Hock spavin- ethanol, steroids, arthramid etc...

[Michen]

I've just booked Boggle in to have steroids injections next week (short background is, positive to flexion following nearly 6 months of on and off box rest/rehab for a ligament injury. Blocked and x rayed to the hocks. Never been positive to flexion before despite being checked about every 6 months since 5 years old). He's throwing me over to one side in his walk hacking and although it is definitely improving, vet and I agree it's not improving quick enough and the hocks may need a little help as they seem to have been effected by his lay off, lack of fitness etc. He's always been kept super fit and active before this.

My vet is a real advocate of ethanol fusion. He has had a huge success rate (97%- 100 horses) with it, and feels it's better done sooner rather than later as a last resort for the highest chance of success...the argument being that steroids will more than likely stop working eventually (horse is 8), and the sooner you fuse and properly fix the problem the better for a multitude of reasons. I absolutely trust his judgement and he is a very well respected and well known vet. BUT, Boggle and I have been through a lot over the last few months. The fusion would involve three months doing very little and in a small ish again paddock. There is no need (from my perspective) for him to be in work as we were planning on just pootling around until next year anyway to give the ligament extra time than prescribed, but I do feel a bit exhausted at the idea of doing something which feels relatively major. He's also really happy out with his mate, doing a bit of work, etc. He is quite literally lighting up when he sees his saddle at the moment!

I have decided to go ahead with the steroids for now just to give myself a bit of time to think and see how Boggle responds to them, but I am seriously considering whether we might as well use winter to have them fused rather than potentially do it next year, where I'd really like to have a chance at us getting back to doing some low key fun stuff again.

I'd be really interested to hear about anyone's experiences with the fusion (I am also satisfied, having spoken to my vet at length, re any ethical concerns with the procedure).

 

[ester]

Did you read Stanley's hock fusion journey post?

 

[Michen]

Did you read Stanley's hock fusion journey post?

Yes I did But hoping for more than just one or two experiences.

Edited to add, my vet seems to feel that you don't work them through it ( I know with Stanley there was a walk, trot etc rehab plan), that for 3 months they should be doing very little other than perhaps some gentle walk work out hacking).. so I wonder if this is "newer" advice and a more successful approach than trying to get the horse back in a reasonable level of work fairly quickly

 

[Tiddlypom]

My vet refuses to perform ethanol fusion on hocks on welfare grounds.

She’s not a wimp, she’s a well grounded Irish lass from a background in racing, but she says that the procedure is too drastic.

She uses steroids or gel injections.

ETA Just saw your posts re ethics. Vets will always have differing opinions.

 

[Michen]

My vet refuses to perform ethanol fusion on hocks on welfare grounds.

She’s not a wimp, she’s a well grounded Irish lass from a background in racing, but she says that the procedure is too drastic.

She uses steroids or gel injections.

As I said, I am satisfied re any ethical concerns so am looking for any experiences of having it done.

 

[doodle]

Minto has a very mild spavin. Only noticeable 2 days after a hunter trial when he was slightly lame. From what I remember it was the top joint and so the vet said he did not want it to fuse. He had the steroid injection. I think he had 2 days off then carry on. He was 13 at the time and that hock never gave him bother again. He did another 5 years of hunter trials, odes, showjumping dressage etc. I would get a lesson wi leg a new instructor and after the lesson ask which hock he had an issue in and it was never picked up.

That was 12 or 13 years ago now though.

 

[SEL]

I spoke to my vet about ethanol injections and she was pretty sceptical about their success rate - interesting your vet sees better results.

I went for gel and until madam decided more time off was needed by hurting her front leg I was seeing really good results.

 

[SEL]

How bad was the hock on x ray?

 

[Michen]

How bad was the hock on x ray?

Yep my vet is really convinced by them... but I think he feels a lot of the success rate is doing it sooner rather than later, and I guess as it’s his recommendation then his cases are less likely to be those last ditch attempt ones. Maybe that’s why he sees better results?

Not bad at all, really minor changes, but obviously now causing him discomfort. Worse in the right (where injury is).

 

[ycbm]

Friend had a mare done two years ago. Totally failed. No big deal, just a complete waste of money. Mare was 12, very low mileage, and it was done as soon as there was a diagnosis.
.

 

[Polos Mum]

I was gifted one which had failed hock fusion to see if 12 months field rest on bute would allow it to fuse. After mega £££'s rehab livery for months following vets instructions to the T. We're close to getting to a level of bute for field rest I'm not happy with - he likely won't do another winter.

I wouldn't do it to a horse I owned. You've melted the cartilage - there is no going back or alternatives if it doesn't work. If the changes are currently only minor then I'd think really really carefully before doing something so drastic and irreversible

 

[TheMule]

There are some useful studies here that could guve you some objective scientific info
https://pubmed.ncbi.nlm.nih.gov/22128830/

 

[Michen]

There are some useful studies here that could guve you some objective scientific info
https://pubmed.ncbi.nlm.nih.gov/22128830/

Thanks yes I read that.. there seems to be a lack of studies more recent and on a wider range of horses. Hmm!

