Fetlock Bone Chip Surgery- please comfort me!

[maggini]

I bought a horse back in late June. His pre-purchase exam was great, EXCEPT that x-rays revealed a small bone chip in the front of his fetlock joint over P1. My vet discussed the implications- it wasn’t making him lame on flexions and didn’t seem to bug him, but that it could become a problem if he goes on to have an upper level eventing career like I envision for him. We made the decision then, and she reaffirmed my decision today, that surgery would be the best choice for his long-term soundness. I’ve had some issues clicking with this horse, but if I do end up keeping him according to plan, I’ll be owning him for the rest of his life. It may not be causing any problems right now, but I’d like to save on future joint injections, Adequan, and joint damage associated with not removing the chip. My vet describes it as a simple arthroscopic surgery with a relatively easy rehab. Both my vet and the surgery center that I scheduled it with said 2 weeks pure stall rest, 2 weeks hand walking, 1 month small turnout/tack walking if sane, and 1 month legging up.

This past weekend I heard a horror story about a horse with this same issue who was sound as could be before the surgery and never right afterwards. And then I googled something along the lines of “fetlock bone chip surgery” and read scary things (although a lot of this seemed associated with sequestration or fractures and was not arthroscopic surgery). And now I’m wondering- am I doing the right thing? My vet made the surgery and rehab sound like a walk in the park (although like a good professional, she did say there’s a risk any time a horse goes in for surgery), but I’ve been putting the surgery off for some reason or another, and I know part of it is because I’m terrified. I made the appointment for Monday and am kind of freaking out… so can anyone who’s been through this make me feel better? Stories of rehabs not gone wrong, sound horses post-surgery, etc. would be greatly appreciated!

[3rdxcharm]

I am dealing with this same issue . . . after the chip has done begun to do damage. I have owned this horse since he was a baby so I had no x-rays until he had a huge leg and couldn’t walk last week. He has never . I am told that my horse’s chip is very very old and has just moved to a location causing the problems now. At this point, I have no choice but to deal with the surgery and hope the damage is not permanent. For what it is worth, I could have discovered that chip earlier, with what I know today, I would have taken it out in a heart beat.

Edited to add: I am lucky that the damage is minimal so that surgery remains an option.

[Whyevernot55]

Magg, I haven’t had one of mine have this surgery but I’ve seen it in other people’s horses and very rarely have I seen complications. There are ALWAYS risks with surgery - that’s life.

If the rehab is handled well and there are no complications, you will be unlikely to have long-term issues. Your vet is your best resource. I know you said you’ve discussed with her, but if you have further concerns, call her and have her talk you through them!

[SquishTheBunny]

Tough call.

I have one who had chips on P2, where they settled they were non-articular. Eventually they just attached onto the middle of C2 and there they stayed. Several full show seasons later, there have been no issues.

Is it an option to just monitor the situation? Meaning, xray every year and see if there is movement?

I think the chance of not needing surgery is much higher if the chips are in an area far away from the joint. If they are close to the joint, it may be a more difficult decision.

[D1nOnlyRocketPony]

Literally just had it done on one of our show horses.Horse was NQR behind for some time. x-rays revealed he had a 1cm chip medially in BOTH hind fetlocks. Went to NC State and had both removed with ZERO trouble. 10 days later, stitches out, and back to light hand walking. It was minimally invasive and have had no complications. Horse used to be slightly stiff at the walk (we’re only allowed to walk so far) and is no longer. Vet just injected today per the surgeons recommendation. Everything about this was easy as pie.

I should add that we do not know how long the chips had been there (horse is a former worlsd title holder we bought in June, has always been slightly NQR behind), but upon inspection of the joint during surgery, neither invaded the joint or harmed the cartilage, so no damage.

Hopefully that will give you some comfort!

[Simkie]

Horses with chips are often fine…until they’re not. The chip is in there, wearing away at the cartilage. Once the cartilage is gone it’s gone and once the horse is bone on bone it is NEVER going to be sound. You cannot image the cartilage via radiograph (I imagine you can via MRI, should you be so inclined), so you have no way of knowing what shape it’s in until you’re in the joint.

If you value a performance career with this horse, then you need to remove the chip. Once you’re in the joint, the vet can give a prognosis based on how badly the cartilage is damaged. Horses that do not do well following surgery generally have serious grooves in the cartilage and are bone on bone or nearly there.

