Severe Knee Arthritis - Need advice

[nefferdun]

In Feb. 2017 my then 20 year old gelding, Sonny, severely slashed his knee and developed an infection before I found him the next morning. He was on abx and seemed to be doing well but was probably taken off too soon because the infection came back. He stayed on the abx longer the second time and the wound closed up after two months. It was a roller coaster ride as he seemed to stabilize and then plunged, got better and then worse. I used LED Infared light on it every day for months and the vet thought it was helpful. When he did not want to put any weight on it, Prevacox worked for a while. Then he went downhill again. We did joint injections and Osphos to see if it would help. The vet finally said I should just give him bute and let the joint fuse.

Now I understand where the expression “dead lame” comes from. Poor Sonny hops around on three legs. He has a very kind gelding to keep him company and an orphan foal that gives him a purpose (he loves her). He enjoys his food, wants to get out to graze and does not seem ready to kick the bucket. I just hate to see him in such pain and not be able to do anything about it.

Is there anything I can do to hasten his knee fusing or just anything that might help ease his pain? I am using the LED infared light again. The corticosteriod injection didn’t work last time. I noticed the vet only injected him in one spot - maybe he needs the other side of the knee injected? This is really depressing. He is struggling so hard to live.

[TWH_Girl]

I’m so so sorry about Sonny. Poor guy. So he’s on bute and still hobbling around? Hmmmmm…honestly it is probably time to think about having him PTS at this point if you are not able to make him comfortable. Dead lame on bute just doesn’t sound like a good life. I am sorry. Any other treatments are not likely to do very much at this point.
If you want to do more, then maybe check with a lameness specialist and consider IRAP or shockwave etc. to try to provide better pain relief at least for a while.

[newhorsemommy]

I assume this is a front leg? I wasn’t aware that the knee would fuse, but I could certainly be wrong. Euthanasia would not be unkind at this point, but if you want to explore other options, I found a round a shockwave very beneficial for my gelding with a torn meniscus and arthritis in his LH. If the joint injections worked before, you could try them again (doing both “sides” as you mentioned). How big is he and how much Bute is he getting? A lot of people stay too low on the Bute, worrying about side effects, but sometimes when that’s all that’s left, getting the horse comfortable is more important than the concern over long-term issues with Bute administration.

[nefferdun]

I looked up IRAP and it says it only works on mild to moderate cases. I have not heard of shockwave treatments before. i looked online and the nearest vet that uses it is too far away. The LED Infared light increases circulation and helps with pain. It is used by NASA and approved by the FDA for speeding the healing of wounds. There are different frequencies and I am suing the one for internal damage. I just started again after the winter.

I am giving him two grams of oral (powdered) byte twice a day. Is that enough?

[khall]

4 g of bute is max dose and should be done for short periods ONLY. You will tear his gut up with bute at that dosage. I’m sorry but it sounds like euthanizing is the kindest thing for him at this time.

I euthanized my first born WB mare at 21 due to DJD in both knees that reduced her ROM to maybe 30%. She could not lay down sternally, only flat and was majorly sleep deprived because of it. She would fall in her stall, falling asleep and not catching herself. I made the call.

[NancyM]

With a horse who is THAT lame, you are risking founder on the opposite front leg, a mechanical founder from putting too much weight on that leg to get off the other leg with the sore knee. Like Barbaro. If this happens, you are “done” trying to save this horse, time to put him down.

4 grams of bute a day is the full sized dose. Many horses have lived on 4 grams of bute a day for many years without an issue with ulcers surfacing or their presence becoming a problem. Other horses can’t handle this dose long term. You have to try your horse to find out what his tolerance for long term full dose of bute is. If he can’t handle it, and can’t be adequately mobile without it, you put him down. The long term pain will be as likely to give him ulcers as the full dose of bute will. So six of one, half a dozen of the other. Injecting bute IV is another option you can consider, 10 cc per day into the jugular. Your vet can show you how to do this. This way, he doesn’t have to eat it, or have it syringed in to his mouth, his meals may be more enjoyable if free of medications.

Depending on the actual location of the injury, fusion of the small bones in the knee is common. Or fusion of the small bones to the upper or lower surface of the joint. Once fused, there tends to be less pain, and less flexion in the joint, obviously. If the entire joint fuses solid, then there is no flexion left in it at all, and this would not be a situation that would be long term survivable, IMO. Fusion will happen naturally over time, if he has time. Vet work may hasten fusion, but there is also risk involved with vet work. Sometimes we try to help by getting involved, and it backfires to failure.

If this has been going on for a year, without fusion and without being able to ease his pain adequately, his quality of life and future seems grim to me. Making the decision to put this horse down would be foremost in my mind, rather than keeping on with vet work indefinately. Not all issues are solvable with vet work. Eventually, an owner must be prepared to let the horse go.