 

[TheMule]

Thanks yes I read that.. there seems to be a lack of studies more recent and on a wider range of horses. Hmm!

I wouldn’t worry about the recency because the treatment protocol hasn’t changed, but I agree it would be great if someone would fund some bigger studies!

 

[Michen]

I was gifted one which had failed hock fusion to see if 12 months field rest on bute would allow it to fuse. After mega £££'s rehab livery for months following vets instructions to the T. We're close to getting to a level of bute for field rest I'm not happy with - he likely won't do another winter.

I wouldn't do it to a horse I owned. You've melted the cartilage - there is no going back or alternatives if it doesn't work. If the changes are currently only minor then I'd think really really carefully before doing something so drastic and irreversible

I guess the issue is that whilst the changes are minor that doesn’t necessarily correspond to the level of pain... so the degree of changes are I guess somewhat irrelevant? Eg there could be changes but you have a totally sound happy horse.

I agree, it’s tricky because obviously I want the best chance of long term soundness, but if I don’t do it it does seem to be a reduced chance of it working if you then have to do the fusion further down the line.

Am going to do the steroids for now and give myself some time to mull it over, but I’m leaning towards not doing it even though this is against my vets advice (whose not being remotely pushy and fully backs up whatever I choose- he is just speaking from his own experience from the 100 horses he’s done it with).

 

[Michen]

I wouldn’t worry about the recency because the treatment protocol hasn’t changed, but I agree it would be great if someone would fund some bigger studies!

I wouldn’t worry about the recency because the treatment protocol hasn’t changed, but I agree it would be great if someone would fund some bigger studies!

I think the post procedure treatment/rehab has changed a bit, after speaking to my vet and my ex OH both said you very much scale things right back to just gentle walk work or nothing for three months or so. Whereas previously it seemed to be a case of work them through any discomfort.

 

[Tiddlypom]

Hmm. Improvement in 60% of the treated limbs, but 19% (4) of the horses deteriorated of which 2 developed significant complications related to treatment.

What is the complication rate for steroid or gel injections, they carry some risk?

Horses were classified as improved based on a 50% reduction from initial lameness grade combined with an increase in exercise level.

Results: Of the 24 horses included in this study, 20 had the treatment performed bilaterally and 4 unilaterally. All horses were available for initial follow-up examination and 21 for a second one 6-9 months after treatment. This represented a total of 44 treated limbs and 35 available for long-term follow-up. Of these, 21/35 (60%) were considered improved, which corresponds to 11/21 horses (52%). Of 21 horses, 4 (19%) deteriorated and 2 of these developed significant complications related to treatment.

 

[SEL]

Yep my vet is really convinced by them... but I think he feels a lot of the success rate is doing it sooner rather than later, and I guess as it’s his recommendation then his cases are less likely to be those last ditch attempt ones. Maybe that’s why he sees better results?

Not bad at all, really minor changes, but obviously now causing him discomfort. Worse in the right (where injury is).

I'm sort of wondering whether pain relief plus movement (with some physio type stuff) might sort him out rather than heading to quite a significant intervention. I guess the steroids will show you if that's possible.

I get the early intervention - I've learnt my lesson on 'wait and see' - but this does feel quite extreme IMO ?

 

[Michen]

I'm sort of wondering whether pain relief plus movement (with some physio type stuff) might sort him out rather than heading to quite a significant intervention. I guess the steroids will show you if that's possible.

I get the early intervention - I've learnt my lesson on 'wait and see' - but this does feel quite extreme IMO ?

That’s how I feel about it too. But it’s confusing me because my vet is such an advocate for the less intervention the better. I remember a dressage instructor saying I should have Boggles hocks jabbed (he always struggles to work through from behind he’s so long in the back and just built totally wrong for it), vet was absolutely against it and said he would want to have a VERY good reason for sticking a needle in there.

It’s not like him to be so pro something invasive, but I guess he’s seen the results so I can understand why.

But I think for Boggle and I at the moment the right thing to do is wait, and if it means having to fuse further down the line I guess I’ll just have to live with that choice.

 

[ester]

I think it can depend what you are jabbing with, steroids obviously have some benefits, but diminishing returns. I've known a few just get the HA component without the steroid for longer term management.

 

[gunnergundog]

Have never used ethanol, but have researched it albeit some years ago. Got away with steroids for mine in the past.
So, some thoughts...

Firstly, I believe that not all horses are suitable candidates for ethanol fusion and until they do the dye test they won't know if it is feasible or not.

Secondly, if you go with the steroids now and then decide to go down the fusion route, is there a set amount of time that must lapse before they can start with the ethanol? Or, do they have to wait for the steroids to totally wear off? If the latter, could be a long wait. Have had horses go over a year.

I would always use HA as well as the steroids if you go that route. Not all vets do automatically.

 

[IrishMilo]

My vet refuses to perform ethanol fusion on hocks on welfare grounds.

She’s not a wimp, she’s a well grounded Irish lass from a background in racing, but she says that the procedure is too drastic.

She uses steroids or gel injections.

