Stifle keyhole surgery or stem cell injection :(

[:0)]

Hi I am really needing some advice. So my lovely horse has been intermittently lame.fornthe last few months. I put it down to thrush as she got it pretty bad. I treated the thrush and had physio out. But she has still been struggling to trot uphill and still a little lame in trot. So.i rang vet and she has been in for nerve blocks and xrays they can't find anything from the nerve blocks but found inflammation around her stifle. But nothing else on xray. The vet has said she should have key hole surgery to see if they can see anything and if they do they may be able to treat it in the surgery or injections after. My other option it to have the stem cell surgery/injection in her stifle. Which can be done at the yard and if see improvement follow up woth anti inflammatory injections. She could end up having this anyway depending what they find in surgery. We only hack out and have the odd lesson. Dont really want to put her through unnecessary surgery but also want to.do the best for her.
Anyone who has been through any similar situations ?
Thankyou ?

 

[Goldenstar]

Yup with Fatty , I should have gone for the surgery .

 

[:0)]

Yup with Fatty , I should have gone for the surgery .

Really . Why what happened? X

 

[Goldenstar]

Well in time the stifle got worse and it ended his career .
I think you should ask the vet about arthrimid or key hole surgery followed by arthrimid .
Arthimid is a gel they introduce into the joint to reduce inflammation and pain and improve function.
you can also use it with steroid .
Arthrimid was not available when Fatty suffered his damage but he had it three years later and it did help but he was never sound enough to return to full work .
One of my biggest horsey regrets is I called it wrong with Fatty I should have gone for surgery straight away when it got worse it was too late to try that .

 

[Tash88]

My horse has stifle issues (chondromalacia in both stifles) and I was advised to go for arthroscopy (which I imagine is the keyhole surgery you're referring to) straight away following nerve blocks that isolated the stifles. My vet didn't even carry out X rays as they would have been repeated by the hospital and as per your experience, they don't always show up stifle issues, or they aren't enough to make a definitive diagnosis on.

The benefit of arthroscopy is that it is diagnostic and also treatment as required, because they can 'tidy up' the joint and often remove any bone chips that are found at the same time. Then depending on what is found you can go down the stem cell / steroid injection / arthramid route based on advice from the vet and surgeon.

My experience was the arthroscopy, then an initial period of 6 weeks box rest, then 8 months small paddock rest, then in-hand walking. Before coming back into work nearly a year ago my horse had steroid injections into both joints. He is now okay, but I am careful with him and we mainly hack with light schooling. He also has Indiba therapy now as I wanted to try and avoid another lot of steroids, but if he needs to have them (or anything else), he will have them.

Happy to answer any more questions you have. The 'Horses with Stifle Lameness' group is also very helpful.

 

[:0)]

Forgot to add she is just used as a happy hacker. She could have try the prp injection ? Seems a lot to put her through surgery. She lives out 24/7 so.qould struggle with box rest too. Just don't know what to.do for the best. All your comments are really helpful xx

 

[HelenBack]

It sounds like a big decision to make based just on inflammation and I'm a bit suspicious about the fact that the vets are offering you two very expensive options!
I wonder if it's worth asking them if they can scan the area to see if that shows anything up. Scans of the stifle are limited because you can't see the whole area but having one might just show some that could help you make an informed decision.

I might also ask about steroid injections before considering surgery. They might help reduce the inflammation and surgery may become unnecessary, or they could buy you a bit of time while you consider your options.

 

[:0)]

They did scan the area as well as xray and just showed inflammation. It's the prp injection she would have if not surgery. But I don't feel i know a lot about this either ☹. She is lame every so often in trot when going up hills or hard surface but it's not all the time xx

 

[Britestar]

Cob damaged his stifle last year. In Sept he was referred to vet school, and they recommended surgery.
Sadly what they found could be career ending. However, they did surgery, repairing as best they could. Post surgery we wanted the best possible treatment for him, to give every chance of recovery. I thought stem cell, prp, irap, arthrimid.
Their recommendation was HA and steroids. This was done 8 weeks post surgery. 6 months post surgery he looked really sound.
Unfortunately he has had a set back, but back on the mend. Again at 6 months questioned all the above, but told for stifles none are particularly useful. Again they have suggested HA and steroids when he starts back under saddle.
Stem cell is VERY expensive, and has had to be done twice (cira 3k a time).

 

[:0)]

It's actually prp injection not still stem cell. It's so hard knowing what to do for the best. Did they do anything for him in surgery xx

 

[Britestar]

It's actually prp injection not still stem cell. It's so hard knowing what to do for the best. Did they do anything for him in surgery xx

He had a meniscal tear, and 3 small fractures. They mended the tear as best they could (extended beyond where they could see), removed the bones fragments and most of the cartilage.

Its just time now.

 

[Tash88]

@Britestar - sounds like your boy has been through a difficult time, fingers crossed he will recover now. I found that HA really improved the steroid injection, with my horse there was a difference in the stifle that had been injected with HA as well and the one that hadn't, as at the time the vet thought that he only needed HA in the worse affected one, which made sense, but the other was injected a month later with a steroid only and sometimes I felt that leg was never as 'good' as the other one. This seems to have been remedied by the Indiba therapy and they are both better now (for now), but if he needs steroids again I'll definitely be having HA injected into both stifles.

