Medicating Coffin Joint - Hyonate?

[starry23]

I'm just looking for some advice/info, apologies this is my first post, I'm a bit of a lurker but I'm currently trying to get as much information as possible about medicating a horses coffin joint. Here's the story:

My mare got a puncture wound to her coffin joint (right foreleg) on the 6th July. She got surgery to have the joint flushed (under GA) and also a regional perfusion of the limb. Vets were happy with the surgery, couldn't see any contamination in the joint etc. She was hospitalised for 7 days and was doing well, a bit sore on her leg after all her medication wore off but the vets were happy. I got her home on the 13th and on the 16th she had her stitches out, still lame but vet said that was normal. On the 18th I noticed one of the surgical portals was angry looking - vet came out and confirmed cellulitis so prescribed danilon for 4 days and norodine (spelling?!) antibiotics for 5 days. The next day she was sound and I started walking her out as advised. Things were fine until Thursday and I noticed she was a bit sore again and there was heat around the portal. Phoned vet who let me pick up some Baytril. Friday she was worse. Vet came out to do a joint tap as he was worried that the joint was reinfected. Results were negative for infection but there was a really high protein count. The joint is highly inflamed. I picked up more Danilon and she is on strict box rest. Vet was hoping that she'd respond to oral anti-inflammatories over the weekend. If there is no significant response to the Danilon he wants to medicate the joint (he is talking about hyonate).

She is worse today so I think medicating the joint will be the next step. I'm not sure if he'll change his mind about hyonate when he sees her as there really has been no response to the Danilon at all yet.

Does anyone have any similar experiences? Any advice? What was the outcome if your horse had his/her coffin joint medicated?

 

[starry23]

Anyone?

 

[pollygbaker]

I'm just looking for some advice/info, apologies this is my first post, I'm a bit of a lurker but I'm currently trying to get as much information as possible about medicating a horses coffin joint. Here's the story:

My mare got a puncture wound to her coffin joint (right foreleg) on the 6th July. She got surgery to have the joint flushed (under GA) and also a regional perfusion of the limb. Vets were happy with the surgery, couldn't see any contamination in the joint etc. She was hospitalised for 7 days and was doing well, a bit sore on her leg after all her medication wore off but the vets were happy. I got her home on the 13th and on the 16th she had her stitches out, still lame but vet said that was normal. On the 18th I noticed one of the surgical portals was angry looking - vet came out and confirmed cellulitis so prescribed danilon for 4 days and norodine (spelling?!) antibiotics for 5 days. The next day she was sound and I started walking her out as advised. Things were fine until Thursday and I noticed she was a bit sore again and there was heat around the portal. Phoned vet who let me pick up some Baytril. Friday she was worse. Vet came out to do a joint tap as he was worried that the joint was reinfected. Results were negative for infection but there was a really high protein count. The joint is highly inflamed. I picked up more Danilon and she is on strict box rest. Vet was hoping that she'd respond to oral anti-inflammatories over the weekend. If there is no significant response to the Danilon he wants to medicate the joint (he is talking about hyonate).

She is worse today so I think medicating the joint will be the next step. I'm not sure if he'll change his mind about hyonate when he sees her as there really has been no response to the Danilon at all yet.

Does anyone have any similar experiences? Any advice? What was the outcome if your horse had his/her coffin joint medicated?

Hi, my horse has went lame 4 weeks ago (a monday) (off fore). He went straight to vets as started off lesson sound then went very very lame and we were worried he had done something that needed urgent attention. He was nerve blocked and narrowed it down to the coffin joint - he then showed up lame on near fore - this was also located to coffin joint. X rays were good and showed no changes.

Because of needle sites into the leg we went back 3 days later on the friday for the cortisone and hyonate injections. This was because the vet was worried about joint infections and cortisone can apparently make the body less able to fight infection for the first couple of days it is in the horses system. Hyonate (I think this is what the vet said it was) is a natural acid which incurs in the joints. If the joint is damaged the natural fluid in the joint capsules can start producing enzymes which attack the bone etc causing arthritis. It is also an anti-inflammatory. He had to be kept in for 24 hours to keep it clean (the vet spent 10 mins carefully disinfecting the area beforehand as bacteria into joint capsule would be a nightmare). It was also bandaged. We were hopeful we had caught it in time.