[GotMyPony]

My 10 yo limited distance/competitive trail gelding had an old bone chip removed from LF fetlock in March 2011 (situation started he suddenly went dead lame in pasture after not having any lameness in the 8 years I know about; winter, doing minimal riding at the time). Until the surgeon got in he didn’t know how bad it was but found that where the chip had occurred (who knows when) the rough edges on the joint dug a groove in cartilage over time until it was, I was told, “bone on bone.” Surgeon cleaned up joint as best he could, removed as much of chip as he could (some had been encapsulated and was left there). After about 2 weeks we began IRAP surgery on the joint; collected blood once, then did 3 IRAP injections. Rehab was months long of stall rest, pen rest, hand-walking then slowly building up from 20 minute walk rides, followed by 2 min. trot sets, etc. Horse has been perfectly sound since for regular trail rides, hunter paces and CTRs, including up to 40-mile rides in mountains. I do not give any injections at this point, just a flax-seed based supplement because it’s what my vet recommended for Omega 3 anti-inflamatory action. Fingers crossed my good luck continues and that you and your horse have the same kind of luck.
As for bone-on-bone/cartilage, I was told that the original (best) cartilage doesn’t regenerate but in the healing it is replaced by a more fibrous cartilage that serves the same purpose, perhaps not as well as the original.

[islgrl]

Client did the surgery on a 4 y.o. when it showed up on a PPE. Shipped from the seller directly to the surgical center. Piece of cake, no issues ever.

[Herbie19]

I had a chip removed from my then 17 year old 4 Star Event horse turned Amateur Jumper. The other fetlock had significant lipping that was addressed while he was on the table–vet said that was from jumping off cliffs for a living!

We did a similar layup/rehab to what you described along with joint injections about a month after surgery. We’ve since done IRAP which I continue to use for maintenance. Horse is sound, very fit and still easily (as in jumping me out of the tack!) jumping around at 1.15m AT AGE 23…how’s that for long term soundness!

If it were my horse I’d do the surgery without hesitation. Good luck!

[maggini]

Wow, what good, comforting stories! Thank you everyone! I’m still nervous as can be, but looking at what other people have to say, I think I’ve made the right choice. When we took x-rays in June, the chip was at the top of P1 and unfortunately closer to the joint than not, which made surgery a serious consideration. I definitely think I’m doing the right thing now by preventing further damage to the area (although hopefully there is little to none- we’ll see what the surgeon says).

I talked to my other vet last night who did not have the benefit of the x-rays as he didn’t do the pre-purchase, but he also had good things to say regarding this type of surgery. He said that the fetlock was one of the best places for it to be and that he also has a lot of faith and trust in the surgeon I’ve chosen, and that he refers a lot of patients there.

[Hetep]

[QUOTE=GotMyPony;6667636]
My 10 yo limited distance/competitive trail gelding had an old bone chip removed from LF fetlock in March 2011 (situation started he suddenly went dead lame in pasture after not having any lameness in the 8 years I know about; winter, doing minimal riding at the time). Until the surgeon got in he didn’t know how bad it was but found that where the chip had occurred (who knows when) the rough edges on the joint dug a groove in cartilage over time until it was, I was told, “bone on bone.” Surgeon cleaned up joint as best he could, removed as much of chip as he could (some had been encapsulated and was left there). After about 2 weeks we began IRAP surgery on the joint; collected blood once, then did 3 IRAP injections. Rehab was months long of stall rest, pen rest, hand-walking then slowly building up from 20 minute walk rides, followed by 2 min. trot sets, etc. Horse has been perfectly sound since for regular trail rides, hunter paces and CTRs, including up to 40-mile rides in mountains. I do not give any injections at this point, just a flax-seed based supplement because it’s what my vet recommended for Omega 3 anti-inflamatory action. Fingers crossed my good luck continues and that you and your horse have the same kind of luck.
As for bone-on-bone/cartilage, I was told that the original (best) cartilage doesn’t regenerate but in the healing it is replaced by a more fibrous cartilage that serves the same purpose, perhaps not as well as the original.[/QUOTE]

GotMyPony,

Is your horse still okay? What did the surgery cost?

My situation is: I bought a beautiful Saddlebred mare without a vet check and after the first trail ride she showed up lame in her left front. Vet diagnosed a bone chip on the fetlock, but said it was “too small to operate on”. He prescribed hyaluronic acid injections as needed (probably every 4 to 6 months). I’ve been looking around the net, and it seems that without surgery to repair the chip, it will continue to damage the cartilage until it’s just not there.

Holly is only 5, and I have since found that she has a champion family and even if she didn’t, she deserves to have a good life. But I need a horse I can ride.

