Fusing hocks - natural vs human intervention?

[jcc813]

I haven’t been finding a lot of info on this topic…last post with a similar question was back in 2012.

Does anyone have experience medically fusing hocks through surgery or chemical arthrodesis?

My 20 yo low-level eventer has been having noticeable issues with his left hind since at least last August. He’s had hock injections twice since then and they didn’t seem to make a noticeable difference for very long. He’s also been on pentosan, recently switched to Adequan, gets daily Previcox, and I rub Surpass on his hock before rides. He’s also gotten chiro and massages when the compensation for his pain ends up affecting other parts of his body.

We finally x-rayed his hocks yesterday and it looks like his lower left joints are fusing which is what’s causing his discomfort. The vet said once they’re done fusing he should be sound and pain free–problem is there’s no predicting how long that will take naturally and, according to some sources, sometimes they never fully fuse on their own.

She said we could give him Tildren (cost of ~$1200) to help with the bone pain in the meantime and consider shockwave as needed plus continuing all the other pain management while we wait for the bone to fully fuse.

I’m not keen on the idea of investing a lot of money on pain management that doesn’t actually solve the underlying problem if there are options to help the hocks fuse and thus make the pain stop.

It sounds like the downside of the chemical injections is that it can be very painful for a short period right after. One article I found said it’s only 15-18 hours and the horse can usually be ridden next day. You also have to make sure the lower joints don’t communicate w/ the uppers and cause issues there. My vet’s office manager seemed to think my vet would not do the chemical option because of the pain.

But the chemical option still sounds like it’d be better than surgery which would require general anesthesia, has long recovery, and could take a full year to fuse.

I’m waiting for a call back from my vet to discuss but curious if anyone has any experience with either medical option or just waiting for hocks to fuse?

[sportyspicepony]

@jcc813

I’m not keen on the idea of investing a lot of money on pain management that doesn’t actually solve the underlying problem if there are options to help the hocks fuse and thus make the pain stop.

I don’t know anything about this and am kinda in the same boat as you, however based on the little bit that I’ve read about this, I think there is some higher risk of 1) complications with chemical fusion and 2) risk that it won’t work at all, whereas if you just focus on the pain management and keep the horse in regular work, you might speed the process along naturally? However it seems like you’re doing a lot already to try to manage his pain and it’s not really working so maybe it would be worth it to try at this point.

I’m also really confused about all the different chemical fusion options because there seems to be a few on the market so will definitely be following this thread to learn more.

[LCDR]

This original post could have been written by me. Just change his to her, and 20 to 21.

What I did was elect to retire her from riding, and discontinued everything but the every 2 month chiropractic treatment. But I am blessed to have a farm and another horse to ride, so her living situation never changed.

It is hard to know when the time comes to stop searching for treatments, and just let rest and nature work things out.

[jcc813]

I spoke with my vet again last week and she’s not convinced that chemical fusions (at least with alcohol) actually work and the horse is in a lot of pain after, which is why she won’t do them at all. I mentioned MIA as another chemical sometimes used, but she didn’t seem familiar with that.

So it sounds like she’s in agreement with the two points you stated.

I may just go ahead with the Tildren and see how that goes. He had a chiro adjustment last week and has actually been moving pretty well the past few days. Could also be the Adequan finally kicking in.

For what it’s worth, at the lameness exam my vet said he looked the most fit she’s ever seen him and is moving pretty well for a 20 yo TB

[jcc813]

Unfortunately I don’t have the luxury of keeping him on my own property.

The soreness doesn’t seem to hugely impact things at the level we’re riding and he definitely still has a lot of go in him. As mentioned above, the vet said he actually looks pretty fit for his age. She said keeping him in work would be better and the concussion from moving may actually help the hocks fuse quicker. Just wish we could have better predictability on the timeframe.

[theresak]

@jcc813

I spoke with my vet again last week and she’s not convinced that chemical fusions (at least with alcohol) actually work and the horse is in a lot of pain after

My vet has said they have found that fused joints (chemically and “naturally”) will still separate during dissection. So even though we call them fused by xray, they are still separate bones and have some slight motion. Like my vet, I’m conflicted about chemical fusions knowing what they’ve found after death.

Besides Tildren, ask about Osphos. There are some potential side effects - I run kidney numbers before we administer, withdraw all NSAIDs for several days, and monitor post-injection for colic. But even with all of that, Ospos is generally easier than Tildren.

[jcc813]

Yes, my vet mentioned Osphos but says she prefers Tildren because generally you’re one and done whereas with Osphos sometimes you need multiple doses.

She said a lot of vets go with Osphos because it’s easier (doesn’t require you to sit around for 2 hours waiting for the IV drip), but she’s had more success with Tildren.

We have to go through the same prep with Tildren (run bloodwork, stop NSAIDs, and monitor for colic). I thought the colic risk was only with Tildren, didn’t realize it was for Osphos as well.

[quietann]

There is a risk, or so I have heard, that in an older horse even a very tight joint space will never fuse “naturally.” My 23 YO mare has one that’s very tight and has been for years; we’ve left it alone other than doing injections every 8 to 12 months (most recently ProStride as she is IR and I don’t want to trigger laminitis with steroids.) Other than that she gets a pain-relieving regimen similar to your horse’s: daily Equioxx and Pentosan IM every 2 weeks. I know she’s not going to last forever, but this is the first year she has seemed “old.”

