Bilateral ethanol hock arthroesis surgery tomorrow!!

Achinghips

Achinghips

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**Sorry - should say arthrodesis **

Thought I'd share for those considering this as an option for hock spavin.

My 13 yo girl has had 2 lots of steroids - they worked for about 2 months each. After a priod of bute in which she showed some relief, 1 year later, she is still 3/10 lame and 4/10 lame in hind. This on its own would be dodgy, but now my girl is starting to develop a VERY sore back and is begining to twist hind feet on pick up, so this needs sorting quickly.

I am opting for the injections to encourage fusion tomorrow and have spoken about the implications extensively with my vet. I wanted to share some of the knowledge I have gleaned with H&H - as this is a relatively new procedure, with little info available.

They will sedate her and apply a dye which will fall into the spaces where the injection needs to go. This will help them pinpoint exactly where they need to inject the ethanol. The ethanol will encourage breakdown of the bones so that in healing they can fuse together.

This is a relatively painfree procedure, believe it or not, but she will experience a little discomfort and so will stay in horsepital overnight with monitoring and bute. Post operatively - I take her home the next day, no box rest and she will need an extensive and surprisingly quite hard exercise regime to encourage the disintegration almost immediately. If this hard exercise regime is not followed, the op will be unsuccessful. The bones have to be worn down and rub together.

Risks: the ethanol will migrate/leak to the long bone above (forget what it's called) and cause premature osteo there - very serious case if this happens and poss pts within a year - but this is rare, esp as the dye helps guide the procedure.

Chances of success: In 37 this surgeon has done, 2 have not been successful - they were ponies, seems to be less success with a smaller horse, for some reason. Also, greater success with procedure if caught in early osteo (like my girl), rather than if advanced cases where partial fusion has occurred. Should the ethanol not work, it will not make things worse (so long as leakage doesn't occur). Should see soundness and fusion within 1 year.

This is my babygirl, looking mightily fat for a Tb (but was a new mum in the photo so forgiveness needed, please) :)
DSC00649.jpg
 
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Yes, sorry I didn't mean to do such a short reply!

He had the alcohol injections following steroids, HA, tildren all of which worked for a short time and then he deteriorated again.

The procedure was very undramatic, after I worked myself up over it! I found it very interesting.

He had a couple of days boxrest as thats what my vets like after joint injections then I turned him out, he had a coupld of weeks off and then I started hacking him. Took about 4 months to see the difference and then he was amazing. The xrays are pretty incredible.

However he then strained a suspensory ligament in the same leg that his worse spavin was, and he is retired at 12. I have heard several stories of horses "doing" a suspensory following this procedure - there is a school of thought that suggests it is linked. I don't know if it's true or not, or whether we were just unfortunate and I have found the stories because I looked (if that makes sense!) Good luck!
 
Thanks minigal for the reassurance. My girl is only a happy hacker - I'm a, shall we say, "maturer" lady, so hopefully as long as she doesn't hoon like a twonk, suspensorys should be ok. Just out of interest, did you continue with bute after procedure and did vet recommend increased turnout? Girlie is on restricted turnout (5 and a half hours a day) at current Yard and I'm worried and thinking about changing, as a result.
 
Zara had this procedure done on Wednesday. She had one day box rest and then turned out for three weeks. I then commence ridden work at walk for the first month then re-assessed by the vet. If all's well, I can work her hard which is quite handy as she was used for endurance before she got her spavin. I'm keeping my fingers crossed that she stays sound but I've been told it will probably be twelve months before we're certain it has actually worked.

She trotted across the field this morning to see me and looked B****y amazing!!!!
 
Paddy was a happy hacker too, I moved to my own place just before the procedure and there is no school so we just lightly hacked.

I think he had bute for 2 weeks following it. I'll give a rough timeline if that helps!

August he had the procedure, followed by 2 weeks off, started on 2 bute a day which was weaned down to 1 and then nothing over 2 weeks.

September/October/November, light hacking in walk and trot.

December he had most of it off due to the weather, I had his shoes off at some point.

January he started cantering in the field and more importantly up and down hills, he stopped scuffing his hind leg and was resting them equally. His bum was much more evenly muscled (the left side was very weak before.) He was much happier.

Feb we hacked and started cantering.

March we went in the school once and continued cantering.

April he went lame from the suspensory.

He lives out but "freerange" they have stables and hardstanding to go onto, he used to get stiff following being in but it was always walked off very quickly.

So I don't really know how I feel about it - it obviously worked the xrays and his improvement were incredible, however (and I think it's down to his unfortunate hindlimb conformation) he has now had 2 serious issues with his hindlegs so there is something making him predisposed to these problems. He certainly wasn't in hard work, he must have tweaked himself in the field.

I can recommend lots and lots of physio and massage, but you probably know that hock pain leads to back pain etc...
 
many thanks for those that have posted on this procedure... can I ask you all the events in the run up to deciding to go to the ethanol option? where did you start (how lame), what drugs had you tried, what was the result. many thanks
mine has had steroids (once bilaterally that worked well, big difference when ridden), and since had tildren (once, 8 wks ago), but she's not great to ride and lame/unlevel on lunge again, although not as bad as at the start of treatment.
 