Any suggestions?

[mswillie]

[QUOTE=Hetep;6753132]
GotMyPony,

Is your horse still okay? What did the surgery cost?

My situation is: I bought a beautiful Saddlebred mare without a vet check and after the first trail ride she showed up lame in her left front. Vet diagnosed a bone chip on the fetlock, but said it was “too small to operate on”. He prescribed hyaluronic acid injections as needed (probably every 4 to 6 months). I’ve been looking around the net, and it seems that without surgery to repair the chip, it will continue to damage the cartilage until it’s just not there.

Holly is only 5, and I have since found that she has a champion family and even if she didn’t, she deserves to have a good life. But I need a horse I can ride.

Any suggestions?[/QUOTE]

I’m not Gotmypony but I had a chip removed from my horse’s fetlock back in September. In an effort to not repeat myself you can see the original post here.

http://www.chronofhorse.com/forum/showthread.php?360851-I-just-want-to-cry-(fetlock-chip)-Update-12-20-post-49

I haven’t ridden at all over the holidays, I’ll be back into my routine after tomorrow but it’s going to take a few months before I’ll make a call on how sound he’s going to be.

FWIW I’d get a second opinion. If you say where you are located maybe someone would have a suggestion on a good surgeon.

When I spoke to the surgeon prior to my horse having the surgery we discussed the chip and the possibility that it might not be the chip causing the lameness. We decided to go ahead and take it out. He called me after the surgery and mentioned that the chip was much larger than it appeared on the x-ray, that there was visible inflammation, and that it really did need to come out.

Doctor Riddle in Cecil County MD did the surgery and I paid $1800.00. That price included everything (five days of board, meds, wrapping, etc.).

[GotMyPony]

Hetep - Yes, my horse continues to be fine and we continue to do long rides on imperfect terrain, lots of hills. Knock wood!

Our bone chip was also small but it turns out it wasn’t the bone chip itself that caused the problem; it was the rough area left on the joint where the chip came off. Bone chip was out floating to the side and had been partially “encapsulated” by tissue over time so it wasn’t moving around; don’t know if encapsulated is the right word but hopefully you get the picture.

The problem was the the rough area(s) left on the joint itself were gouging into the cartilage, which ultimately wore through. My surgeon said that was not something you could see without going in and looking at it; apparently doesn’t show on X-rays, ultrasound. He smoothed the rough areas and removed as much of the chip as he could just to get rid of it. A couple of weeks after the surgery we started IRAP procedure, which helps stop cartilage deterioration. I think my costs were about $1,400 for the surgery and another $1,500 or so for the IRAP. Somewhere around there. I did have major medical so that certainly helped me.

I hope that info helps. I had the surgery and IRAP done at Tryon Equine in Tryon, NC, by Dr. Bill Hay. I don’t know if you’re anywhere near us but I’d highly recommend him.

[caryledee]

[QUOTE=Hetep;6753132]
GotMyPony,

Is your horse still okay? What did the surgery cost?

My situation is: I bought a beautiful Saddlebred mare without a vet check and after the first trail ride she showed up lame in her left front. Vet diagnosed a bone chip on the fetlock, but said it was “too small to operate on”. He prescribed hyaluronic acid injections as needed (probably every 4 to 6 months). I’ve been looking around the net, and it seems that without surgery to repair the chip, it will continue to damage the cartilage until it’s just not there.

Holly is only 5, and I have since found that she has a champion family and even if she didn’t, she deserves to have a good life. But I need a horse I can ride.

Any suggestions?[/QUOTE]

Where are you located? I would definitely get a second opinion on this; you can send the x rays to the closest vet school and they will usually give you their opinion on it. I would think that if it is large enough to cause lameness it should come out! Good luck!

[WilSprFarm]

How did the surgery go? I also wanted to add that I had great success with this surgery. Here’s a before and after video:

http://youtu.be/ZSNjP4-rNa4

[Perfect10]

I have a pony who had bone chips taken out of both fetlocks. Recovery was easy and he’s completely sound now. He stocks up easily, but with regular turnout he’s just fine.

[Hetep]

Thank you everyone for your replies. I’m in Phoenix, AZ. Is it proper on the boards here to mention the name of the vet who’s opinion needs to be reevaluated? I really tried to research who was a good vet in our area, and thought that I had one of the best in town. He may have looked at me and the barn and thought “She’s not going to follow through” or something like that. I was nervous and couldn’t even tie the halter on right… (sigh) Anyway, he did X-rays and a sonogram, told me that her feet had what was left of a Saddlebred “big foot” trim, and he called a farrier for me who was up on the breed, and he fixed the trim and she was shod on all four in a normal trim. He took quite a bit off. I was surprised at how much.

