friend who is involved with research at Cornell involving the silicon product. Seems they've been working on this awhile. Apparently they have stabilized it and are using it again this year with 100% positive results. The owners are wanting to try this route before anything as invasive as the ACT. Waiting to get the product and to find out a few more things such as how long the silicone is supposed to last and if it will interfere with the ACT process if it does not work. I'll keep you updated.
Member:
Paul303

Posted on Wednesday, Aug 30, 2006 - 3:14 am:

Please do Kris, much appreciated.
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