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Service Information

Joint Injections

Numerous medications exist which can be injected directly into equine joints. These ‘intra-articular’ medications allow us to deliver therapies right to where they are needed in cases of joint disease.

Medicating a coffin joint
Radiograph demonstrating osteoarthritic changes
Radiograph demonstrating osteoarthritic changes

JOINT DISEASE AND TREATMENTS

Osteoarthritis is the most common disease we treat with joint medications. However, this is often predisposed by soft tissue overuse and injury. Other conditions we treat include synovitis (inflammation of the membrane lining), capsulitis (inflammation of the joint capsule), cartilage or bone fragmentation and soft tissue injuries such as ligament or meniscus tears. Intra-articular medications act to decrease joint inflammation and soft tissue swelling, thus removing associated pain. They can also modify the action of inflammatory enzymes to prevent further joint damage.

CORTICOSTEROIDS are potent anti-inflammatories which cause a rapid and significant reduction in pain.

HYALURONIC ACID is a naturally occurring substance within joints, which can also be produced synthetically. It acts as a lubricant but also has anti-inflammatory and cartilage-protecting effects.

Commonly used corticosteroids
Commonly used corticosteroids
A preparation of hyaluronic acid
A preparation of hyaluronic acid

PLATELET-RICH PLASMA (PRP) is produced by processing the horse’s own blood to increase the number of platelets in it. Platelets release growth factors so PRP is often used to promote repair of soft tissue injuries within joints.

AUTOLOGOUS CONDITIONED SERUM (ACS) is also produced using the horse’s own blood, but after it has been incubated for 24 hours. It contains anti-inflammatory and regenerative substances. Like PRP it can be used to promote healing, it also has added anti-inflammatory effects so is also used for synovitis or osteoarthritis when corticosteroids are not indicated or have failed.

A PRP preparation kit which can be used horse side on yard
A PRP preparation kit which can be used horse side on yard
Medication of a hock joint
Medication of a hock joint

STEM CELLS are produced by processing cells taken from fat, skin, blood or bone marrow. They can mature to become another type of cell so are injected into joints to promote repair and regeneration.

POLYSULPHATED GLYCOSAMINOGLYCANS (PSGAGs/AdequanTM) and PENTOSAN POLYSULPHATE (CartrophenTM) reduce damage to cartilage and have anti-inflammatory properties. They can be injected into joints but are more commonly used as intra-muscular injections.

Mild osteoarthritis in a knee managed with a course of CartrophenTM injections
Mild osteoarthritis in a knee managed with a course of CartrophenTM injections
cartrophen

WHAT ABOUT THE RISKS?

Historically, corticosteroid use has been controversial due to negative effects associated with high doses used in the past. One possible side effect is the occurrence of steroid-induced laminitis. However, clinical trials have shown the risk of this at therapeutic doses is very small. At Towcester and Onley Equine Vets we are careful to stay within the safe dose range.

Infection is a potential complication with any joint medication. However, we take great care to ensure all joint injections are done using aseptic technique after sterile preparation of the injection site to minimise this risk.

A post-injection joint flare is a more common occurrence whereby the joint becomes inflamed and painful. This is a much less serious complication, easily treated with a short cause of anti-inflammatories.

The risk of complications after a joint injection is very low, however, we ask that you closely monitor your horse afterwards and contact us immediately if you are concerned.

ADDITIONAL TREATMENTS

Most cases will also require a short cause of Phenylbutazone. We may also recommend other systemic treatments. For example, OsphosTM, which reduces the activity of cells that break down bone.

joint supplement

We may also advise a joint supplement. However, it is important to use one with the correct concentration and preparation of glucosamine, as it is otherwise very difficult for the body to absorb. Glucosamine is the main beneficial ingredient as it is a key building block to make cartilage, synovial fluid and soft tissues within joints. Other compounds may be helpful but most are added with no evidence to support their use and only serve to add expense. To ensure you buy the highest quality and best value product we recommend Towcester Joint Aid.

Our wireless digital radiography system and modern ultrasound scanners obtain the highest quality diagnostic image possible, allowing us to pick up even the most subtle changes. Some injuries, especially early on in the disease process, cannot be seen with external imaging so require arthroscopy to confirm the problem.

Arthroscopy is a keyhole surgical procedure whereby we look inside the joint with a small camera. Full surgical facilities are available at our Towcester clinic where arthroscopies are routinely performed by Alice Sheldon, who has further qualifications in orthopaedic surgery.

Complex cases may require the added expertise of specialists and we have a very good relationship with several visiting consultant surgeons, who hold Diplomas in the European and American Colleges of Equine Surgery.

Radiography of a horse's hocks
Radiography of a horse's hocks
Arthroscopy of a knee joint
Arthroscopy of a knee joint

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