Bony spavin, lameness, hock fusion (questions)

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Naiad

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My gorgeous horse was diagnosed with mild hock arthritis/bony spavin last fall 2010 via full lameness exam/joint block/xrays. He had a few episodes of lameness at trot pre-exam. We did a steroid injection and it worked for 6+ months. I ride low-level dressage with him (nothing collected yet), and since the hock injection we rode in a nice relaxed frame doing large patterns etc.

Fastforward to this summer. He started going intermittent lame at trot, and the lameness was more obvious. So I rested him initially, but then got another hock injection (the new vet preferred a different steroid) which did not help at all. So I was worried if something else was going on (ligament issue etc.), so my horse had a very thorough lameness workup done a few days ago to rule out other things (more nerve blocks, more xrays etc.). We ended up at bony spavin again - only the radiographic changes showed much deterioration of the arthritis, incl. relatively large bony spurs at front of lower hock bones etc. The vet thinks that his hock arthritis is bad enough now that hock injections may not control it any longer.

We could try one more hock injection using the initial steroid that had worked last fall, but I am not counting on that helping. I've been resting him for quite a bit of the summer and early fall, but in hindsight since I know that this was arthritis all along, this rest may not have helped matters so I am going to try some light walk work etc. to see if this helps.

My questions etc.:
(i) I would appreciate hearing anyone's stories of horses with bony spavin, especially those with notable lameness at trot.
(ii) What I cannot find out is how often "natural" hock fusion happens. Some sources say not often, some suggest that if I wait long enough that the bones will fuse, and my horse will become pain-free. But that this can take years. Again, I would like to hear about people's stories in this regard.
(iii) What about the drilling surgery to encourage hock fusion? Vets usually follow conservative route first but if hock injections don't work, then this is an option. Has anyone had this surgery for their horse or some horse they have heard about? Was it a success? How long did they wait for natural hock fusion to occur, before turning to surgery?

My biggest concern is that if the hock injections don't work any more due to degree of arthritic change, I've lost my main management tool (other than some conversative use of bute or other supplements - but if steroids won't work, then that says something about how severe things are). Riding aside, I don't like that my boy is sore in his paddock.
 
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My boy has bone spavins. He was slightly lame in trot when first picked up. He had the steriod injection which worked for about 2 months. He then became alot more noticably lame and had more xrays which didnt really show much changes so he had tildren and was put onto bute. This made no difference and was still visably lame with 1 bute a day. I was really not happy with keeping him on more bute for god knows how long so after more xrays we opted for the surgery to drill into the affected area. Best thing I ever did. I think were about 3 months after the operation now and he is off bute and back into full work without bute and is sound. It can still take upto a year after the operation for the joints to fuse (I think vets say this to just cover their backs). Best thing to do those is try to ride everyday, even if just a short walk just to keep them moving and also to keep them warm
 
Now that is a great success story with the drilling surgery. So happy for you. My vet is also a surgeon and he says he does have good success with this surgery.

I would love to hear more experiences with the drilling surgery (good/bad or somewhere in between too) so I can really begin to think about this more.

I researched some veterinary journal articles and the success rate that people seem to find is about 70%. It would be nice if it is higher, so I'd like to talk more to my vet about what he has found in his practice for success rates.
 
I meant to ask, how uncomfortable/lame was your horse in trot before you went the surgery route?? My horse is quite lame at trot, the vet pointed out how his hip is not moving properly and what I see more is that there is a very notable short striding.
 
He was very notably lame, very shortened stride. He had spavins in both hocks but only showed to be lame in the one. We decided to do the operation on both hocks as we didnt know if he would become lame on the other side once the lame side was fixed.
You wont find many people who have had this surgery done on their horse as its very rare these days to get to the stage of surgery. I know one person on here has had the ethanol injections but im not sure that turned out very well
 
MiCsarah said:
You wont find many people who have had this surgery done on their horse as its very rare these days to get to the stage of surgery.
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Why is this the case? Do most horses respond to IA injections then? But what about as the arthritis degenerates more and more? Do most of the hocks fuse along the way - or even if they don't fuse can IA injections manage the lifetime pain in most cases?

Not sure if you know the answers to these questions, but I am very interested.
 