Holly is kept at a private neighborhood barn, mare motel setup. A lot of us here work for the same employer, so it is definitely not a show barn by any stretch. Some of the guys here are real “Cowboy” types.

I’m an older gal (60 in April) getting back into horses. My daughter is 30ish, and I haven’t owned any horses since her father and I split up when she was 4. As a kid I’d ride anything you put me on like a wild gal and when married took some hunt seat lessons in Washington. These days, I started taking equitation and am coming along there and bought Holly with the intention of not having to buy another. Just stick it out together until we both die. I figured that we should both have about 30 years left in us… So when I saw her, she was thin, and the seller/breeder said that she had stopped riding her about a year ago, and I asked why, she said her life was going in a different direction (She started breeding and showing Standard Poodles). I looked at Holly and thought that the gal just didn’t want to feed over the winter. So I bought her and brought her home on Nov. 1. Holly has spent some time here learning what grass is, what cars are, how to stand in a wash rack, etc. and flirts with a walker stallion who stays a few stalls down, and eats. She has put on weight and looks good now.

I enjoy trail riding (Trails here tend to be rocky) and am also having fun learning the the sorts of aids in equitation that I never learned as a girl. The trails that are nearby are rocky, and have one or two spots that a horse looks at and says “I think that should be jumped”. So soundness is really up there on the needs list.

So I have rambled on and everyone knows the story… Thanks again for all your support. I really appreciate it.

Bath time 2 weeks after her HA shot. Not too sure about the wash rack…

https://sphotos-a.xx.fbcdn.net/hphotos-prn1/148226_3960018678973_1482406897_n.jpg

[Hetep]

Just a note. That pict of Holly was from Mid-November and I had brought her home on Nov. 1., so mainly shows how she was. She’s heavier now.

I got a referral for another vet from my instructor, and consulted him. I should be calling the surgi-center on Monday and she will be set up for chip removal. Thanks again!

[KentuckyTBs]

I worked on a TB breeding farm and we did surgeries on chips ALL THE TIME - fetlocks and knees. Never had any issues, rehab protocol varies based on the vet hospital but mostly it is stall rest, hand walking, and bandage changes. Fetlock chips are much easier to remove than knee chips, but even with the knee chip surgeries we never had any issues.

As with any surgery, of course there are risks - but if you take the horse to a vet hospital that is very familiar with removing chips, and you follow the rehab instructions, the likelihood of problems is fairly small. I think a lot of people who end up having lameness issues after chip removal make the big mistake of turning horses out too soon after surgery. We had ours typically on stall rest for 10-14 days then would hand walk 15 mins/day for a week, 30 mins/day for another week, 45 mins/day another week, then 30 mins 2X/day for another week - so typically about a 6 week rehab then we would gradually start turning them out again.

[maggini]

I came upon this post when I was looking for something else I’d asked about on here, but I thought an update might be in order.

The surgery went great- we were in and out in about 4 hours, plus I got to watch (and take home a souvenir bone chip)! I had Dr. Sutter with Lexington Equine Surgery complete the surgery. His bedside manner was fantastic, he seemed to me as a layperson to be very skilled, and any time I’ve mentioned his name to different area vets before and after the surgery, he’s gotten very positive comments. As a bonus, Lexington Equine Surgery has the lowest quote for the surgery (verses Rood and Riddle and Hagyard) and my referring vet felt very comfortable since the hospital was mostly for elective surgery for sporthorses/racehorses so there was less chance of picking something up by virtue of being in a big hospital.

I’m very happy I had it done, as Dr. Sutter told me that there was already a bit of damage from the chip and he suspected that my horse had raced on it. Had I of waited longer, I’m sure the damage would’ve been worse because of how close it was to the joint and because of my plans to move up the levels of eventing with this guy.

My horse went through layup perfectly (never mind that he was TERRIBLE to hand walk) and although I was told to expect swelling once the stitches came out, there never was any. Two days before he was clear to ride and go on full-size turnout again, he sliced open the same leg (although closer to the knee), presumably on something (we never discovered what, or how) in his tiny layup paddock and required a lot of stitches and a few more weeks of layup. After what felt like forever, though, I legged him up and he’s been perfectly sound since, including regular low level (2’6"-2’9") jumping and XC schooling. He even completed his first little BN CT and seems to have a promising future as an event horse.