Stifle lameness - Arthroscopy or conservative treatment?

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LouiseG

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Just wondered if anyone had any experiences they would like to share… My boy had a work up yesterday and is bilaterally lame in both stifles, as well as mild spavin in his right hock (x-ray was clear on the left) from a bad kick as a 4 year old, he’s 6 now. Looking back the signs have been there for months, but it was always put down to a training issue, or a weakness which makes me feel very upset thinking I could have done something sooner.

X-rays were all clear which was not a surprise. The vet is sure it’s a soft tissue problem within the joints and that arthroscopy would be the best option as it could be something very simple to fix with a good prognosis, even a middle of the road case could see us back in full work in 6 months, or it could be something horrendous of course, but we won’t know for sure unless they get a camera in there and have a good look around. They have said they could treat conservatively with steroids/med, the inflammation would probably go and he would probably be sound… but the vet said usually these problems come back in a year or 2 and the damage by then could be worse and he’d need surgery anyway (and of course my insurance would then be null and void). Can anyone share any experiences and if you went for the arthroscopy or conservative treatment and what the outcome was? I'm trying to stay positive but it is impossible! x
 
LouiseG said:
Just wondered if anyone had any experiences they would like to share… My boy had a work up yesterday and is bilaterally lame in both stifles, as well as mild spavin in his right hock (x-ray was clear on the left) from a bad kick as a 4 year old, he’s 6 now. Looking back the signs have been there for months, but it was always put down to a training issue, or a weakness which makes me feel very upset thinking I could have done something sooner.

X-rays were all clear which was not a surprise. The vet is sure it’s a soft tissue problem within the joints and that arthroscopy would be the best option as it could be something very simple to fix with a good prognosis, even a middle of the road case could see us back in full work in 6 months, or it could be something horrendous of course, but we won’t know for sure unless they get a camera in there and have a good look around. They have said they could treat conservatively with steroids/med, the inflammation would probably go and he would probably be sound… but the vet said usually these problems come back in a year or 2 and the damage by then could be worse and he’d need surgery anyway (and of course my insurance would then be null and void). Can anyone share any experiences and if you went for the arthroscopy or conservative treatment and what the outcome was? I'm trying to stay positive but it is impossible! x
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Arthroscopy is the only way to see what is going on, but it is a big op, and very invasive. Personally I retired my horse with stifle problems as didn't want to put him through that - but he was field sound, just not sound to ride.
 
My horse is only 6, and I cant retire a 6 year old unless I've tried everything I can. My friend's horse had this done and has come back better than ever, there are some really positive outcomes, as well as ones that aren't so great! 3 horses at my yard have had this procedure and they are all back in work, 2 of which are jumping. It all depends on what they find I guess! :(
 
Had the same thing with mine last year, work up showed that he was, in the vets words 'had his pants on too tight' after nerve blocks he was completely different and again the x rays of his hocks and stifles where clear.
The orginal thought was OCD but we went down the route of steroids and what i can joint juice (cant remember the proper name) and he came back into full work better than ever. There where a few hic ups but with the work of my vet and a fab physio we felt that there was a lot of muscular problems that needed to be sorted as well, dont know it they where a by product of the stifles or the other way round.

Unfortunately i cant tell you how well it has lasted as he was kicked and fractured his knee this August, a year after he was treated. I was offered the op but we didnt have anything to really go by, the plan was to scan and give the results to someone who was an expert but that never came about because of my vet being off as he suffered a fractured neck earlier this year and i was reluctant get a different vet up as my vet knew him right from the start of it all.

Up until he was kicked with correct work and good management i had no reasons to be concerned, he was jumping very well and we where going to step up to 1.10m this winter, his canter was fab rather than bunny hoping behind and it was all falling into place with the way he went.

Now looking at him i would say they have deterioated but possibly not to what they where before he was medicated but its very hard to tell because of him being lame in front. I have no idea if i will be able to get away with not having them medicated again, i will cross that bridge when he is sound enough to bring into work. I'm hoping the slow re hab i will have to do with his knee will help his stifles but who knows.

Oh and he was 7 when this started.
 