There are many other treatments which help to fuse the hocks. Many horses respond very well to the cortisone injections and just have a few of these for a couple of years until hocks fuse naturally. Then you have tildren which is given via a drip and is used to try and fuse the hocks quicker, some people give this to their horse more than once aswell. Alot of horses arent that lame with spavins and are happy to just hack until they fuse. Some people help with the pain with just bute. Once the hocks fuse the horse shouldnt feel any pain at all. So you can either medicate until hocks fuse naturally. Bone spavins in my eyes isnt like general arthritis as they dont have a life time of aches and pains as when the hocks fuse the horse shouldnt feel any pain. The operation is just a way to speed the natural process up alot quicker
 
Rest is not the treatment for hock arthritis, work is.

Work keeps the joints more flexible and it also encourages the cartilage breakdown that will cause fusion. I am very surprised if you have been told to rest your horse, it is likely to have made him worse.

I used to own a horse, now fifteen and perfectly sound, who was hopping lame at ten years old. It took three years from start to finish, but he got there with no treatment other than a bit of bute on bad days.
 
cptrayes said:
Rest is not the treatment for hock arthritis, work is.

Work keeps the joints more flexible and it also encourages the cartilage breakdown that will cause fusion. I am very surprised if you have been told to rest your horse, it is likely to have made him worse.
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Agree with this. My horse has bilateral bone spavins and is best kept in work, and turned out as much as possible. Keep him working and moving wherever you can.

Mine has had Adequan, Tildren, an expensive joint supplement (which IMHO did bugger all), and bute when needed. I believe I've seen the most improvement after Tildren. It's 2.5 years since he was diagnosed with spavins and I think his hocks look great ATM. He's in full work, 5-6 days per week. I hack maybe 3-4 days - weekends are usually 2 long hacks (couple of hours with plenty of trotting and cantering where possible), plus 20-30 min hacks before schooling to loosen up. Working in straight lines is great, ie hacking. I do lunge but no more than once a week. Unfortunately mine also now has ringbone in front so that sometimes limits the work he can do as he does get stiff in that leg, but the hocks don't really cause him any problems.

He was shod for nearly 2 years with lateral extensions behind, on vet's advice to help stablise and straighten his movement behind. I've always struggled with him being short and not being able to track up behind and I now think the LEs caused this. He now has a new farrier and normal shoes behind - moving much better (in walk he overtracks a huge amount, for him, and tracks up in trot). His movement isn't entirely straight behind because of the spavins but he's clearly more comfortable without the LEs on.
 
Have you considered the ethanol injections? I think they are supposed to have a fairly high success rate, my horse has spavin and was noticeably less lame after ethanol injections.
 
I should explain more why I rested him the few times I did as I did not explain things very well my initial post. The initial couple of times that I did not ride was just for a particular ride if he was particularly uncomfortable and unable to work through things that day etc. Re the main rest that I mentioned - I should clarify as my wording about the timing of things was all jumbled in my initial post. I knew that if this was hock arthritis working him through things was correct and I had been doing that since he was diagnosed in November. But once the lameness got much worse this summer, I began to wonder "what if the diagnosis is not correct"? So I decided that for peace of mind, I needed a second vet opinion on the diagnosis before I felt comfortable working my boy through his issues (the radiographic changes were minimal on the first exam in November). I was moving barns in the midst of all of this, so to be overly cautious in case we were dealing with a misdiagnosed upper suspensory issue etc., I did not work my horse (he is outdoors 24/7 so he was moving, just not working) while we moved to the new barn and he settled in, and I got the new vet out. (In the past, I had a very bad misdiagnosis on a lameness with my now retired horse when we did some of the wrong things during rehab, so I thought it best to be cautious).

So no worries, now that I have the rediagnosis and it has remained hock arthritis, we are resuming some light work. :)

What is the success rate with the ethanol injections? Doesn't it have risk in that if the injection leaks to the upper joint it can be catastrophic?
 