We went back to the vets 10 days later (last tues). Vet very disappointed as no improvement. Was expecting 100% if not 90% improvement as there had been no bony changes. As he is insured we tried just injecting Hyonate in again (vet not to hopeful as had not worked before, but had nothing to lose as insurance paying for it.) He suggested putting egg bar shoes on with rolled toes and set back on the foot. This was done on Friday. He is going back to the vets a week on monday when we will see if it has worked.

If not there seem to be to options at the moment - 6 months off and then see (I have gone down this route before with another horse and you never know where you are and what you are dealing with) or an athroscopy (apparently this will be better than an MRI as if there is a problem seen it can be dealt with there and then. If there is a problem found on an MRI we will have no money left on the insurance for the op.). i have a feeling we will be going down the athroscopy route as he still does not look right - is point his toes (resting) and has a short choppy stride in front.

I hope this makes sense - this is how i have understood it from my vet. I hope i have understood it right. Good Luck

 

[starry23]

Well she got her joint medicated on the 31st July with a small amount of steroid and hyonate. It did bring down the inflammation (heat and swelling have gone now) however my horse is still lame.

We are awaiting an MRI (booked in over at Edinburgh a week tomorrow). The surgery she had previously was a joint flush and arthoscopy under GA to treat the original injury (puncture wound to the joint resulted in a life threatening infection). They saw nothing contaminating the joint and nothing out of place and so my horse has already been through what you are suggesting. Unfortunately insurance money has run out so I have scraped together the money for the MRI. Having spoken many times to my vet it looks like there is some sort of soft tissue damage. Vet is leaning towards tendon or ligament damage either from the original puncture wound or from the surgery and he doubts it is cartilage damage. If it were cartilage damage he said there would have been an inflammatory cell count in the results from the joint tap and there wasn't (if it were cartilage damage they might operate to remove any rough/loose bits but other than that surgery is an unlikely option). All the signs are pointing to tendon or ligament but we don't know what and to what extent which is why we are going for the MRI. After 8 weeks of box rest I feel it is only right that I know I am keeping her in for a reason! The most likely treatment for us is looking like physio, box rest and controlled exercise. I'm not sure about remedial farriery or barefoot rehab (horse is currently barefoot as she had her front shoes taken off before the surgery 8 weeks ago and has been barefoot behind for well over a year) I'm not sure our ground is suited to barefoot rehab but I'm more inclined to give that a go if I can as there seem to have been many success stories with that.

One thing I will say about the arthoscopy - remember it is invasive. The coffin joint is a very small joint difficult to get into and to actually get the arthoscope in it takes a lot of force. It is possible that in my case that force has been enough to cause the damage that has made my horse lame. Obviously it might not have been that and I won't have any idea until the MRI is done (and even then I might not get a definitive answer) and at the end of the day if that surgery wasn't done then I couldn't have a horse at all. Personally I'd speak to your vet about what they think is most likely to have gone wrong. If it is tendon or ligaments then I'd be leaning more towards the MRI because of the reasons I mentioned above. I can understand if they believe it is something that will be more likely to require surgery to treat that the arthoscopy might be a better option.

All I can say is it is a very difficult situation to be in and I understand how you are feeling. I have gone over and over in my head whether it is worth forking out for this MRI but I do believe it is the right thing for me and my horse. I hope you get to the bottom of your horses problem and that he is sound soon.

 

[pollygbaker]

hi. yes it is so difficult. I lost my old horse only last december due to soft tissue damage in his foot. We did not go down MRI as knew it was soft tissue as X-rays were fine. He had a lot of rest, remedial farriery (lateral extensions - to help his pigeon toes), physio, supplements. Unfortunately all this would work and as soon as he started a controlled excursive programme he would be lame again after about 2 weeks. Eventually it got worse and worse until in the end he was on 2 sachets of bute a day. We were worries about the long term effect on his liver - he was only 10. The last straw was when he could not keep his shoes on bless him as his hoof wall was coming off in chunks. We made the most sad decision to put him down. It was not fair to keep him in a field as he hated doing nothing and he was in pain. He was my horse of a lifetime.
Sometimes it seems so unlucky. My new horse who has the coffin joint problems was 5 stage vetted, has not jumped all summer due to hard ground and i am so careful and paranoid about his legs.
I hope it goes well for you

 

[pollygbaker]

I think going down the MRI route is a good idea. I know that I did not with my old horse. And even though putting him to sleep was the right thing, I still have questions and guilt for not doing it