Were all 3 compartments in both stifles injected? That would be 6 doses. I know because I’ve paid to have Noltrex done on one stifle and it was 3 full doses 
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No, 1 in each stifle
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Interesting, since I too got multiple sites, 2 hocks+1 stifle
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I think if you are getting 6 doses out of one ProStride draw, the vet is probably not injecting enough, when you are talking a joint like the stifle. You could get 5-6 doses out of one IRAP draw, though.
I would not do IRAP unless you are going to do the full series of 3 injections.
For stifles, it depends on what the issue is. A lot of the time, you’ll want to inject at least 2 of the joint spaces, typically medial and middle, as those are the areas more likely to have chronic use or conformation based inflammation.
IRAP is mostly IL-2 receptor antagonist protein. There is not as high a concentration of that particular protein in ProStride, but ProStride has other anti-inflammatory proteins and healing factors in it that IRAP does not have. There are other non-autologous products like Renovo that are even higher in some of the proteins. My vets like Renovo for horses who have not responded well to IRAP or ProStride or who may have metabolic conditions that would affect how many of these things are able to be pulled from their own blood.
I think Vetalog = a triamcinolone brand name.
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I’m embarrassed to say I don’t know where in the stifle my horse gets injections. I know it’s just one injection, but also suspect it’s whatever the middle of the joint is. After surgery he had a lot of fluid and inflammation so we’ve been injecting since then. My horse got kicked there a couple years ago as well. He points his toes when he starts to get stifle sore and does the whole stepped in a hole thing.
I’m not sure we have Renovo. Looks like it’s pretty new. Honestly my vet JUST got Prostride within the last couple years.
I think my plan is Arathrmid stifles and Vetalog hocks if I can swing it. And I’ll plan to do adequan in 6 months.
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I’ve read a lot of the available literature and studies on Arthramid (as well as listening to recommendations from my own vet) and they are using for hocks as well. It might be worth having a further conversation with your vet about it.
Also, from my research, the manufacturer doesn’t recommend Arthramid and steroids at the same time in the same joint. Rather, if needed, a steroid injection first to bring the inflammation down, then follow up with Arthramid a few weeks later. Obviously, ymmv.
ETA: There is a rehab period following an Arthramid injection, so I think important to discuss with your vet as well
Ironically I JUST emailed and asked!!!
I was not planning to do steroids and Arthramid in the same joint (I can confirm my Vet says they have to be in separate joints, but can be injected at the same appointment in different joints).
I did see the rehab period following Arthramid. It’s like a week stall rest, a week of light trot and building up from there I think? It’s actually a bit of a deterrent since it’s cooling down here and you know how they can get frisky as the weather breaks!
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I think the typical rehab period is 48 hours of stall rest or small turnout, then 1 week limited walk trot & build from there. Arthramid has a lot of good podcasts discussing how the product is used, and how they’ve developed the rehab process. I really enjoyed listening to them but I’m a little odd 
I’m jealous to hear your weather is cooling down!
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That’s doable! A week of stall rest is hard.
You can be jealous right now, but when the winter hits – sounds like I’ll be the jealous one LOL. We have terrible winters in MI!
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My only concern with the synthetics is that we are uncertain if there are some long term unintended consequences with their use. Right now I’m approaching them much the way I use bisphosphonates: not my first or second option, but if nothing else is working, I’m willing to go that route.
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I also thought about that. With anything new, there’s no real information about it. I am thinking I will try it on his stifles and skip the hocks and see. I would be hesitant to re-inject his stifles with the Arthramid again in a year, but perhaps there will be more information at that time about long term use or I could go back to steroids. He’s also older, so as much as I’d love to keep him working into his 20’s that’s impossible to predict.
My vet said this, "Arthramid is only tricky in hocks due to the degree of osteoarthritis present and the small spaces available. If the joint spaces are very small or limited then it may not be the best product to put in those joints. Stifles may be the place to use Arthramid in his case. " she also said, “Getting 9 months out of his previous hock and stifle injections with the boost from adequan is a wonderful result.”
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My clinic has me do stall rest day of injection and then turnout is okay. Day 5 okay to ride after use of hydrogels but they do take longer to kick in. We’ve also used a small amount of steroid w Noltrex and that was perfectly fine. Not sure if that hold true when Arthramid. Most people who use them do so because steroids are contraindicated so it’s probably not very common.