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LouiseG said:
My horse is only 6, and I cant retire a 6 year old unless I've tried everything I can. My friend's horse had this done and has come back better than ever, there are some really positive outcomes, as well as ones that aren't so great! 3 horses at my yard have had this procedure and they are all back in work, 2 of which are jumping. It all depends on what they find I guess! :(
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Yes, it is the only way to be sure about anything soft tissue related in the stifle. However I didn't feel a big op like that was fair on my horse who could easily be a companion, though only 9, as he was sound in the field. Yes it depends on what they find, and on how well the horse copes with the op itself, and how it recovers - you are relying on fairly major wound healing there.
 
Thank you vam for your reply! Your boy has had a rough time!! My vet thought conservative treatment would work but only in the shorter term. In his experience, stifles that are conservatively managed normally have problems again somewhere down the line. I am scared to put him through an operation but I also think, how can they treat something properly when they dont know exactly what is going on. They might need to fix something when they're in there and I'd rather they do it now than get him sound and then he goes off again and we need to do it anyway. I dont think there is ever a wrong decision, it's finding the right one for him that's important. Hope your boy makes a speedy recovery!! x
 
khalswitz said:
Yes, it is the only way to be sure about anything soft tissue related in the stifle. However I didn't feel a big op like that was fair on my horse who could easily be a companion, though only 9, as he was sound in the field. Yes it depends on what they find, and on how well the horse copes with the op itself, and how it recovers - you are relying on fairly major wound healing there.
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Thanks for your reply :) The arthrospcopy is keyhole and the wounds are tiny, they normally only need 1 stitch in each hole I am lead to believe? x
 
LouiseG said:
Thanks for your reply :) The arthrospcopy is keyhole and the wounds are tiny, they normally only need 1 stitch in each hole I am lead to believe? x
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yes the outer wound is only small, but the stifle is a very complex joint so poking around in it is fairly major!! Layers of cartilage, layers of joint membranes, ligaments connecting patella to femur, patella to fused tibia/fibula, between the menisci and then the tendons etc which run across the joint and act as part of the locking system etc. So a very complex joint to be messing around in, and a lot of healing to have to do - if this joint capsule gets infected you are in for a world of problems. I've known a few horses who have had extended recovery perod from arhtorscopies due to complications in healing, more than anything else.
 
From my understanding the op isnt very invasive and was done by keyhole, i think i was more worried about him going under and how well he would come round. That said it is invasive as it is going into a joint, that is not something you want to do if you can help it and its the healing from that that will take the time.
From what i remember (i've seen far to many vets for far to many things in the last year, add 2 sets of stitches for kicks after his stifles and surface fracture to his radius just before his knee!) my vet was happy to go down the medicate route from what he saw at the time, if there was no improvement or it only worked for a short period of time then a op would be nesessary. At about 9 months after there was next to no steroid left in the joint and he was still as good as when he had just been injected so my vet was happy that he wouldnt need an op at that time. That doesnt mean that he might not need it done in a few years or as he get older.
It really is best to discuss it with your vet, from the sounds of it your horse possibly is worse than mine which is why the vet is suggesting an op. Good luck, i know how awful it is not knowing what might happen nad having to make that choice.
 
I am not convinced that everything now needs stifle operations, they are definitely far too widely recommended IMO. Is it your own vets that are recommending an operation or a referral clinic?
 
My own vet is recommending it is done at the practice by a specialist orthopaedic surgeon who comes up once a month. Not sure how I can possibly make this decision! I wish there was no choice but sadly there are other routes to go down! x
 
I had to reply with my experience as it was so similar to yours at the begining.

My boy was 12, bilateral lameness. Had a full lameness work up and nerve blocks, found stifles were the problem. I was given the options of athroscopy or turn away for a year and hope he comes back sound (not an option in my mind) So ahead i went with the surgery.

The surgery itself went as well as it could have surgeon said i had a very good chance of getting him back to how he was, a fit competition horse. You really do have to think of the bigger picture here. The surgery itself, although invasive, is nowadays quite a routine procedure but the aftercare is paramount. Quietness and control is key for the full recovery. Has your vet fully talked you through the aftercare? Mine didnt and i feel this was where it all went wrong, in my shock and upset i just agreed with the vets.

My box couldnt handle the box rest and inhand walking. We had several incident including him going up and over on himself inhand, almost taking me with him! Vet then said he could go out in a 12x12 pen. He jumped out, went crazy and fell over again. I tried absolutley everything, i really did.

