Clinical Experiences of Treating Septic Arthritis in the Equine by Repeated Joint Lavage: a Series of 39 Cases

Abstract

The condition of septic arthritis was treated in 12 foals with 21 affected joints (Group I) and in 27 adult horses. The adult horses were divided into three groups, based on aetiology of the condition: haematogenous (Group II, n = 6), iatrogenic (Group III, n = 6), and perforating trauma (Group IV, n = 15). The treatment consisted of an initial systemic antibiotic that anticipated the microbial agents that were considered most likely per group, repeated through-and-through joint lavages every other day and non-steroidal anti-inflammatory drugs. The antibiotics were adjusted to the results of bacteriological culture and susceptibility tests. Joint lavages were continued until the white blood cell count dropped below 15 G/l and bacteriological culture was negative, after which a single dose of a short-acting corticosteroid was administered intra-articularly. Joint recovery rate in group I was 71%. Patient recovery rate of the foals, however, was lower (42%). Three foals were killed for reasons other than arthritis; one foal because of an arthritis-related problem and three foals because of persistent arthritis. Overall joint recovery rate, equalling patient recovery rate, in the adult horses was 81%. The expected predominance of Streptococcus spp. in haematogenous arthritis in adult horses was not confirmed, indicating that in these cases also, an initial antibiotic treatment with a broad-spectrum combination is preferable. It is concluded that with intensive treatment, the prognosis of septic arthritis in the adult horse can be classified as fair to even good. Results in the foals are not as good, but this seems to be more due to the specific problems surrounding the equine neonate than to unresponsiveness to the treatment.

Clinical use of antimicrobial regional limb perfusion in horses: 174 cases (1999–2009)

“…The tarsocrural joint was most commonly affected in cases of septic arthritis followed by the fetlock joint, which corresponds with the literature. 24,35,51 When referring to synovial sheaths, the digital flexor sheath was mostly affected both in septic cases and in lacerations, as reported. 15,31,32,40 Regional limb perfusion with antimicrobials was used for a variety of conditions in the horses in group 3.…”

“…It was our purpose to be as specific as possible when defining sepsis in a synovial structure and to evaluate septic synovitis and nonseptic contaminated intrasynovial lacerations separately. Previous studies 15,24,[33][34][35][36][37][38][39] evaluating septic synovitis in horses have found survival rates of 62% to 92% in adults and 42% to 85% in foals. In our study, 72% of horses with septic synovitis were discharged from the hospital, and 53.43% of the horses with follow-up information available were alive at long-term follow-up.…”

An iatrogenic septic tenosynovitis of the digital flexor tendon sheath after diagnostic anaesthesia in a horse

“…Such reactions are much less common with the use of local anaesthetics than other medications (Ross et al 2003). However, it is one of the most difficult conditions to differentiate from a synovial infection (Kuemmerle et al 2006), which itself is also a possible sequela of a lameness examination when an intrasynovial anaesthesia has been performed (Schneider et al 1992a, Meijer et al 2000, Ross et al 2003, Bergman 2010). The clinical signs are similar (severe lameness, joint distension and an acute inflammation inside the joint) and there are no easy means of differentiation.…”

“…The aetiology of the infection has a significant effect on the type of bacteria identified by culture (Schneider et al 1992a). Horses that develop an infection secondary to a penetrating wound frequently provide cultures of more than one organism (Schneider et al 1992a, Meijer et al 2000, Taylor et al 2010. In this case, only one organism, a Methicillin-ResistentStaphylococcus-Aureus (MRSA) was cultured from the DFTS.…”

“…Furthermore, diagnostic anaesthesias are not without risk, and minor local inflammatory reactions after perineural anaesthesia occur (Ross et al 2003). Also iatrogenic septic synovitis after intrasynovial injections has been described (Schneider et al 1992a, Meijer et al 2000, Ross et al 2003, Bergman 2010, Smith 2010). …”