I posted a similar comment in the Alpha2 thread in OC. I spoke with the lameness specialist for my area this morning, who is very highly regarded, about different IA options. We were discussing coffin joints but he gave me a run down of his opinion on nearly all. His go to is Noltrex for most cases (when steroids are no longer lasting or not an option - his first line of defense is always steroid/ HA combo). Then IRAP, though he mentions the difficulties of his clients doing the whole series of injections as his clinic no longer does farm calls and everyone has to trailer in. He said in his experience PRP and ProStride are not as “strong” of an effect but can work well too. The Arthramid is similar to the Noltrex but I think the Noltrex came out first so that’s what he uses. He doesn’t like the Alpha2: he gets a lot of second opinion consult requests where the diagnosis is correct but Alpha2 was used as the treatment and the horse didn’t get any/ enough clinical relief. He said there is another product called Spring, but he hasn’t used it as he has good success with the other products his clinic has already invested in. I am going to get my horse on the books for a Noltrex injection.
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Interesting! I think it depends on the horse and severity of the condition being treated. I’m trying to determine if the Alpha is a potent anti inflammatory; I didn’t find Prostride to be.
I don’t know much about Noltrex but Arthramid is FDA approved and has been used for quite a while for human tissue augmentation, so that makes me more comfortable with its use. Also, that’s what our vet uses 
My daughter’s horse had his hock injected a year ago and so far so good. It was used as a therapeutic for a specific injury, so likely some of the concerns with joint space didn’t apply to him.
From my reading, I think it does require some skill when injecting because it is very thick but needs a large gauge syringe to properly inject into the joint. Not sure whether those concerns apply to Noltrex.
Out of curiosity how long does it take for Noltrex to show it’s working on your horse?
Husband’s horse has been dealing with a lot of off/on lameness issues. We just did RF coffin Noltrex + Kenalog, RH lower Noltrex + Depo, LH Depo + Kenalog.
It’s been nearly 3 weeks. He started off feeling ok under saddle then progressivly more uneven. We did a 3-day trial of double dose previcox to narrow down that it was indeed a pain issue and he showed improvement but still sticky in the hocks w/ some toe dragging.
Trying to decide if we just need to give it more time or take additional measures…
His lower and middle hocks were injected last year by a different vet using hyaluronic acid and betavet and he seemed to show more improvement. Current vet doesn’t inject middle hocks unless client asks.
What protocol did you follow after the Noltrex? There’s a rehab program with rest and then controlled exercise for a few weeks. The hydrogel needs time to set - if you go back to work too soon it basically gets squished out of the joint space.
I’ve found with mine it’s about 2.5-3 weeks before I really feel the difference, and that’s following the post-injection protocol. With HA it’s about 10 days.
Interesting—our vet never warned that it could be pushed out of the joint.
Per his instruction we waited 4 days before getting back on. Since then have only walked and trotted maybe up to 15 mins per ride.
During the rehab period is it typical that you’d feel no change at all or even have days where he feels worse before it all starts getting better?
I have no experience with Noltrex but from my experience with Arthramid and my research, the hydrogels do take time to integrate into the joint - between 2-6 weeks for Arthramid, so I would imagine around the same time frame for Noltrex.
Again, not sure for Noltrex but it’s my understanding from our vet and my reading that the gel does not run the risk of being pushed out of the joint, that is fully absorbed into the synovial tissue shortly after the injection. YMMV
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Here’s the link to the vet user guide. I see they’ve updated it again (I’ve used Noltrex for years - I think this is the third version I’ve seen as they continue to adjust protocol based on further research).
It looks like they’ve got two scenarios now - early disease stage and advanced. The protocol used to be the advanced stage for all cases so that’s what I follow (and have had great success with). https://noltrexvet.com/wp-content/uploads/2023/09/NoltrexVet_User_Guide_2023_email.pdf
So it looks like you may be following the early stage protocol correctly. They do note that you can do a second injection if the lameness is not resolved, but give it some time. I haven’t had the horse get worse during the rehab period, but there’s always a week or so when I worry that he doesn’t feel any better and then remember this happens every time.
Just a note as well from that link:
Noltrex says to give it a full 30 days to see results before looking at any additional treatment.
There’s also a warning about adverse effects:
A very small number of horses have reported the development of symptoms, consistent with aseptic synovitis,10-20 days after intra-articular injection with Noltrex®Vet. Aseptic synovitis (i.e., joint flares) can often be avoided by pre-treating cases with an intra-articular anti-inflammatory product, a two-week controlled exercise protocol post-injection, and consideration of smaller volumes per treatment with multiple treatments spaced 30-45 days apart if indicated.
Not to panic as it’s very rare and I found this info on a site for Arthramid (same type of hydrogel product):
2.5% iPAAG induces a typical foreign body response5, which is actually how it works. Within 1-2 weeks, some animals can develop transient pain and oedema at the treatment site. If not caused by infection, these reactions are typically self-limiting and will resolve within a few days. But in severe cases it is important that infection is ruled out as a possible diagnosis as this requires a different treatment strategy.
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