Stifle Injections Without Bad Rads

[Ottbaxel]

Curious if anyone has seen any improvement doing stifle injections on a horse whose radiographs look fine?

I have a 17 year old ottb that gets routine hock maintenance. His left hock has been in the fusion process for 7+ years, and his right hock has some bony changes and osteoarthritis. At this point, he has some other issues unrelated to the hind end that mean he is no longer in competition level work-he is half leased out and does flatwork and occasional jumping with both of us just for fun - jumps generally are at or under 2’6.

Anyways, years ago I had his stifles X-rayed while I was trying to figure out what was up with his hind end, and his stifles look totally fine. As he gets older though and it is clear he needs his hocks done again, I am thinking about maybe doing his stifles too. In the past few weeks he has started to feel hitchy at the trot. I was hoping, since he had an abscess on a front foot recently, that he was just sore from compensating, but it’s been a couple weeks and he’s still a little funky. It also feels like his stifle is “slipping” at times, which is why I am considering injecting them too.

I have started doing some stifle strengthening exercises with him, and I will ask my vet what they think as well. There is also the possibility that there is now some OA in his stifles that wasn’t there years ago, but I’m curious if anyone has seen positive results when rads appear fine?

[TWH_Girl]

Honestly, once you see changes in X-rays, things are harder to treat. I would flex him and based on his age and symptoms, injections are probably a good bet. Are you comfortable keeping him on equioxx while that fuses? Tha t may help too.

[Lunabear1988]

Personally I would be inclined to retake X-rays and or do an ultrasound before injecting him myself. But at his age maybe your vet would feel comfortable just going ahead and try injections.

Other thoughts are do you have him on any joint maintenance like Adequan, Legend or Zycosan?

[GraceLikeRain]

I’ve been injecting stifles on one horse for two years. No rads taken. There were clinical signs the stifles weren’t awesome and the injections help so the vet never pushed for rads.

[Ottbaxel]

@Lunabear1988

Other thoughts are do you have him on any joint maintenance like Adequan, Legend or Zycosan?

He gets Legend monthly.

@TWH_Girl

Are you comfortable keeping him on equioxx while that fuses?

I can but I’m not a huge fan of doing that - I don’t want to upset his stomach. It’s taken so long to fuse already that I expect he would need to be on it for a few more years lol.

[Ottbaxel]

@Lunabear1988

Personally I would be inclined to retake X-rays and or do an ultrasound before injecting him myself. But at his age maybe your vet would feel comfortable just going ahead and try injections.

I am thinking about doing this-however with my other gelding his stifles x-rayed fine and my vet still wanted to inject (kind of a last-ditch effort before a bone scan. It didn’t do anything but he clearly has other problems). So I am wondering if I take new rads and they still look fine, if I should still try injecting.

[Lunabear1988]

I think it’s commonly done. Especially if you’re vet thinks that it’s potential compensation from the hocks fusing.
I am one that likes to have all the answers I can though, to the detriment of my wallet lol!! Personally I have been happiest with ultrasound on stifles.

[cnd8]

Honestly (flame suit on), I rarely do rads for hocks or stifles. I go by my vets flexion tests. I inject first and see if symptoms improve. They usually 9/10 times do. On the rare occasion they don’t improve, the next time I request rads or more flexions to see if it may be isolated somewhere else.

It sounds like stifles to me.

[Ottbaxel]

I hear ya! It seems odd to me that a horse could have no OA or any other issues in a rad of a joint, but then an injection still helps.

[Lunabear1988]

So my horse had a few issues that were much better seen on ultrasound. Stifles are such a complicated joint that even ultrasound is not always enough. That being said, if it’s compensation from hocks, I guess I want to be a huge deal to inject and see if it makes a difference!

I also think giving your horse’s age that it’s less of a concern to just try injecting.

[TWH_Girl]

@Ottbaxel

I hear ya! It seems odd to me that a horse could have no OA or any other issues in a rad of a joint, but then an injection still helps.

Synovitis is usually the cause and won’t show as boney changes on X-ray.

[Demerara_Stables]

Tl;dr yes I’d do it, especially if you’re not using steroids.

I think I had rads on my mare’s stifles like 15 years ago and they (rads) were fine. Her stifles have always been weak (since a baby - she’s 21 now) and when she was 17 she was acutely lame on the right stifle. We decided to do ultrasound guided injections, and when we looked at the joint before injecting the vet said her meniscus was “pretty much shredded.” I did one round of steroids and have now done 3 rounds of PRP. It lasts about a year on the right and a little longer on the left. It’s $$$ but totally worth it.

My vets have said for a while that imaging doesn’t matter as much as how lame the horse is. If it flexes to the hock/stifle and you’ve already done hocks, chances are it’s the stifle. PRP is much better for the joint than steroids, so if you can stomach the price, I’d go for it.

ETA she’s also been on equioxx for over a year. I used to take her off of it when she was strong and in full work but honestly she just wasn’t staying comfortable all the time. She’s had zero gut issues (knock wood) and is the soundest she’s ever been.

[FjordBCRF]

@Demerara_Stables

I did one round of steroids and have now done 3 rounds of PRP. It lasts about a year on the right and a little longer on the left. It’s $$$ but totally worth it.

We did our first of four electo-acupuncture treatments today for the neck, and the rehab barn vet said PRP could definitely be something worth exploring depending on how things go. What is the ballpark cost for the PRP injections? And how often was it recommended to do?

[Demerara_Stables]

I’m in a high COL area (SF Bay area), and it was $2400 for both stifles, all in (including farm call, sedation, etc). I’ll DM you my itemized invoice so you can see the breakdown.

My mare needs it once a year. I’ve stretched it out before but it’s clear she gets uncomfortable longer than that. For some background: She’s 21, has been in moderate work her whole life (started at 3.5 yo, 3-5 rides a week beginning at 4yo, including 1 long trail, 1 low jump school, and 1-3 w/t/c/dressage rides). Her right stifle has been problematic since birth, she had locking stifles bilaterally until 5 or 6, and her sire passed on weak stifles to all of his offspring. I x-rayed the stifle once ever, at 5yo. There were no OCD lesions, chips, or bony changes. At 17(18?) she had her first ultrasound guided injection (not PRP), which was the first time the stifle had been ultrasounded. The meniscus was “pretty much shredded” according to the vet, and the joint space was narrow, but nothing else abnormal was found on ultrasound. She’s had the occasional Adequan, more recently in the past 6 years, but at most a 28 day round twice yearly when she was showing, and never once monthly.

Hope that helps!

ETA lol just scrolled up and saw I said a lot of this already. 🤷

[FjordBCRF]

@Demerara_Stables

ETA lol just scrolled up and saw I said a lot of this already. 🤷

Thank you!! Very much appreciated and I’m glad it helped your mare!