R. J. Payne

What is the likelihood that Thoroughbred foals treated for septic arthritis will race

REASONS FOR PERFORMING STUDY Septic arthritis is a serious problem in the neonate, with a poor prognosis being reported for recovery. The impact of neonatal septic arthritis on the likelihood that Thoroughbred (TB) foals will start on a racecourse is not known. HYPOTHESIS The development of septic arthritis in a TB foal significantly reduces the likelihood that it will race when compared to foals from the same dam. METHODS Medical records of 69 foals treated for septic arthritis were reviewed. The dams foaling records were reviewed and lifetime racing records were then retrieved for both the affected foals and at least one of their siblings (controls). Outcomes that were statistically evaluated included discharge from the hospital and whether the foal eventually raced. Univariate analyses of categorical variables were conducted for each outcome. The number of affected and unaffected foals that raced at least once were compared using regression analysis. Survival analysis was used to compare age at first race between the study and comparison groups. RESULTS Foals with septic arthritis were less likely to start on a racecourse compared to controls (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.12-0.62, P = 0.001), while those foals that were discharged from the hospital were also less likely to start on a racecourse compared to controls (OR 036; CI 0.15-0.83, P = 0.008). The presence of multisystem disease was associated with a decreased likelihood of surviving to be discharged (OR 0.13; 95% CI 0.02-0.90; P = 0.005), but did not affect the likelihood that they would start in at least one race if discharged successfully (OR 0.45; 95% CI 0.04-2.81; P = 0.34) compared to the other foals with septic arthritis. Log-rank comparison of survival curves confirmed that foals discharged following treatment for septic arthritis took significantly longer to start in their first race compared to the sibling population (mean age of study group 1757 days, CI 1604-1909; mean age of sibling group 1273 days, CI 1197-1349; P = 0.0006). CONCLUSIONS The development of septic arthritis in a TB foal significantly reduces the likelihood that it will start on a racecourse when compared to controls. POTENTIAL RELEVANCE Accurate figures allowing a realistic assessment of the athletic future of a foal following treatment for septic arthritis are of significance for both owner and treating veterinarian.

Costs and complications of equine castration: a UK practice‐based study comparing ‘standing nonsutured’ and ‘recumbent sutured’ techniques

REASONS FOR PERFORMING STUDY Clinicians are often asked to guide owners and trainers over the relative advantages and disadvantages of equine castration performed in either the standing horse with an open unsutured scrotal wound with healing by second intention, or a recumbent horse under general anaesthesia in aseptic conditions, with sutured scrotal skin allowing primary wound closure. OBJECTIVES To identify types and frequency of complications following the 2 differing approaches, and to compare the financial cost associated with each procedure, based on practice charges. METHODS Veterinary expenses of 217 horses castrated by a Newmarket equine veterinary practice over an 18-month period were analysed. Of these, Group 1 (n = 121) were castrated standing and nonsutured by one of 2 ambulatory clinicians and Group 2 (n = 96) castrated in recumbency, in aseptic equine hospital conditions. RESULTS Group 1 had a complication prevalence of 22% with no mortalities, and Group 2 a significantly lower complication prevalence of 6% (P = 0.001) with a mortality rate of 1%. The financial cost of Group 1, without complications, was approximately one-third of the cost of uncomplicated Group 2. However, the cost of Group 1 with complications increased to approximately two-thirds of the cost of an uncomplicated Group 2 castration. CONCLUSIONS Even though the complication prevalence for Group 1 castrations leaving an open scrotal wound was significantly higher than for a recumbent horse with a sutured scrotal wound in a hospital, the average cost of Group 1 was still less, even taking into account the additional follow-up costs associated with treating such complications. POTENTIAL RELEVANCE This report provides a benchmark for the outcome of 2 methods of castration based on a database obtained from particular circumstances within the practice involved. Further studies are required to corroborate and take into account future development in surgical and anaesthetic techniques.