My girl was unbalanced and not tracking up, stumbling a lot, odd buck in canter, falling out on one rein - schooling after 2 months had still made no difference. She was very green though - 12 year old and kept as a pet all her life, though backed and passed a vetting when bought 6 months previously!!
1. Vet called, declared her lame, hocks suspected, into horsepital, full lameness workup with nerve blocks and exrays. Diagnosis bilateral bone spavin.
2. Steroid injections, with corrective farriery (wedges) - results good but shortlived (2 months per injection). Vet concerned with weak back.
3. Moved livery to skilled schooling to strengthen her back and get her balanced. Started to scuff and knock her own legs. 4 months later, vet workup still lame.
4. moved to bute for 2 months. Good change with bute.
5. Discontinue bute for 3 days and full lameness workup with nerve blocks and more exrays showing no fusion had occurred during year. Diagnosis: Lame now but also with sorer back and now starting to compensate by twisting ankle in walk when back feet hit floor.
6. Immediate decision to go with ethanol before insurance runs out. Will also need different corrective farriery (wide outside shoe to stop ankle twist).
 
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Lateral extensions made a huge difference to my lad. I forgot about the remedial farriery he had!

I've been thinking about this all day!
 
Injections been had. Right hock went fine. Left not so successful, some joint collapse meant that surgeon could only get 2mgs rather than 6mgs of ethanol in. Guess it's now a waiting game .................:rolleyes:
 
Minigal - How long after the injection did your horse take to go sound? My vet said she should go sound almost immediately as its killed off the nerve endings so she shouldn't be feeling any pain.

She looked amazing yesterday but today is back to 4/10ths lame as before. The problem is that I won't want to ride her to fuse the joint if she's lame and no amount of persuasion or force will get her to eat bute or danilon!!
 
VITAL to ride em, othertwise bones won't fuse. My surgeon was clear - the bones are now softer, they need breaking down in order to fuse. The op will be unsuccessful if I don't follow this strict exercise regime to break them down so they can heal - no debate. "You don't put in the work, your horse won't fuse"
This is the regime I have been given:
First 7 days - box rest, walk in hand for 15 mins every 8 hours
from Day 7 - Start with straight line hacking for 30 mins daily. Increase the total exercise period by 5-10 mins per week up to 70-90 mins DAILY
From Day 14 - Start intermittent trot work
From Day 21 - 5-10 mins of trot work 2/3 times per 90 min exercise period
From Day 28 - as above
From Day 35 - allow 15 mins of trot work 2-3 times per 90 min exercise period
From Day 42 - as above

Day 49 - Reexamination and exray
 
My boys fused despite not being on a strict exercise regime. I would find it extremely hard to ride a lame horse.

I think it's a difficult one, every horse is going to be different! I certainly didn't do much with Paddy till about 4 months after the injections. I would actually be very wary of doing anything strenuous after it - it might be good for the bones but probably not so for soft tissues.
 
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Forgot to add, sachet and a half of Danillon a day advised throughout exercise regime, but surgeon said to "play it by ear" as the injections will already have killed a few nerve endings.
I took her out in hand tonight, she's happy, bright and alert, muching her hay and wolfed down her hard feed.
 
It's interesting to see what different vets advise. This is what I've been told :

2 days box rest followed by 3 weeks paddock rest.
After the 3 weeks, I can commence ridden work at walk for 30 mins increasing to 60 mins over a 4 week period.

Before commencing any trot work or extending the length of time ridden, the vet wants to re-assess.

So which vet is correct Achinghips, yours or mine? Probably still have the same outcome at the end - hopefully both our horses will be sound!
 
Haha, wish I'd been given this advice - towards the end of July I have to do 90 mins per day with 3 ten minute trot sessions!!! I'm so oldand arthritic myself I think I'll need open heart surgery after that regime.

Wonder if the exercise regime is linked to extent of the osteo. My girl is in early osteo.
It'll be interesting to see the results of how this pans out for each of us.

Hope yours is ok - they are such a worry to us.
 
Hi Achinghips, Zara is still 4/10ths lame and my vet originally told me she should go sound straight away but I noticed your vet has told you to give bute. Is yours sound on bute and how lame was she before her treatment?
 
Quick update for you all - 8 weeks later - Now gone from 4/10 and 3/10 lame with very sore back to 3/10 and 2/10 lame with moderately sore back. Lat ext's have caused her to move "differently", not necessarily better. Now feet comes centally under belly but no twist on pick up and no voluptuolus rolling of hips. 1 sachet of danilon a day.
 
Zara has gone from 4/10ths lame to sound in a straight line and only 1/10th lame on a circle (had to lunge her for vet to see progress - I don't normally lunge her as straight lines recommended!).

She is working for up to 2 hours four times a week, trotting and cantering and was due to do a 10 mile pleasure ride in a fortnight's time that was until she decided to slice an 8" chunk out of her leg in the field! This unfortunately made her slightly unsound but she should be back in work by Wednesday.
 
Mitchyden said:
Zara has gone from 4/10ths lame to sound in a straight line and only 1/10th lame on a circle (had to lunge her for vet to see progress - I don't normally lunge her as straight lines recommended!).

She is working for up to 2 hours four times a week, trotting and cantering and was due to do a 10 mile pleasure ride in a fortnight's time that was until she decided to slice an 8" chunk out of her leg in the field! This unfortunately made her slightly unsound but she should be back in work by Wednesday.
Click to expand...

That's fantastic progress!!!!!!!! You must be soooo chuffed!!:)
 
So are you doing 2 hours total per week or 2 hours x 4?
My girl is much less agitated than before so I've seen another change in her:)
 
2 hrs x 4 times. I found it too difficult to work her everyday as I have to work my other horse as well and I work full time. I spoke to the vet and she said it would be ok to do it this.
 
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