ETA Just saw your posts re ethics. Vets will always have differing opinions.

I know of the risks and that it's a painful process - did she have other reasons? Would be interested to hear as it's obviously an option for mine as well (not that I would do it as anything other than a last resort). HA is my first choice.

 

[Michen]

I know of the risks and that it's a painful process - did she have other reasons? Would be interested to hear as it's obviously an option for mine as well (not that I would do it as anything other than a last resort). HA is my first choice.

IM have you had the steroids done? I didn't realise HA was an option but I think that's what we injected Boggle's fetlock with when we had an adhesion/manica tear....

 

[Tiddlypom]

I know of the risks and that it's a painful process - did she have other reasons? Would be interested to hear as it's obviously an option for mine as well (not that I would do it as anything other than a last resort). HA is my first choice.

I didn’t go into it in detail with her. I raised the question with her after reading about ethanol fusion on here, and was rather surprised at how at against it she was. I also didn’t ask if any other of the vets at the practice would do it.

I’m happy with gel injections, IMHO they are a step forward from steroids.

 

[QueenT]

Our pony was diagnosed 1½ years ago, and we discussed it then. Vet didn't think the success rate was good enough towards the risk, and we very quickly agreed that it was a way too drastic procedure. As it turned out, she was unfortunately not one that fused quickly. We've had an endless trail of steroids, hyalyronic acid and two tildrens - and vet bills, constant worry and hope. Reading your post I was thinking whether we should have gone for the fusion much earlier - I don't think so.

 

[QueenT]

I've just booked Boggle in to have steroids injections next week (short background is, positive to flexion following nearly 6 months of on and off box rest/rehab for a ligament injury. Blocked and x rayed to the hocks. Never been positive to flexion before despite being checked about every 6 months since 5 years old). He's throwing me over to one side in his walk hacking and although it is definitely improving, vet and I agree it's not improving quick enough and the hocks may need a little help as they seem to have been effected by his lay off, lack of fitness etc. He's always been kept super fit and active before this.

My vet is a real advocate of ethanol fusion. He has had a huge success rate (97%- 100 horses) with it, and feels it's better done sooner rather than later as a last resort for the highest chance of success...the argument being that steroids will more than likely stop working eventually (horse is 8), and the sooner you fuse and properly fix the problem the better for a multitude of reasons. I absolutely trust his judgement and he is a very well respected and well known vet. BUT, Boggle and I have been through a lot over the last few months. The fusion would involve three months doing very little and in a small ish again paddock. There is no need (from my perspective) for him to be in work as we were planning on just pootling around until next year anyway to give the ligament extra time than prescribed, but I do feel a bit exhausted at the idea of doing something which feels relatively major. He's also really happy out with his mate, doing a bit of work, etc. He is quite literally lighting up when he sees his saddle at the moment!

I have decided to go ahead with the steroids for now just to give myself a bit of time to think and see how Boggle responds to them, but I am seriously considering whether we might as well use winter to have them fused rather than potentially do it next year, where I'd really like to have a chance at us getting back to doing some low key fun stuff again.

I'd be really interested to hear about anyone's experiences with the fusion (I am also satisfied, having spoken to my vet at length, re any ethical concerns with the procedure).

Do you have any experience with arthramid?

 

[ester]

I don't know the answer Michen, but I would want to check what the impact of steroid/HA/arthramid is on going back in with ethanol to fuse/the timing of doing so.

 

[Michen]

I don't know the answer Michen, but I would want to check what the impact of steroid/HA/arthramid is on going back in with ethanol to fuse/the timing of doing so.

Oh I spoke to vet about that he said 6-8 weeks post steroid if you then decide to fuse is ok. Not sure about arthramid/HA.

I really don't think I'm going to fuse though... I just think Bog and I have been through enough over the last 6 months. He actually looks amazing at the moment, he feels like he's grown, I feel like I have a 16hh sports horse in front of me not a 15hh squit, he's super happy but also relaxed...

I don't relish the idea of Boggle in a small paddock for the next three months in winter, trying to keep him calm etc (vet said you really do need to do your best to make sure they don't get up too much speed/be too silly as it can make them very sore). I'm already worrying about keeping him sane enough through winter with enough work to keep him occupied and flexible and help the spavin but keeping it very light to respect the ligament injury.

I think I'd rather take my chances on having to do it further down the line and it perhaps not being successful, than do it right now.

 

[Barlow]

Someone on our yard had it done. Would perhaps had been fine but horse was a chronic boxwalker to boot so it didn’t have a good outcome in the long term as box rest was not truly achieved.

 

[IrishMilo]

IM have you had the steroids done? I didn't realise HA was an option but I think that's what we injected Boggle's fetlock with when we had an adhesion/manica tear....

Not yet. My vet recommended either Cartrophen (IM injection once a week for four weeks then topped up as required) or steroids into the joint with HA first. We haven't discussed fusion at all yet as I imagine most vets see it as a last resort/use it in the most extreme cases. Post back with what you go for and your experience and I'll do the same. It sounds like we're on the exact same journey TBH. Two young idiotic Connies both with mild changes.