Electrosurgery as the sole means of haemostasis during the laparoscopic removal of pathologically enlarged ovaries in mares: a report of 55 cases

REASONS FOR PERFORMING STUDY There is little published clinical evidence on the use of a laparoscopic approach for the removal of pathologically enlarged ovaries in standing mares. OBJECTIVES To show the orders of success and complication rates that can be expected if pathologically enlarged ovaries are removed from standing, sedated mares under laparoscopic guidance using only electrosurgical means of haemostasis. METHODS A retrospective analysis was made of 55 mares in which the removal of an enlarged ovary was attempted by applying a standard laparoscopic procedure for routine ovariectomy in standing mares including a reliance solely on one of 2 types of electrosurgical bipolar forceps with an integrated guillotine for haemostasis and transection of the ovarian pedicle. The outcomes and complications encountered were recorded. Logistic regression analysis was performed to identify the risk of any complications associated with the size of the ovary removed and the instrument used. RESULTS In 54 of the 55 mares, the surgery was successfully accomplished by the planned approach. In one mare there was significant intraoperative haemorrhage and this necessitated the additional use of a prosthetic haemostatic device. The only other complications encountered were post operative abdominal discomfort (n = 9), delayed incisional wound healing (n = 6) and iatrogenic uterine puncture (n = 2). One mare developed a rectal tear, but not as a direct complication of the surgical procedure. None of these prevented a long-term successful outcome. CONCLUSIONS The removal of pathologically enlarged ovaries (up to 30 cm diameter) from mares under standing sedation can be accomplished predictably and safely by applying the standard laparoscopic approach that is established for routine laparoscopic ovariectomy, including a reliance solely on endoscopic electrosurgery instruments for haemostasis of the ovarian pedicle. POTENTIAL RELEVANCE This study shows that the simple standing laparoscopic technique now favoured for routine ovariectomy can be used safely and reliably for the removal of pathologically enlarged ovaries. This promises to be of significant clinical advantage to mares so affected.

Outcome and long‐term follow‐up of 20 horses undergoing surgery for caecal impaction: A retrospective study (2000–2008)

REASONS FOR PERFORMING STUDY If untreated, caecal impaction may progress to rupture of the caecum and reports of long-term outcome for horses undergoing surgery for caecal impaction are required. OBJECTIVES To describe short- and long-term complication rates for horses undergoing surgery for caecal impaction in an otherwise life-threatening gastrointestinal condition. METHODS Case records were reviewed for horses undergoing surgery for caecal impaction. Horses were included in the study if an abnormally large, fluid-distended or feed-impacted caecum was the primary diagnosis at surgery and excluded if the caecum had already ruptured upon opening the abdomen, necessitating euthanasia. Short-term follow-up data were obtained from clinical records; and included complications, repeat celiotomy and survival to discharge. Long-term survival was defined as survival for >1 year post operatively. Long-term follow-up data were obtained through telephone interviews with owners and referring veterinary surgeons. Survival, occurrence of post operative colic and subsequent use of the horse were recorded. RESULTS Twenty horses underwent surgery for caecal impaction: 16 horses underwent caecal bypass (typhlotomy and removal of caecal contents, ileal transection followed by ileocolostomy); 3 underwent typhlotomy alone; and one horse underwent typhlotomy followed by a second procedure where caecal bypass was performed. Five horses (25%) were admitted for colic evaluation with primary caecal impactions, in 10/20 (50%) of cases the impaction was secondary to previous orthopaedic surgery and in 5/20 (25%) caecal impaction was identified at repeat celiotomy following a previous colic surgery. Sixty-five percent (13/20) of horses survived to discharge; 11/13 (85%) of horses discharged survived long term; 100% (3/3) horses that received typhlotomy alone were discharged and survived long term. CONCLUSIONS The prognosis following caecal impaction surgery is fair, if the horse survives to discharge then prognosis for long-term survival is good. POTENTIAL RELEVANCE Surgery for caecal impaction carries a fair prognosis for a potentially life threatening disease, in particular where caecal dysfunction is suspected.