2 weeks ago, 7 months after the op the vet came out to declare he was to be retired. He is for now field sound but im not sure for how long, what his future holds, or what exactly i am supposed to do with a 13 year old retired horse. Although of course he has a home for life with me and is the most beautiful field ornament anyone could wish for!

Just to add there was another horse in for the same op on the same day with the same surgeon and he is now fully sound and in full work. My lad just had too much stacked against him :(
 
mine was diagnosed with OCD of the stifles as a nearly 9yo. we tried steroids which did nothing, went down the arthroscopy route which wasn't helpful as they couldnt do much. it did let them see what was going on though, as it was actually presenting more like a meniscal tear. IRAP and 18months rest and rehab after that he was pretty sound for hacking and light schooling. He might have been sound enough to do more but I didn't want to risk breaking him. I then lost him to melanomas at 11 so can't tell you what the very long term outlook was. I didn't have alot of choice wrt surgery-he would be sound after 3 weeks box rest and then non-weightbearing lame on his RH (three cycles of this, last one with steroids) so I had to either PTS or give him a chance.IRAP totally helped him but they are all different. Good luck.
 
SammyDingle said:
I had to reply with my experience as it was so similar to yours at the begining.

My boy was 12, bilateral lameness. Had a full lameness work up and nerve blocks, found stifles were the problem. I was given the options of athroscopy or turn away for a year and hope he comes back sound (not an option in my mind) So ahead i went with the surgery.

The surgery itself went as well as it could have surgeon said i had a very good chance of getting him back to how he was, a fit competition horse. You really do have to think of the bigger picture here. The surgery itself, although invasive, is nowadays quite a routine procedure but the aftercare is paramount. Quietness and control is key for the full recovery. Has your vet fully talked you through the aftercare? Mine didnt and i feel this was where it all went wrong, in my shock and upset i just agreed with the vets.

My box couldnt handle the box rest and inhand walking. We had several incident including him going up and over on himself inhand, almost taking me with him! Vet then said he could go out in a 12x12 pen. He jumped out, went crazy and fell over again. I tried absolutley everything, i really did.

2 weeks ago, 7 months after the op the vet came out to declare he was to be retired. He is for now field sound but im not sure for how long, what his future holds, or what exactly i am supposed to do with a 13 year old retired horse. Although of course he has a home for life with me and is the most beautiful field ornament anyone could wish for!

Just to add there was another horse in for the same op on the same day with the same surgeon and he is now fully sound and in full work. My lad just had too much stacked against him :(
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Thank you so much for your experience! I am so scared I make the wrong choice. He is so laid back and trusting that I dont think there will be a problem with the box rest and in hand walking, but I could be wrong :( His last bout of box rest was for 2 weeks and he didn't even fart when we trotted him up and lunged him, he really is a gem and not highly strung in the slightest. The turnout would be a concern because he has gone through the tape a few times in the field, and where they are thinking of putting him is right next to his current field with 7 other lively geldings and I think he would go through the tape if they were carrying on next to him. I never thought I'd be facing this with a 6 year old, I am heartbroken! But I will need to be brave and make a decision! x
 
Firstly, thankyou to all who have contributed to this very informative thread. I will be taking my 7 yo to the vets with a swollen stifle in the new year, the operation has been suggested but as she box walks i have decided against that in any case.

I am hoping that nerve blocks, x rays and a scan will give an idea of what we are dealing with andhow best to treat.

OP, thinking of you and keep us updated.
 
Hi Louise, I've just came across this thread and it just so happens that my mare is undergoing a bilateral stifle arthroscopy this monday (9th) and I'm terribly nervous, she was diagnosed in March although looking back i personally feel the problem was looming since last november but just got progressively worse, now to look at her she is only about 2/10 lame but its obvious she is in pain and the injury has put her under a lot of stress, she is constantly extremely tense and isn't the loving mare she used to be, she always shy's away from me and is extremely highly strung its sad to see her like it but after trying everthing steroids, shockwave treatment etc. surgery is out only option and we really need to get it out of the way before our insurance claim runs out. I am hoping the best for her and am definitely being a worried mummy about it all but fingers crossed all goes well and will let you know how she gets on x
 
Hi sally12. My horse is due a stifle arthroscopy this week (March 2014) and so I am very interested to see how your mare got on as she had it done in December 2013 according to the thread. My horse is also 2/10 lame. Was it a success (although still early days I guess as you are probably still at the leading in-hand stage or have you progressed from that?). How did your mare cope with the journey home from hospital and the box rest? Did the hospital explain fully what the rehab involved before you took her home? I am apprehensive but arthroscopies are frequently done on humans (with mostly successful outcomes I believe) so feel I can only give it a try as if I don't I will never know.
 