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Hey there, my boy was diagnosed with bilateral hock arthritis around 4 (ish, give or take a year or so) years ago. He was initially given the tildren infusions (3 in total over a roughly 6 month period) and whilst these seemed to work at first he came lame again after 2nd one and didn't come sound again. It was then decided to manage with bute (eventually after around a year got the dosage down to 1/2 bute a day after a lot of playing about, with more being given on his stiff days, such as when it was wet and cold) and a joint supplement (tried various ones over years, right now on synequin). Just over a year ago it was found that he was still sound for hacking (which is pretty much all current loaner does with him) on just the synequin and no bute (he erm decided to take himself off it by refusing to eat it!) and I think some degree of fusion has occurred as last year he more or passed a flexion test on what used to be his worst leg (still lame on flexion on other leg). Must admit that at first when he went lame I would give him more bute for a few days and then resume work, until the vet assured me that I would not be causing further damage by riding him and that the work would help ease his stiffness, so then I started giving him his extra bute a few hours before I rode and then just taking him for a gentle hack, which he would then be sound by the end of having worked through the stiffness, but as time went by I found he was having less and less stiff days and was actually mostly sound. Didn't go down the joint injection route as vet at the time was keen on doing joint injections and didn't like using steroids in horses unless he really had to (may have considered it had he turned out not to be able to be managed on a low dose of bute). Same vet also advised against the surgery as he felt the risks outweighed the benefits (this was a few years ago though so techniques may have changed slightly). Have also heard good things about the alcohol injections from loaner's vet (when re-investigating the hocks as a stab in the dark when looking for cause of another problem he did say it was something he might recommend depending on what he found, as it turned out we had to show him old xrays before he would believe this horse had prev been diagnosed with arthritis)
 
Naiad said:
What is the success rate with the ethanol injections? Doesn't it have risk in that if the injection leaks to the upper joint it can be catastrophic?
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I believe the success rate for fusion after 1 year with ethanol is very high, with a lot fusing within this time as well. Yes it is bad if ethanol gets to the upper joint, but as I understand the most expensive part of the procedure is to prevent this. A dye is injected into the lower joints to check the communication in these joints and the absence of communication to the upper joint- X-rays show result. If dye in upper joint, ethanol injections not possible.
 
Update about 7 months later

If anyone wants a bony spavin success story to give them hope, my horse's story can give them hope.

Since this thread was started, we soon after did try another hock injection to no avail. Did nothing. But I did not give up...

I moved barns, got my horse into a much larger field, flipped off the shoes, and started in on walk rehab work 4x per week. That is it - no further medical intervention. And I kept surgery/ethanol options in the back of my mind as a last resort. But within a month of being at the new barn, I heard reports from people that my horse was seen trotting sound in his field. So I continued walk rehab work for another few months, all the while testing his trot now and again, and the trot remained sound. Evenutally, I added in very gradually some light trot work, and my horse remained sound and several months later still continues to be so.

Has my horse's hock fused? Is the larger field helping? Not sure, all I know is that I did not give up a horse that some people were telling me to give up on. I had planned to retire him if need be, but I decided not to give up so easily. There was light at the end of our tunnel for bony spavin, so my advice is don't give up too easily - it might take a while to get through, but it is possible for good things to happen.
 
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Thank you Naiad for reporting back. My gelding (19) is today having xrays of his hocks. He is currently 6/10 lame but looks fine in walk - its when he trots its very noticeable. I am very worried about him and so have been trawling through posts on here so that I can make informed decisions about what to do. Its great to be able to read a 'later' post.
 
Naiad said:
Update about 7 months later

If anyone wants a bony spavin success story to give them hope, my horse's story can give them hope.

I moved barns, got my horse into a much larger field, flipped off the shoes, and started in on walk rehab work 4x per week. That is it - no further medical intervention.
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My cob was diagnosed with spavins last November after a couple of lameness investigations and was very lame after flexion tests. My vet gave me only 2 options 1) steroid injections 2) bute for life...from the beginning despite numerous ppl calling me cruel i refused steroid injections. My cob is 20 and has only ever been a happy hacker and didn't feel this was suited to him. Hind shoes came off, magnetic bands on, he has always lived out 24/7, linseed meal added to his feed, devils claw and bute only when he has the farrier or when we had incredibly cold nights. He went unridden for the first month but walked out in hand a couple of times a week. Fast forward only 4 months and *touch wood* he is now sound in walk and will be testing short trots soon. He can easily manage hacks out for nearly 2 hours. LOTS AND LOTS of walking. :D

He is so much more comfortable and yes he still has his bad days but the transformation from the pain and discomfort he was in in November to his usual happy, relaxed self now has even surprised me. Time is the biggest healer so being patient is the key. People have shot me down for refusing medical intervention but invasive treatments aren't for everybody or their horse. At 20, even if my cob can only ever walk out for a long hack and he's happy and pain free who am i to have steroids put into him!?
 
I'm another with sound horse with spavins with no medical intervention, apart from IV Adequan injections (over 3 years ago now), and suppliments (Cosequin and Turmeric), along with regular low impact exercise (walked in stright lines for 2 months, then gradually brought back into work). He has been back competing at riding club level (90cm SJ, XC and prelim dressage), occasional hunting, and plenty of hacking, since then and hasn't had any problems at all. I know that they are all different, but there can be light at the end of the tunnel.
 