@:0) - the reason that surgery is a good option early on is that if there are bone chips or damaged cartilage in the joint, the injections may only have a limited efficacy, as the stifles will still be 'irritated' by anything that is going on. Best case scenario is that surgical intervention won't be needed and the arthroscopic camera will just have a good look inside the joint, but if there is something there then they can deal with it. I have heard of horses who have had the injections etc, they didn't work so well and then they had the arthroscopy; in those cases it would have been more cost-effective and straightforward to just have the arthroscopy first. But I do agree with the PP who said that the injections will give you some time and they may help for a lot longer, you never know!

How does your horse feel when going downhill? That was always a struggle for my horse before investigation, he used to feel very unbalanced as he found it rather tricky, but going uphill always felt ok.

 

[Birker2020]

They did scan the area as well as xray and just showed inflammation. It's the prp injection she would have if not surgery. But I don't feel i know a lot about this either ☹. She is lame every so often in trot when going up hills or hard surface but it's not all the time xx

Just be aware that I have been told that PRP can cause calcification deposits although I've never found any research that has backed that up. But when talking to my vet about PRP in general and I said I'd heard that to my vet I didn't get a negative response so I believe it to be true.

 

[HelenBack]

I just think it's weird that they're only offering surgery or PRP based on not very much evidence and aren't offering something cheaper like steroids first. I completely get that arthroscopy is the best way to go to get a definitive diagnosis when it comes to the stifle but it's a lot to put a horse through anaesthesia and the rest afterwards when it sounds like the vets aren't really sure.

It was a good point further up about nerve blocking actually, have the vets done this to confirm that the lameness definitely is in the stifle? Just because there's inflammation there it doesn't necessarily mean that's where the current issue is arising from.

 

[:0)]

I just think it's weird that they're only offering surgery or PRP based on not very much evidence and aren't offering something cheaper like steroids first. I completely get that arthroscopy is the best way to go to get a definitive diagnosis when it comes to the stifle but it's a lot to put a horse through anaesthesia and the rest afterwards when it sounds like the vets aren't really sure.

It was a good point further up about nerve blocking actually, have the vets done this to confirm that the lameness definitely is in the stifle? Just because there's inflammation there it doesn't necessarily mean that's where the current issue is arising from.

I can't help but think because I I insured they might be pushing for surgery!
They nerve blocked her right stifle and she did improve.
Thats exactly what I think its a lot to put her through when they are not really sure. I was convinced it was her front right leg! She had Thrush in her front right foot and has never been right since. It might be just a coincidence. But even though the thrush has gone she still doesn't like picking that leg up.
But he said when they trotted her up she didn't look lame in that leg ! X

 

[:0)]

My horse has stifle issues (chondromalacia in both stifles) and I was advised to go for arthroscopy (which I imagine is the keyhole surgery you're referring to) straight away following nerve blocks that isolated the stifles. My vet didn't even carry out X rays as they would have been repeated by the hospital and as per your experience, they don't always show up stifle issues, or they aren't enough to make a definitive diagnosis on.

The benefit of arthroscopy is that it is diagnostic and also treatment as required, because they can 'tidy up' the joint and often remove any bone chips that are found at the same time. Then depending on what is found you can go down the stem cell / steroid injection / arthramid route based on advice from the vet and surgeon.

My experience was the arthroscopy, then an initial period of 6 weeks box rest, then 8 months small paddock rest, then in-hand walking. Before coming back into work nearly a year ago my horse had steroid injections into both joints. He is now okay, but I am careful with him and we mainly hack with light schooling. He also has Indiba therapy now as I wanted to try and avoid another lot of steroids, but if he needs to have them (or anything else), he will have them.

Happy to answer any more questions you have. The 'Horses with Stifle Lameness' group is also very helpful.

Thankyou . I would be interested to see another horse with stifle lameness to see if it's similar. Is the group on here ?
Thankyou x

 

[PinkvSantaboots]

Sometimes hind limb lameness can make a front limb look lame you could ask them to nerve block the front just to see though if you are not totally convinced.

 

[Tash88]

Thankyou . I would be interested to see another horse with stifle lameness to see if it's similar. Is the group on here ?
Thankyou x

It's a Facebook group

The thing with stifles is that they are probably never going to be sure without having a proper look at the joint using keyhole surgery, which is why they propose that early on. If she is insured then I would go for it as the diagnostics are expensive; my horse's X rays, surgery and hospital costs were £2,500 so half of a standard £5k vet bills payout.

 

[VScall]

Thankyou . I would be interested to see another horse with stifle lameness to see if it's similar. Is the group on here ?
Thankyou x

My horse has just been seen by vet as he was lame on one of his forelegs in trot on any surface.
His fore legs are fine, no swelling etc but he has swelling in both stifles which we found as I asked for scans after we did a full lameness workup..
We have xrays due soon so reading this thread is interesting!

 

[:0)]

My horse has just been seen by vet as he was lame on one of his forelegs in trot on any surface.
His fore legs are fine, no swelling etc but he has swelling in both stifles which we found as I asked for scans after we did a full lameness workup..
We have xrays due soon so reading this thread is interesting!

Yours sounds so similar to mine. Mine seemed lame on right foreleg but vet said looked like right stifle. There was no swelling etc any where was only on xrays/scans showed inflammation. Let me know how you get on xx