Osteoarthritis of the talocalcaneal joint in 18 horses

REASONS FOR PERFORMING STUDY Talocalcaneal osteoarthritis (TO) is an uncommon cause of moderate to severe hindlimb lameness, on which only isolated case reports have been published to date. OBJECTIVES To review the clinical features of TO and determine optimal methods for diagnosis, management and prognosis. METHODS The case records from 4 referral centres of 18 horses showing hindlimb lameness considered, as a result of clinical investigation, to be caused by TO, were reviewed. RESULTS TO affected mature sports and pleasure horses (age 7-16 years) and caused moderate to severe lameness, usually of sudden onset with no obvious inciting cause. There were few localising signs, other than worsening of lameness by hock flexion. Tarsocrural joint analgesia produced improvement in lameness in 6/11 horses (55%) and perineural analgesia of the tibial and fibular nerves complete soundness in 6/14 horses (43%) in which it was performed; 7/14 horses (50%) showed a further substantial improvement. Radiological findings included subchondral bone lysis and sclerosis and irregular joint space width, seen most obviously in a lateromedial view. Nuclear scintigraphy revealed marked uptake of radiopharmaceutical predominantly plantaromedially in the region of the talus in the 7 horses in which it was performed. Fourteen horses were treated conservatively with box- or pasture-rest, with or without intra-articular corticosteroids, hyaluronic acid or polysulphated glycosaminoglycan, and all remained lame. Intra-articular corticosteroids appeared to have no effect in any horse. Of 10 horses receiving conservative management only, 6 were subjected to euthanasia, 3 were retired and 1 remained in light work, but was still lame. Two horses treated by either partial tibial and fibular neurectomy or subchondral forage failed to regain soundness and were retired. Six horses were treated by surgical arthrodesis of the talocalcaneal joint with 2 or three 5.5 mm AO screws introduced obliquely across the joint from the plantarolateral aspect of the calcaneus, which resulted in improvement in lameness in all cases. CONCLUSIONS Osteoarthritis of the talocalcaneal joint causes acute onset severe lameness, but clinical findings and diagnostic analgesia often fail to identify precisely the site of pain. Consistent radiographic changes suggested TO was contributing to the lameness and this diagnosis was supported by nuclear scintigraphy. The poor success of conservative treatment (including intra-articular medication) suggests that surgical arthrodesis is the treatment of choice, although the prognosis is still poor for a return to full soundness. POTENTIAL RELEVANCE The clinical features described should facilitate more accurate diagnosis and prognosis. A novel surgical treatment is described which appears to offer significant improvement in the lameness. Further work is necessary to determine the causes of this condition and more effective management.

Prevalence of supporting limb laminitis in a UK equine practice and referral hospital setting between 2005 and 2013: implications for future epidemiological studies

The electronic patient records of all equine patients of Rossdales Equine Practice between January 1, 2005 and November 1, 2013 were reviewed to determine the number of cases of supporting limb laminitis (SLL) in a large equine practice and referral hospital setting in the UK and to discuss the implications for future epidemiological studies. The clinical notes were searched electronically for a combination of ‘laminitis AND (contralateral OR supporting OR overload OR weight bearing)’. The prevalence of SLL within each identified denominator population and the corresponding 95% CI were calculated. SLL developed in nine horses, one donkey and one pony. Thoroughbreds were the most commonly affected breed (72.7 per cent, CI 46.4 to 99.1 per cent), aged 2–14 years (median six years), and only mares (n=9) and stallions (n=2) were represented. SLL was not restricted to horses that were non-weightbearing lame, it developed within 4–100 days after injury (median 14.5 days) and occurred most commonly in a forelimb (54.6 per cent, CI 25.1 to 84.0 per cent). During the same time frame, a total of 65,327 horses were registered with Rossdales Equine Practice, resulting in an overall practice prevalence of SLL of 0.02 per cent (CI 0.01 to 0.03 per cent). Future epidemiological studies to investigate risk factors for SLL prevention will, therefore, be a logistical challenge.

Osteomyelitis of the Patella in Eight Foals

OBJECTIVE To describe the characteristics of osteomyelitis lesions of the patella and to report short- and long-term outcome after treatment in 8 foals. STUDY DESIGN Retrospective case series. ANIMALS Foals (n = 8). METHODS Medical records (2003-2007) and radiographs of foals that had osteomyelitis of the patella were reviewed. Inclusion criteria included clinical, radiographic, and surgical findings consistent with osteomyelitis of the patella, and a long-term follow-up of >15 months. Information acquired included signalment, hematologic and serum biochemical profile results, clinical and radiographic signs, surgical technique and perioperative treatment. Follow-up radiographs were evaluated and outcome was determined from veterinary examination, race records, and telephone questionnaire. RESULTS Six foals survived long term (15 months-4 years); all had intralesional and systemic antimicrobial therapy, along with synovial lavage and antimicrobial medication. All were sound and achieved either yearling sales (n=3), show hunter or racing (2). Two foals died in the short term from renal failure and suppurative peritonitis secondary to cecal perforation, 1 remaining lame with suppurative osteonecrosis confirmed at necropsy. This foal was not administered intralesional antimicrobial therapy. CONCLUSIONS Prompt medical and surgical therapy for osteomyelitis of the patella can result in a good prognosis for soundness and a potential athletic career. Concurrent septicemia or other systemic perinatal disease can result in prolonged therapy and delayed recovery.

