Hi all, I have a 22 year old Danish warmblood, FEI dressage. He’s been off work for a year due to loss of cartilage in the P1 joint. Tried injections, and shoeing, no success… he’s a very active horse but he remains lame. Does anybody have any suggestions? He’s a wonderful horse, I’ve contemplated stem cell therapy or IRAP but if anyone has any experience with this I would really appreciate your advice!
Low ringbone diagnosis? Not the greatest outlook for this. Time marches on for everyone. Pain management, light work or full retirement. Creative shoeing, rolled toes. Some people can nurse them a long for a limited amount of time in light work, but things don’t get better with problems like this and advancing age.
Good luck.
What kind of injections did you try - x-ray guided into the P1 joint space? I don’t think IRAP or PRP would do much for this unfortunately 
except deplete your wallet. They won’t stimulate growth of new cartilage - they are more for clean up up inflammation but inflammation really isn’t your enemy here since it’s not where the originating problem is. It’s tough - you can’t really recreate what cartilage can do for a joint. Steroids can decrease some of the secondary inflammation that happens due to bone/bone friction etc. but ultimately if the padding is gone it’s gone If your vet can “fit” HA + steroid into the space that might give you a very modest benefit but you are fighting a losing battle.
Is your goal just to try to get him sound/keep him more comfortable or are you hoping for return to work?
My horse required surgery for an old bone chip off the fetlock a couple of years ago. What the surgeon found was “bone-on-bone” in the area where the chip had come off the joint and rough edges had ground it down over the years. He recommended IRAP and told me that, while the “original” cartilage won’t come back, a more fibrous type of cartilage will fill the void and provide some cushioning. After the surgery and the IRAP follow-up a couple of weeks later (3 injections, which were generated from the original draw of his blood), my horse has been sound since. I use him for LD endurance and competitive trail, so that’s rides of +/- 20 miles a day in competition, as well as trail rides of 2+ hours on all kinds of terrain in between.
My horse was 11 at time of surgery and IRAP which is quite an age difference from yours. There was no guarantee IRAP would make him sound but I felt it was worth the $1500 or so to try. Full disclosure: I am clearly not a vet and I don’t know if I’ve explained my circumstance in the correct technical terms. This is just my understanding of what I was told and the results I’ve seen.
I’d ask your vet to explain what he/she thinks IRAP could accomplish for yours. When you consider $1500-ish IRAP cost versus cost of ongoing injections, Adequan, etc., it’s not a bad option. (My horse has not gotten any kind of joint injection since the IRAP, or before for that matter.)
FYI, I believe stem cell is used more often for tendons/ligaments and IRAP for joints. Something else to ask your vet. Good luck…
IRAP definitely more benefit than PRP but at 22…
The good news is there are many different things in the pipeline in human medicine to try to actually stimulate growth of cartilage, repair cartilage, cartilage transplants (!), etc. Most of these things are only in very early study/trials but there is hope that in our future there may be many possibilities for cartilage loss/osteoarthritis. This site had a nice summary of some of the more cutting edge things being tried in human knees - obviously not horses but I would imagine similar attempts will be tried, which is super exciting! http://www.ucsfhealth.org/treatments/cartilage_repair/
Perhaps a vet in an academic setting might know of veterinary studies that you could consider participation in?
[QUOTE=rockfordbuckeye;7299922]
The good news is there are many different things in the pipeline in human medicine to try to actually stimulate growth of cartilage, repair cartilage, cartilage transplants (!), etc. Most of these things are only in very early study/trials but there is hope that in our future there may be many possibilities for cartilage loss/osteoarthritis. [/QUOTE]
Fun fact: many of these “cutting edge” technologies actually started in large animal models, i.e. horses. You don’t have to go through as many regulatory steps to get such products to market/practice in equine patients as you would with humans, and just about everything on that list is already commonly in use by the top equine orthopaedic surgeons.
However, it’s very important to note that the technologies mentioned on the link you provided are designed primarily for the treatment of focal chondral defects - NOT widespread, progressive cartilage loss like you see in OA (as is likely the case with the OP’s horse).
ACI (cartilage “transplants”):
http://www.ncbi.nlm.nih.gov/pubmed/21319216
“Cell-based Cartilage Resurfacing”
http://art4dvm.com/index.html
Microfracture:
http://www.ncbi.nlm.nih.gov/pubmed/21862278
Osteochondral Allograft:
http://www.ncbi.nlm.nih.gov/pubmed/12784198
Osteochondral Autograft:
http://www.ncbi.nlm.nih.gov/pubmed/?term=Osteochondral+Autograft+equine
So AE - what would you recommend for the OP’s horse?
I had wanted to return him to full work- but at this point I just want him to be happy and pain free. We have to turn him out otherwise he goes nuts- but in turn out he runs and slides and plays way too much and then he is lame. but continues to run despite the lameness