Sorry to think that you have these tough decisions to make with a horse you love. Unfortunately these sorts of decisions happen to all horse owners every now and again. Don’t let the horse suffer, is the key. Horses do tend to be stoic about things like this, but that doesn’t mean that it is always the best decision to allow it to continue indefinately.

[scrbear11]

It’s time to put him to sleep. He’s suffering.

[khall]

I have never seen where a vet prescribes 4g of bute for any extended time. NEVER. 1-2 g yes, but anything over that is way too much for the horse and IMO if they need that much to maintain some sort of soundness then they should be euthanized.

[merrygoround]

^ This. I am amazed that the horse has not already colicked from a bleeding ulcer.

[nefferdun]

Thanks for your thoughts. I have put a dog and three old horses down in the last year so I understand and generally accept when it is time to let go. The reason I have not put Son down is because the vet did not say it was time and also because Sonny has some enjoyment left in his life. I have a 28 year old horse that has ringbone. A bad farrier cut his heels back causing his fusion to break and he could hardly walk. I took him to the vet expecting him to be euthanized. He took x-rays and said to give him more time because he was fusing. It took a few months but now he can canter.

I do not expect a miracle for Sonny but if he is trying to fuse the joint, giving him more time might be what he needs.

I am glad you warned me about the Bute. He has only been on it about two weeks.

I know that he can founder on his “good leg” and that would be the finish of him. I know someone who nursed a horse for two years who had this happen.

What is hard to understand is that he was doing much better six months ago, putting weight on it. Sometimes he could walk almost normal. I think I need to get a second opinion from another vet about what is going on - with new X-rays. My current vet told me to expect a lot of pain until the joint fused and then he would be out of pain although stiff. This vet is sometimes right, sometimes wrong. If I had listened to my gut instead of him, I would have kept Son on ABX for a month to make sure the infection was gone.

[shayaalliard]

We have a gelding with a partially fused knee from an old injury. Skip is by no means sound, but previcox and actiflex have kept him moving ok as a pasture pet. When he becomes as lame as your guy, we will let him go- which is what I would do for your guy.

Skip was never nearly THAT lame. Injury happened at 3, we bought him to retire him at 13 because we loved his daddy, who died. I think we will be lucky if he makes 20.

[beau159]

If injections and Previcox or bute are not keeping a 21 year old horse pain free, then for me it would be time to let go; especially since fusion is not going to provide a rideable sound horse, most likely.

Only you can make that decision, but that is what I would do. Good luck.

[joiedevie99]

It sounds like you’ve given it quite a bit of time without improvement in his quality of life. I’d take him to a new vet to get some quality x-rays of the knee and see if it is almost fused. If not, you can speak with the vet about alcohol fusion or surgical fusion (plate). I’m not sure either is appropriate, but it will ease your mind if you understand all of the options and think them through. Most importantly, I think a new opinion will help you be at peace with letting him go now rather than waiting around in pain for what may be a long time/never for fusion to happen.

[warriorhorse]

If you decide to put him down just remember better a day to soon then a day to late.

if you can’t get him pasture sound within a reasonable time. I’d consider putting down his quality of life now isn’t good. He’s hobbling around on 3 legs.Sometimes the kindest act of love is letting them go. Never easy but we are their stewards and its our responsibility to do right by them, no matter how hard it might be.

[Bluey]

Our feral horse, according to our vet, had rickets in his knees.
They may have been forming and closing as he went thru a drought or bad winter in the area he grew up in Nevada.

His knees were never that good, he was not exactly lame, but we didn’t ride him on the longer days, afraid he would get sore on them.
They started seriously bothering him in mid teens, we had quit riding him then and we finally had to euthanize him at 20, as he was in pain every time he tried to move around.

As our vet told us, knees are one structure that causes a poor quality of life most, the horse still otherwise fine.
That makes it harder to see you have to go there, the horse is not really going downhill as with other, when such decisions are easier, but just enduring.

Pain hard to control is one of the AVMA points to think euthanasia:

https://aaep.org/horsehealth/euthanasia-most-difficult-decision

If a horse has to be on serious pain medication all the time, it may be time to consider alternatives.

[RedHorses]

Given what you shared I would want new x-rays to see if there is any sign of fusion occuring. Further decisions would depend on what is happening. If there is fusion starting I would give it a set time and redo the x-rays to judge speed of progress.

[nefferdun]

I started him on low dose naltrexone to boost his immune system and help ease the pain (it triggers the body to produce massive endorphins). And I am giving him oral HA and methionine. Someone suggested boron for arthritis so he gets a pinch of that.

Today when I was using the LED Infared light on his knee, I saw what appears to be an abscess that opened overnight and is draining. The vet is coming tomorrow. I will get new xrays to see what is going on. The swelling has gone down on one side of his knee where the abscess is.

This is why I do not like steroid injections - they can cause infections. The LDN will help clear up infection. I was listening to the vet instead of to my own gut feeling and experience.