Thank you for the various replies and stories here.

MardyMare said:
Thank you Naiad for reporting back. My gelding (19) is today having xrays of his hocks. He is currently 6/10 lame but looks fine in walk - its when he trots its very noticeable. I am very worried about him and so have been trawling through posts on here so that I can make informed decisions about what to do. Its great to be able to read a 'later' post.
Click to expand...

I was hoping that this post might give someone some hopeful information so it seems my timing was good. My horse was also always sound at walk. Just lame on the left hind at trot. I really never gave up hope, but I admit it did catch me off guard when so soon after the move people told me how well he was trotting in the field. Of course, this not only meant that I could ride him properly in due course, but that he would be comfortable in the rest of his life to play and run. We might have downturns and blips (or not), but I know now that he can come sound again if that were to happen.
 
My TB was diagnosed with bone spavin in February of this year and was given cortisone injections into both hocks. He's only 5 and I was devestated as I'd only had him 3 months and he had passed a 5 stage vetting.
The vet was very optimistic about the outcome as he said he had seen it a lot in young thoroughbreds and the prognosis was good for what I want him for. I had to walk him for 10 days after the jabs and then gradually build up the work.
Although it's early days, he is moving much better already. I've even had to put over reach boots on him as he is improving so much. He is so much happier in himself, which is the best thing. He is still slightly lame but the vet said to keep working him as he feels he will come right.
Thanks OP for returning to this thread as it's so encouraging to read success stories as there are a lot of depressing ones around on the internet
 
Naiad said:
My questions etc.:
(i) I would appreciate hearing anyone's stories of horses with bony spavin, especially those with notable lameness at trot.
(ii) What I cannot find out is how often "natural" hock fusion happens. Some sources say not often, some suggest that if I wait long enough that the bones will fuse, and my horse will become pain-free. But that this can take years. Again, I would like to hear about people's stories in this regard.
(iii) What about the drilling surgery to encourage hock fusion? Vets usually follow conservative route first but if hock injections don't work, then this is an option. Has anyone had this surgery for their horse or some horse they have heard about? Was it a success? How long did they wait for natural hock fusion to occur, before turning to surgery?

My biggest concern is that if the hock injections don't work any more due to degree of arthritic change, I've lost my main management tool (other than some conversative use of bute or other supplements - but if steroids won't work, then that says something about how severe things are). Riding aside, I don't like that my boy is sore in his paddock.
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Long reply but please bear with me.

Ok first of all don't panic! Things have come a long way since the old hock fusion method thankfully :) Steroid injections are okay to start with (my hock spavin horse had his first one which lasted three years). But the time between the injections becomes less and less. In cases where horses have mild spavin its sometimes advisable to treat with Tildren. Here is the fact sheet http://www.georgevetgroup.co.uk/pdf's/equine_factsheets/TILDRENFACTSHEET.pdf (I don't endorse the George Vet Group its just that there's is the clearest fact sheet I can find). My horse had three lots of Tildren as well as steroid injections but three years later he needed another steroid injection.

His last steroid injection was about six months ago. After four months it became apparent that he would need another one. :eek: I was very upset about this as i thought as the first one had lasted three years this second one would last equally as long.:(

My friend had just had her youngster aged 5 who was diagnosed with juvenile arthritis as a four year old hocks fused using a relatively new (circa 2006) treatment called ethanol which is plain old alcohol (but in high concentration). He was so much better in his movement and the ethanol kills the nerves within the hock immediately so the horse can't feel any pain anymore.

Due to my horse constantly overloading from his off side hock onto his near fore leg which is injured (suspensory ligament problem) I decided to bite the bullet and I had my horse's hocks fused about a month ago now and the difference is amazing, he is more forward going, he is bouncier in trot and canter, he lifts his hind legs so much higher now to pick out his feet, and he seems a lot happier.

In answer to your questions:

Hock fusion is very hit and miss anyway. In some horses it can take months in others years, and in some I believe I have read that it may never take place at all.

With the use of ethanol to fuse hocks it can still take up to 18 months to two years to fuse the hock but the pain is taken away immediately as the alcohol kills the nerves. The horse can still feel sensation on the outside of the joint, i.e. the skin and muscle, but not the joint itself. Here are the results of experimental findings regarding it. http://avmajournals.avma.org/doi/abs/10.2460/ajvr.67.5.850

With hock fusion using the drilling technique it is, from what I have read, extremely painful for the horse, he is off a considerable time afterwards, it is classed as major surgery as the horse needs a GA and there is considerable risk with that plus the fact there is the change of infection post surgery and other complications.

