Knee and stifle injections: what to expect?

[awaywego]

My sports med vet recommended knee and stifle injections, which I am planning to schedule in the next few weeks. The horse doesn’t look unsound but he has more limited range of motion in his knees than he used to - and the stifles don’t really surprise me because he does trip in the hind. The last time I had this horse injected was almost 10 years ago when a different vet did back injections for kissing spines. That went horribly: turned into a full-on rodeo horse. I’ve been nervous about injecting ever since and have maintained him with Osphos, pentosan, equioxx, cosequin, magna-wave…everything but joint injections! We later ended up determining that the back soreness was connected to Lyme and treatment for Lyme has since been my go-to when he is back sore. (Lyme is my arch-nemesis!) I am not a vet or scientist of any kind but I really believe the cortisone injections aggravated the Lyme infection (the immune suppression effect is my unqualified guess). The last few Lyme tests have had very low numbers so I feel like it is worth taking a chance on the knee & stifle injections (and since they don’t have to be cortisone like was done 10 years ago maybe not the same effect anyway?)

Under normal circumstances, what should I expect with injecting the knees and stifles? I would hope I really wouldn’t see any change but that my horse would just be more comfortable? I just really do not want to end up with a rodeo horse again I am hoping to keep him comfortable in his 2’6"-3’ job. The only “tell” that I occasionally see that suggests he is uncomfortable is when he’s out of shape he will swap off going to a jump (in such a fluid way that half the time I can’t even tell that he’s done it). Otherwise he never ever misses a change and is a top 3 hack class type - he doesn’t “look” arthritic in any way. He also does not lie down, so if anything that is the thing I am hoping to help the most.

[cnd8]

The vet has agreed to do both areas in one day? Mine wont do that. She’s kind of known as the area expert in IA injections and she prefers to space them out a couple weeks.

If everything goes as planned, there’d be no issues. I inject my horse annually and it is a day of bute and 4 days rest before riding resumes. Different vets suggest different protocols.

[awaywego]

Ugh. I don’t know about timing now that you mention it. I hope they can do them in the same day though because it is not close and I truly hate the drive there.

[cnd8]

Maybe others will weigh in here. Everyone in our area uses the same vet for injections, so maybe that’s just her rule, but I have never seen anyone do multiple areas at once. Maybe it’s just her thing.

[knic]

I’ve had multiple areas done in a day more than once by local clinics and university vet hospitals.

[TheHunterKid90]

Totally normal IME to do more than a set of injections at one visit. IE; knees and stifles…hocks and knees…coffins and knees. Etc
Are you referring to how good the horse felt after that he was a rodeo horse? Or the injection process itself.
The actual injecting should be done on a fairly heavily sedated horse along with a twitch for added control for the handler. I’ve never had it turn into a rodeo.
Maybe remind your vet what a wild child he is to inject and they will try a different sedative or a slightly higher dose.

[joiedevie99]

There is some amount of steroid that is too much for one day, but two locations shouldn’t put you near that. We routinely do coffins and hocks in the same day. I’ve also done stifles and hocks in the same day.

If you have concerns about steroids, you can go with one of the biologic products, like ProStride, that doesn’t have any. These have been a game changer for horses that can’t have steroids.

Your horse will likely have a few days of stall rest with hand walking (my vet does 3), then one day of turnout only, then a return to full work over a few days - so about a week total before a hard ride. Your vet should write out what they want. Some cold hose the areas for a few days and give banamine as well.

[awaywego]

Haha, yes, right, they are sedated for the injection process.

It was when I rode after the injections - so much bucking. Like “weeeeee, pain free!” So I may have PTSD thinking I’ll get his knees & stifles injected and once again it will be “weeeeeeeeeeee, pain free!” all over again

[awaywego]

@joiedevie99

Your horse will likely have a few days of stall rest with hand walking (my vet does 3), then one day of turnout only, then a return to full work over a few days - so about a week total before a hard ride. Your vet should write out what they want. Some cold hose the areas for a few days and give banamine as well.

Thanks - was also thinking about that kind of after-care. It’s been probably 20 years since I last had a horse getting hock injections, and I couldn’t remember if it was rest or right to work (like you do with Estrone.)

[TWH_Girl]

My guy just had Arthramid today and this was lameness vet’s recommendation:

“Same protocol as normal - stall rest for today, normal turnout starting tomorrow, could start riding Saturday. Response time, as with the Noltrex, is typically a little longer (~30 days for peak effect).”

I would do ProStride or Noltrex/Athramid in stifles and steroid in knee if there’s a concern on amount of steroid. I’m sure your vet has a recommendation. What is horses age?

[awaywego]

@TWH_Girl

I would do ProStride or Noltrex/Athramid in stifles and steroid in knee if there’s a concern on amount of steroid. I’m sure your vet has a recommendation. What is horses age?

Thanks! My vet actually recommended the opposite - something non-cortisone for the knees (I don’t think he said what but I’ll go with whatever he wants to do) and cortisone for the stifles. We discussed the research that suggests that cortisone use may accelerate the progression of arthritis in the knees. Since he’s not that old nor that bad yet I think we will try to use alternatives for now. I don’t really understand why the concern is not the same with the stifles: maybe because his arthritis is worse there but the vet also mentioned something about it being a bigger joint. I’ll ask more questions when we go for the injections, which I’m thinking I’ll shoot to schedule for the next few weeks.