Complications of ethanol fusion (chemical arthrodesis in hock)

Birker2020

Birker2020

Well-Known Member
Joined
29 October 2008
Messages
23,597
Visit site
Has anyone had complications following spavin fusion with ethanol some three or four years after?

My horse had his hocks fused using the procedure some three to four years ago and has got on brilliantly and is in full work. It really helped him and my vets were amazed by how well he has gone with the procedure.

Last week I got the physio out to him as I noticed he was very slightly leaving his leg behind in trot, in some situations it was barely noticeable. My friend has been riding him for the last eight or nine weeks so sitting and watching her ride and looking at my horse I noticed the slight difference from previous weeks. The physio thought it might be his hock, he was slightly sore in his back on the off side and she wasn't sure if the back was an affect of the hock or the hock was caused by the soreness in the back. SHe recommended lateral extensions on the hinds and gave him manipulation and told me to continue work.

A week later I had the vet out for my horses booster injection and I requested he watch him on the lunge for an assessment. After watching him and palpating the hock he said there were no evident changes but if he was really picky he said he could feel a very slight warmth on the inside of the hock compared to the opposite one and he wasn't completely sound in trot.

In a nutshell (and I probably am not explaining this very well) he said that three plus years after ethanol fusion its been found that in 5-8% of horses because the two lower hock joints have fused the mechanics mean that the concussion absorbed by the lower hock joints then go into the top hock joint. Therefore the top joint in the hock becomes inflammed which has what has happened in my horses case.

He suggested lateral extensions on the hinds and a course of strong bute for three weeks followed by a maintenance level. He said he thought that this would do the trick but if not he can have steroid injected into the top joint.

He told me to keep him in work, walk trot and canter, hacking and schooling, no collection or lateral work and no jumping for 2-4 weeks to see how he gets on. He said that the workload the horse is having needs to be kept up otherwise with his other problems he will fall apart which he has said before. The vet is happy to ask me to do this as when worked the horse swings through his back, his ears are forward and he is forwards going so it is clear he is happy in his work. He has had both saddles reflocked and seems happier , his strides have got longer, and he stretches down even more whilst warming up and cooling down.

I don't really want to go down the steroid route to be honest as I know it often has to be repeated. I just wondered if anyone else had experience of this as I know ethanol fusion is becoming more and more common.

Please I really don't want any nasty comments about me or my horse I just want some stories from people who have been through the same. Thank you.
 
Hi sorry I haven't any experience of it but have been to a lecture on the various fusion option in hocks and it as your vet said the lower joints function is to absorb concussion so whatever fusion option is taken ethanol/surgical/bute&work you'd end up with that risk. If your horse could cope I wonder if it might be worth taking the shoes off behind to try and get a bit more concussion absorption that way?

I really hate working horses on bute as it makes subtle monitoring pretty impossible but from what you've said I'd still go for the bute and keep moving (+ the lateral extension if I was staying shod) over the steroid as you normally only get a good effort the first time with the efficacy seemingly apart half or less each time after, save it unless you really need.
 
Amicus said:
Hi sorry I haven't any experience of it but have been to a lecture on the various fusion option in hocks and it as your vet said the lower joints function is to absorb concussion so whatever fusion option is taken ethanol/surgical/bute&work you'd end up with that risk. If your horse could cope I wonder if it might be worth taking the shoes off behind to try and get a bit more concussion absorption that way?

I really hate working horses on bute as it makes subtle monitoring pretty impossible but from what you've said I'd still go for the bute and keep moving (+ the lateral extension if I was staying shod) over the steroid as you normally only get a good effort the first time with the efficacy seemingly apart half or less each time after, save it unless you really need.
Click to expand...



Hi Amicus. Thanks for your reply. The problem with steroid is like you say, it is less effective the more you do.

5-8% of post ethanol procedure complications seems such a small amount of horses affected, typical it should be my boy! Most of the studies done on the internet only show the results 12 months on, but as time goes by it appears that it has become apparent that more horses are affected.

I'm glad I had the procedure done as its given my boy another three or four years of useful life and we had nothing else to offer him. It was only done as a last resort after it became apparent that the intra articular injections and Tildren hadn't worked as well as had hoped.

I might have a conversation with my vet about taking the hind shoes off. From what you are saying taking the shoes off will direct forces downwards instead of upwards, but I am not sure whether forces will always be directed upwards anyway, I kind of got the feeling from speaking to the vet that this is how the mechanical forces work - in an upwards fashion.

Thank you, your comments are thought provoking and I will certainly ask the question.