I would ask your vet if Tildren or hock fusion using Ethanol is the best way forward. Tildren is about £450 to £500 a time and my horse had three treatments within the year. Hock fusion using ethanol was £394.00.

A word of warning though about fusing using Ethanol. Because only the lower joints in the hock can be fused the vet needs to administer a contrast dye into the joint. If the dye goes upwards into the top joints of the hock the horse cannot receive the ethanol because if it did the horse will be in agony and crippled as the joint would 'seize'. If the contrast dye stays where it should this indicates that it is okay to proceed. In order to xray and use contrast dye the procedure needs to be performed in a hospital. I think the vet said to me that 30% of horses cannot be treated because the constrast dye goes upwards into the joint.
 
my 5 year old cob was diagnosed with hock spavin a month ago and has had the alcohol injection treatment to speed up joint fusion.
He had been lame on/off for 6 months or so especially when schooling and couldn't get into canter on either lead. Eventually lessons had to be abandoned and we were suprised that rest seemed to make matters worse. He was so grouchy-not like his usual soft self- and clearly didn't want to be ridden. Wouldn't pick his feet up etc.
he has now has his check up with flexion and the vet feels that he is 70% recovered and will benefit from being ridden again.
He has had 24/7 turn out since his treatment and I am trying to get him off haylage, onto very minimal hay when brought in on really wet nights.weight is an issue as i haven't been able to ride-or push him for ages.
I have my lovely soft boy back again. He still needs the less affected left hock injected in a few months but for now he is so much happier.
I hope to ride, walk, trot in the school tomorrow and will let you know how he goes. fingers crossed. xx
 
Hi,

My (recently turned) 6 - yr old gelding (cob) has injured his hock. Vet , physio and myself think hekind of twisted it hacking out. The hock was swollen with heat at the front and outside. I initially put him on 2 days box rest - swelling went - back out into field but he ran and jumped around too much and as a result it flarred up again. Discussion with vet - 7-14 days box rest - he had 11, then turn out in small p addock for 3/4 days then back in his own paddock. Stabled at night. All swelling was practically gone apart from a tiny littlepocket of fluid in the outside grove above the capsule. Vet said to start rehab work - 1-2 per week, 20-30min in walk on the flat, no hills. We did this twice but the hock flarred up again and swlling retunred - equally disappeared again over a couple of days. Vet out again, ultrsound done. No injection needed, fluid pocket not even big enough to inject. 2 fluid pockets inside his capsule on either side showed up in ultrasound, no fragments or other damage. Vet said same - retstart. work. Ridden 4 x naow - first 2 times with hock boot, second times without (over a period of 2.5 weeks) - swelling returned, small amount and heat. After 3 days gone again.
I have been takeing him swimming once a fortnight which seems to help.
Sorry about hijacking the thread....

Questions -
- does swelling return with work?
- should i be working him if swelling returns?
- how long will it take to fully heal?

He is barefoot but wears hoofboots when hacking.

- should i try hacking without hind boots?

Have been cold hosing/cold wrap, magnetic wrap, gets joint and multi vit /min supplement

Any advise suggestions help would be welcomed :)
Thank you
 
My vet says normal fusion is very hit and miss and it can take forever or never. fusion with ethanol is a good treatment but theres no space left in the joint if it fails to work therefore its a treatment that is normally carried out after steroid injections and tildren have failed to work as u cant put anything else in the joint after as there is no room. With spavin its a management issue more than anything i.e picking your surfaces minimal trotting on the roads and remedial farriery as well as physio.
 
This is a very old thread so you might be better doing a new post :) Doesn't sound like spavin either, more like soft tissue injury?
My main question would be which hoof boots are you using?
but that if a swelling is getting worse with work I suspect he needs more rest.
 
thanks for both above replies...

I'm planning on calling the vet again tomorrow and go fron there. swelling only now occures after ridden work and not always...just the last 2 times.

he used to ge barefoot but wore his heals off quickly so hoof boots on all foiurs - had cavallos which fitted well and just changed to scoot boots.

ultrasound showed no soft tissue injury.

I think he did have some stiffness during the last winter on one day only though. Maybe there was something underlying already that has only become apparent since the day of the accident???

Any suggestions welcomed :) Thank you.
 
to add to the above - the heat and swelling seems to be located just below the capsule on the front, outer side, then going up on the outside of the capsule...if that makes sense. :)
 
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