IME vets prefer Osphos mostly because there is less risk of a bellyache. My mare had Tildren once and got a very painful gas colic. She has had Osphos twice. The first time she didn’t react badly; the more recent one she didn’t colic, exactly, but got very very “depressed” – she was standing in the corner of her paddock with her head down, breathing a little heavily. I put her halter on and walked her in laps around the barn and arena, stopping at her favorite grassy area on each round. She gradually became more interested in the grass, I would stop and let her have a few bites, and on lap 10 or so, she realllyreally wanted it, as usual. The first time I don’t think the Osphos helped much; the second time it definitely did.

[sportyspicepony]

I wonder how common the success story is of having a horse’s hocks fuse naturally and then they’re pain free afterwards!

[horsephotolady]

I had a horse’s hocks chemically fused many years ago and would not do it again. The pain is extreme. And it did not bring her back to soundness,

[jcc813]

@quietann

There is a risk, or so I have heard, that in an older horse even a very tight joint space will never fuse “naturally.” My 23 YO mare has one that’s very tight and has been for years; we’ve left it alone other than doing injections every 8 to 12 months (most recently ProStride as she is IR and I don’t want to trigger laminitis with steroids.)

So your vet was still able to get the needle in enough to give the hock injections? I was under the impression that once the spacing is pretty tight, hock injections aren’t really useful anymore because there isn’t enough space for the medication to get in or to do anything.

@quietann

IME vets prefer Osphos mostly because there is less risk of a bellyache. My mare had Tildren once and got a very painful gas colic.

Did the colic reaction happen right away? Did the Tildren at least seem to help her move better?

[jcc813]

@sportyspicepony

I wonder how common the success story is of having a horse’s hocks fuse naturally and then they’re pain free afterwards!

According to a barn friend of mine it happened to one of her previous horses. They couldn’t figure out what was going on at first (partly because her horse was younger—early teens). After a few months of realizing it was the hocks, the bones apparently fused and she was sound again. I think in her case it was over the course of a year or just under.

[quietann]

The joint space is tight but not impossibly so. She is 23, had her first hock injections at 11 or 12, and if it hasn’t closed yet, it’s probably not going to. If I had to do it all over again, I might have asked the vet whether it would be prudent to skip injecting the tight joint in hopes that it would fuse. It’s the lower joint space on the right side IIRC.

As for Tildren vs. Osphos… With the Tildren, done IV, the colic happened a couple of hours later. It was my birthday, Tildren was administered late in the afternoon, DH and I were out to dinner, and I got a call around 8 p.m. from the night check staff saying she looked pretty uncomfortable. On the advice of the on-call vet, they didn’t feed her hay, and gave her milk of magnesia because it was what was on hand, and then DH and I went over and walked her up and down the barn aisle occasionally, waiting for the Poop Fairy, who arrived around midnight.

With the second Osphos it was much more quick. She was definitely irritated right after the shot, and was shaking her head. I decided to turn her out and keep an eye on her (1/4 acre paddock so I could get to her quickly if needed.) The head shaking slowed down but within about 20 minutes she was just miserable. It didn’t really look like a colic, and she had gut sounds throughout the episode.

[endlessclimb]

No on the surgical arthrodesis, as well. Been there. Done that. He’s still lame.

[gailbyrd]

My mare reacts to her Osphos injections fairly quickly as well. My vet hangs around for about an hour, within that time, I see her be uncomfortable (head shaking, depressed, not eating (and she is ALWAYS eating)) then within the hour she’s back to her normal self. She’s had 3, all within 6 months (bum knee and fusing hocks). The knee keeps her from being anything but walk/trot occasional canter sound but the Osphos keeps the hocks bending and allowing her to take the weight behind to get her off her front end.

[theresak]

@jcc813

Did the colic reaction happen right away?

My horse had his first dose of Osphos and had an almost immediate spasmodic “colic” that was resolved with a single dose of meds. My vet said it was the first time he’d had a horse with that side effect. For subsequent doses, we’ve pretreated.

My vet waits around for 30 minutes after the injection and recommends owners stay for an hour just in case. The documented side effect is specifically spasms I think and show up right away.

[MsM]

My horse had Osphos. My vet’s protocol is to give buscopan with it to forestall the spasmodic colic. He also stuck around for a while. He said he never had a horse have a serious colic from it, just muscle spasms, but he pretreats to avoid any pain for the horse.

[MidlifeCrisis]

I know too many horses that have gone into kidney failure after Osphos to ever consider it again for my own horses. Also, I have a retired QH that had multiple treatments for his bad hocks. After steroid injections stopped working, we tried the alcohol fusion. He was good for about 6 months probably because the alcohol kills the nerve endings. Once the nerves grew back, he was just as lame. Then I took him to one of the best lameness vets on the west coast and we did the drilling. A year or two later, no changes in the hocks. That vet would talk about this horse’s case as one of his great failures and that sometimes horses are refractory to treatment. So now said horse is retired. If I had to do any of this again, I wouldn’t. I tried pretty much everything out there because this was my one horse and he was young and I didn’t want to give up. In retrospect, I was doing it all for me and nothing for him except causing him a lot of pain. Never again.

[StormyDay]

Have you looked into Cunean Tenectomy surgery? This is something I just recently learned they can do and I had never heard it mentioned before. Apparently it’s not done super frequently anymore but can be really beneficial for hock issues and the layup time is only 2 weeks.

[endlessclimb]

Same, same, same. I could have written this myself.