If the shoeing and the extra bute to take away the inflammation don't work then I am not certain I would go down the steroid route. Instead I would just use my horse for hacking and not bother with the jumping and dressage comps that we normally do.
 
The forces will always go upwards but the idea of no shoes is that the hoof is able to expand and contract as it naturally would - and a good bare hoof also means the boney column is resting on nice thick lateral cartilages and a good thickness of other soft tissue all contributing to dampen the force transferred up the limb.
 
ester said:
The forces will always go upwards but the idea of no shoes is that the hoof is able to expand and contract as it naturally would - and a good bare hoof also means the boney column is resting on nice thick lateral cartilages and a good thickness of other soft tissue all contributing to dampen the force transferred up the limb.
Click to expand...

I can see what you mean about barefoot but I am assuming that the lateral extensions are to support the foot which obviously would not be feasible if there were no shoe. So I am kind of stuck between a rock and a hard place with that one, because the point of the lateral extension is to make the horse comfortable by changing his weight distribution and to prevent overloading of the tarsal joints. The vet said that Bailey has started to carry his off hind in such a way that it is adding strain to the joint and the lateral extensions would help to prevent this. That's my understanding of the situation, I think I have explained that properly.

Having had experience of taking shoes off a previous warmblood - shoes were removed for a six week trial period whilst on box rest with hand walking - the poor horse ended up lying on his stable floor sweating and groaning in pain because he had no shoes and was asked to walk in hand up the drive way and back a distance of 100 yards, I am not sure I could go through this again.

I know most horses go through a transition period from shoe to barefoot , but this was one hell of a transition period! So much so the horse was given bute and another farrier was quickly summoned to put the shoes back on!
 
Well at the moment the vet obviously thinks he has the kind of stance/movement that would be helped by a lateral extension to widen his stance/prevent excessive pressure, and I don't see there would be any harm in popping a pair on and seeing if it makes him more comfortable. Just wanted to explain what the theory of going bare would be. Also if he does have that sort of stance then you would see the hoof capsule possibly distorting in response to that. Which may or may not be a good thing - when unshod some horses do just create their own supportive lateral extensions.

The previous warmblood must have had some pretty compromised feet to be in that much pain tbh.
 
ester said:
Well at the moment the vet obviously thinks he has the kind of stance/movement that would be helped by a lateral extension to widen his stance/prevent excessive pressure, and I don't see there would be any harm in popping a pair on and seeing if it makes him more comfortable. Just wanted to explain what the theory of going bare would be. Also if he does have that sort of stance then you would see the hoof capsule possibly distorting in response to that. Which may or may not be a good thing - when unshod some horses do just create their own supportive lateral extensions.

The previous warmblood must have had some pretty compromised feet to be in that much pain tbh.
Click to expand...

thanks for your help any suggestions/advice/experience welcomed. Previous boy had really good foot balance/confirmation and farrier on vets list of very good farriers. He just couldn't cope with the pain of no shoes, it was a flinty drive. If I had given him a few days maybe he would have come okay. He was just very sore to start with.
 
Always frustrating to be the percentage with complication. Yes as the other say doesn't change direction of forces but allows the rubbery back of foot to absorb some of the force so less impact passed through to the compromised hocks. Some horses do grow some quite impressive diy lateral extensions looks ugly as sin but very effective. There's a really nice lecture by a USA vet on how the hoof adapts in the same way as bone laying down more material where it experiences more impact, will see if I can find it (I thought it was fascinating but then I find a lot of dry research fascinating! Some horses hardly notice having hind shoes removed, so worth a try as often cope without hinds without barefoot type management and certainly wouldn't expect the sort of pain your previous horse experienced I'd have found that pretty off putting/traumatic.

I too wouldn't want to start steroids if he's sound hacking without either without hindshoes or with lateral extension then I'd save steroids so I still had a if all else fails option.
 
I fail to see how any vet can palpate a hock and advise anything without a full set of current plates being done. No self respecting farrier would want to put extensions on without xrays being done.
 
AdorableAlice said:
I fail to see how any vet can palpate a hock and advise anything without a full set of current plates being done. No self respecting farrier would want to put extensions on without xrays being done.
Click to expand...

Adorable Alice I don't think you are aware of the horses history. The horse has had extensive xrays done when he was diagnosed with spavin in 2009. He then had intra-articular injections, followed a couple of years later by Tildren. Again xrays were taken before the Tildren. Then he had further xrays before having ethanol fusion after the contrast dye was injected before the ethanol was given as is normal policy. Xrays were taken some 12 - 14 months follwoing fusion which showed both hocks had fused. There are no need for further xrays. We know the bottom hock joints have fused. We know that the top joint is inflammed. He's had lateral extensions on previously when first diagnosed back in 2009 and then normal shoeing after the situation was resolved. The vet will speak in to the farrier in conjunction with my physio about having lateral extensions for his next shoeing early next month.