My horse was not lame, but kept changing behind on a circle. Would canter, gallop, jump out xc no problems, it was just on a circle it showed itself.
June 2012 I took him to vets who gave him an injection in the joint. He went worse so they carried out an arthroscopy and found a tear in his meniscus.

He never recovered. The joint swelled, became full of fluid. He had more injections, PRP treatment, box rest etc. in September 2012 the vet suggested the last straw would be to turn him away and see if that would help.

He was shot on November 1st 2012 after he was so lame in the field he couldn't walk to the gate.

I was gutted. I felt completely responsible and wish I had never had the operation. This horse only showed signs that there was a problem when cantering in a circle.
If I'd have just kept to xc, I might still be out competing him now.

However, my YOs 4 year old had the same injury last year, same treatment and is now coming to the end of a seasons hunting.
 
JustMeWillDo said:
Hi sally12. My horse is due a stifle arthroscopy this week (March 2014) and so I am very interested to see how your mare got on as she had it done in December 2013 according to the thread. My horse is also 2/10 lame. Was it a success (although still early days I guess as you are probably still at the leading in-hand stage or have you progressed from that?). How did your mare cope with the journey home from hospital and the box rest? Did the hospital explain fully what the rehab involved before you took her home? I am apprehensive but arthroscopies are frequently done on humans (with mostly successful outcomes I believe) so feel I can only give it a try as if I don't I will never know.
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I made this thread looking for advice and what I would advise is not to look on the internet!! All you hear are bad stories!! My horse had the surgery on 16th December so we are currently 2 weeks off the all important 12 week check up. They found a finger nail size piece of partial thickness cartilage damage on both stifles which they debrided and smoothed off. He was given a 65% chance of a return to full soundness including jumping. His case is exactly middle of the road, the vet had seen much worse, and much better.

The surgery went well, no problems during or after, all very straight forward to be honest, was surprising how quickly he recovered and was home within 5 days. He had 2 weeks complete box rest followed by 4 weeks box rest but with 3x daily walks in hand (by far the worst part of the whole thing... I would advise ACP's, and lots if them!!!) but we survived with minimal stupidity from my horse, he was actually pretty damn well behaved all things considered. I took him back every 2 weeks for his IRAP injections which he tolerated, and travelled well. 6 week post op trot up he was ever so slightly dropping his right hip but all in all pretty damn sound much to my relief!

He has been on restricted turnout now for 5 weeks, he's out for 3 hours a day with a very old pony as a companion, mainly because there is no grass left in his paddock, if he was out any longer he would get into mischief. It took a couple of weeks for him to settle into the routine. He hasn't been going crazy and hasn't had any stupid moments sliding around, he's had a good few bronks and will happily canter about showing off as others hack past, but nothing scary, and he looks sound. The explosive time was the first few days but I gave him ACP's for the first couple of weeks gradually decreasing. He is a very laid back horse naturally which has helped massively with all of this.When the vet comes back in just under 2'weeks he will decide if he has recovered enough for me to start his ridden rehab.

Had he not had the surgery and we injected the joints, he might have come sound, but would have been very short term and we would have been back to square one. The cartilage damage would have increased by that time and the inflammation would return and create even more damage.

The hope now is that because they've removed the unstable cartilage,
the IRAP should hopefully stop the inflammatory process in it's tracks, then rehab to build up the muscles to support the joints.

I don't regret for one moment putting him through it, how could i have injected his joints without knowing what damage was in there. That's why I would try not to go looking for answers on the internet, there are 4 horses i personally know who have all had this surgery and all are sound and back to full work. I doubt you would even find 4 positive stories on the internet!!

Feel free to PM me if you have any questions, I'm happy to share my experience! It's very early days for my horse, and every case is different, but treating aggressively provided there are no complications during/post op in my opinion is the best way forward. xx
 
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