Laser surgery as a treatment for histologically confirmed sarcoids in the horse

REASONS FOR PERFORMING STUDY Laser resection for the treatment of sarcoids is an established part of equine practice; however, few studies have provided long-term follow-up results. Additionally, many previous reports have evaluated several treatments concurrently or have not been able to provide a definitive histological diagnosis of sarcoid. OBJECTIVES To establish the success rate following laser resection as a sole treatment for histologically confirmed sarcoids and evaluate risk factors for recurrence. STUDY DESIGN Retrospective time-to-event analysis. METHODS Horses included had laser surgery to remove at least one sarcoid between 1 July 2005 and 1 September 2012. No previous known/concurrent veterinary treatment was administered. Diagnosis was confirmed by histology in all cases. Clinical data were retrieved from the hospital database. Follow-up information was obtained by telephone questionnaire. RESULTS Ninety-nine horses, with a total of 235 sarcoids, were included in the analysis; 82 (83%) had no recurrence of the sarcoid removed and 71 (72%) had no occurrence of any sarcoids following surgery. Horses with sarcoids on the head and neck and those with verrucose sarcoids were at increased risk of recurrence (hazard ratios of 1.61 and 4.03, and 95% confidence intervals of 1.02-2.56 and 1.11-14.7, respectively). CONCLUSIONS Laser resection of sarcoids in the horse has a positive post operative prognosis. Further work is required to fully evaluate risk factors for recurrence fully.

Mineralization of the Equine Palmar/Plantar Annular Ligament Treated by Surgical Resection.

OBJECTIVE To document the clinical presentation, diagnosis, and surgical treatment of mineralization of the equine palmar/plantar annular ligament (PAL). STUDY DESIGN Retrospective study. ANIMALS Ponies (n=7). METHODS Case records from 2 referral hospitals were examined to identify cases with lameness associated with PAL mineralization treated surgically. Follow-up information was obtained from the owners by telephone questionnaire. RESULTS Duration of lameness before referral ranged from 5 weeks to 6 months, and degree of lameness from grade 1 to 5 out of 10. In 3 cases, records noted obvious pain when pressure was applied over the PAL. Pain resulting in lameness was localized to this area and all cases were treated surgically, although the extent of resected tissue varied among cases. Histological examination of resected tissue (4 cases) revealed fibrocartilaginous and/or osseous metaplasia. Following surgery, 6 of the 7 ponies became sound. CONCLUSION Based on this limited case series, surgical treatment for mineralization of the PAL offers a favorable success rate without severe complications where conservative methods have failed.

Fracture of the medial intercondylar eminence of the tibia in horses treated by arthroscopic fragment removal (21 horses)

Summary Background Fractures of the medial intercondylar eminence of the tibia (MICET) are scarcely reported in horses. Objectives To report the clinical and diagnostic findings, surgical treatment and outcome in a series of horses presented with MICET fracture and treated with arthroscopic fragment removal. Study design Multicentre retrospective case series. Methods Case records of horses diagnosed with MICET fractures that had undergone surgical treatment were reviewed. Follow‐up information was obtained from re‐examination visits and/or owners. Results Twenty‐one cases were identified at 9 equine hospitals between 2004 and 2016. A history of trauma and acute onset of lameness was reported in 12 horses. All cases underwent fracture removal via arthroscopy of the medial femorotibial joint. The cranial cruciate ligament was intact in 6 horses and damaged in 15 horses (damage was ≤25% [n = 9], 25–50% [n = 4] or ≥50% [n = 2] of the cross‐sectional area). The cranial ligament of the medial meniscus was damaged in 11 horses (≤25% [n = 8], 25–50% [n = 3]). The medial meniscus was damaged in 5 horses and articular cartilage damage was identified in 14 horses (mild [n = 8], moderate [n = 6]). Follow‐up information (median 14 months; 4 months–6 years) was available for 20 cases; 2 horses were sound but convalescing; 13 horses were sound and returned to their previous or expected use. Of the 4 horses with the most severe changes to the articular soft tissue structures, 2 remained lame and 2 were subjected to euthanasia because of persistent lameness. Main limitations The retrospective, multicentre nature of this study and the limited number of horses are the main limitations. Conclusions Fractures of the MICET are commonly associated with a traumatic event. Prompt diagnosis and early arthroscopic removal of the fracture are recommended.