When the vet came out last Friday he carried out an extensive hoof test with pincers and palpated around the fetlock joint and the stifle. He felt slight heat in the hock and after watching the horse trotted up and seeing him on the lunge and watching his foot placement the diagnosis was made.

Hope that explains it for you! I am sure my farrier wouldn't have put the lateral extensions on the first time if it hadn't been for the indepth conversation he had with the vet prior to his visit. He is a good farrier with an excellent reputation and the vet was very impressed with the horses hoof/foot balance on seeing xrays plates of his front feet some three or four years back.

Here are a couple of videos taken a month ago showing my friend riding him, you can see he doesn't look like he is lame or compromised in these videos, it was only by watching him hard that I noticed a slight loss of movement in the off hind which is what has led the vet to his diagnosis.
https://www.youtube.com/watch?v=1q1Fn_0VIcI
https://www.youtube.com/watch?v=BV0YvouNeA0
 
Last edited by a moderator:
Amicus said:
Always frustrating to be the percentage with complication. Yes as the other say doesn't change direction of forces but allows the rubbery back of foot to absorb some of the force so less impact passed through to the compromised hocks. Some horses do grow some quite impressive diy lateral extensions looks ugly as sin but very effective. There's a really nice lecture by a USA vet on how the hoof adapts in the same way as bone laying down more material where it experiences more impact, will see if I can find it (I thought it was fascinating but then I find a lot of dry research fascinating! Some horses hardly notice having hind shoes removed, so worth a try as often cope without hinds without barefoot type management and certainly wouldn't expect the sort of pain your previous horse experienced I'd have found that pretty off putting/traumatic.

I too wouldn't want to start steroids if he's sound hacking without either without hindshoes or with lateral extension then I'd save steroids so I still had a if all else fails option.
Click to expand...

Thanks Amicus. Will have a word with the vet and farrier and see what they think, but may try without back shoes. Are you still able to hack without hinds in the same way do you know? He is a WB and has very strong feet and has never lost shoes or had any other shoeing issues as such so he may be able to cope without hind shoes okay.
 
**BUMP***
Anyone else who has had this procedure done three to four years earlier? Your comments gratefully received positive or not.
 
applecart14 said:
Thanks Amicus. Will have a word with the vet and farrier and see what they think, but may try without back shoes. Are you still able to hack without hinds in the same way do you know? He is a WB and has very strong feet and has never lost shoes or had any other shoeing issues as such so he may be able to cope without hind shoes okay.
Click to expand...

With regard to this, my horse had her back shoes removed over 6 years ago. I don't think she ever noticed. We hack over all terrain in all paces.
 
Haven't had my boy's hock fused (although he is undoubtedly feeling some arthritis behind) but he hasn't worn hind shoes for a good four years (except for a brief 4-month interlude when he was being rehabbed for his off fore PSD). He has hunted, hacked on all terrains, evented, etc. with no hind shoes on with no bother whatsoever - and I actually think removing his back shoes improved his hind limb stance. I am now seeing a similar transformation with his forelimbs (albeit slower) - his front feet are a very different shape since I removed his shoes over two months ago - but he is sound in the field, sound walking over scalpings and coped with a hack (in hand and in walk only) on the road with no bother whatsoever. Interestingly, he is also much more sprightly in the field than I have seen him for a long time, which makes me think not only is his (long standing) foot pain resolving, but that it is having an affect further up in his body.

I highly recommend you remove Bailey's hind shoes.

P
 
I have one horse with extremely mild spavins he was responded extremely well to small lateral extensions ( he was bf at diagnosis ) .
We Gave steroid jabs and the newer tidren type drug and later we put on the lateral extensions , I hate all forms of remedial shoeing but have to admit he's jumping better than he has ever done since we put them on .
Might not be the shoes and I am not about to take them off to see just saying I would not assume he'll be better with out shoes .
Hard one Applecart by that I mean hard to know what to do for the best .
 
Goldenstar said:
Hard one Applecart by that I mean hard to know what to do for the best .
Click to expand...

Yep, you are right there! I hope the Tildren works for you Golden Star.
Polar Skye - will speak to farrier today and suggest this as a possible and ask him to ring vet to confer.
9tails - thanks, sounds like it could be a positive experience then.
 
You must log in or register to reply here.
Top