What do you think of injecting joints in competition horses

[acerdrum]

What do you think of injecting joints in competition horses as part of maintenance? I know that lot of people do this, and it is something I have been told I might have to think about for my mare, as she is 11 next year, 17.2hh and has been doing dressage since she was 7 or 8.

There is obviously some risk involved with injections into the joints - is this a risk you would be willing to take as a part of maintenance? How high is the chance of something going wrong?

I understand that this happens much more routinely (or should that be much more openly - hmmm, not sure) in the States than it does here.

Your thoughts much appreciated.

[dalpal]

I personally wouldn’t do it unless it was needed. I would use Adequan for PM. With that said, I had my 8 year old’s hocks done this past fall, because she needed it.

I wouldn’t allow just any veterinarian to do this…I went with one who was highly recommended and I knew several people who use him for their hock injections. He’s pretty meticulous when he’s doing joint injections. For my mare, it made a big difference in her performance/comfort level.

[ThreeFigs]

Agree with dalpal. There are some folks around here that start injecting whether the horse is showing signs of discomfort or not around age 8 or 9. My philosophy is, “if it ain’t broke, don’t fix it”.

Unless your horse is showing signs of discomfort or is finding the work more difficult or getting an attitude about the work, i’d leave her be. I do use Adequan and Legend for a bit of extra support before shows or clinics, and had my mare’s hocks injected when my vet recommended it.

Talk to your vet about it. The pros, the cons, the risks, the benefits. Some horses need injections earlier, some later, some never. We do what we can and must to support our horses and keep them comfortable & happy.

[quietann]

There is also the option of doing an IV injection of some of the drugs used for hock injections. This is what I’m doing with my 11 YO mare, who is stiff in other joints as well as having some arthritis in her hocks. (It’s not bad; she flexes at +1 when untreated, and either 0 or what the vet calls a “scant +1” when treated, and she works out of the stiffness pretty easily.) I’m trying to save hock injections for when she gets to a point where she really needs them, to reduce trauma to her hock joints. We are not a high level team and we’re not going to be; it might be different if we had that potential.

[poltroon]

I would not mess with the joint unless the horse is showing discomfort.

On the other hand, if the horse is showing discomfort, I wouldn’t hesitate to do injections. It’s wonderful to have these in our tool kit compared to the Bad Old Days.

[cute_lil_fancy_pants]

I would do IRAP the second a horse starts to show signs of soreness that is consistent with osteoarthritis. It prevents further degeneration of the cartilage, decreases inflammation and increases healing.

[goeslikestink]

[QUOTE=Beasmom;4581540]
Agree with dalpal. There are some folks around here that start injecting whether the horse is showing signs of discomfort or not around age 8 or 9. My philosophy is, “if it ain’t broke, don’t fix it”.

Unless your horse is showing signs of discomfort or is finding the work more difficult or getting an attitude about the work, i’d leave her be. I do use Adequan and Legend for a bit of extra support before shows or clinics, and had my mare’s hocks injected when my vet recommended it.

Talk to your vet about it. The pros, the cons, the risks, the benefits. Some horses need injections earlier, some later, some never. We do what we can and must to support our horses and keep them comfortable & happy.[/QUOTE]

echo this

[goeslikestink]

i wouldnt do it just for the sake of doing it

in all my years of horses i have had to have any and in uk as far as i am aware its not a done practice unless the horse needs it for medical reasons

[mvp]

Which joint and how often?

I think injecting the lower joints of the hocks is a useful, well-understood tool. That’s because it is a low-motion joint which often fuses in middle age.

The primary risk involved in injecting joints is infection. But good sterile technique practiced by vets who commonly inject joints really minimizes this.

A second risk is causing the joint to degenerate faster than it otherwise would. This is why injecting higher motion joints like coffin joints ought to be done with more caution.

When do you start injecting moving joints in a “legitimate way”? For me it’s when every other less invasive (and cheaper!) option has been tried. That means better shoeing and management, joint supplements, and Adequan or Legend if your DVM thinks either is appropriate for the horse’s age and symptoms.

The injection philosophy that bugs me is the one where a horse is merely NQR and the trainer or rider wants him superlatively sound, ASAP for a horse show. When this comes with inadequate conditioning, T/O or good supporting vet/farrier work, I think it’s a problem.

The other part of joint injections that can be a problem is an owner, trainer and vet not communicating. When the trainer does the prescribing-- telling the owner that the first line of attack ought to be asking which joints to inject, or the tells the vet to hurry up and do that, I think something has gone wrong.

In addition, all involved ought to think about the long-term effects of putting different chemicals in joints. The research is incomplete on this topic, but more worrisome, it’s not clear to me that the owners and trainers are even considering the question.

[slc2]

I am considering the question.

First, what is HA and what does it do for a sport horse? Hyaluronic acid can improve the quality of joint fluid. What degrades the quality of joint fluid? Ongoing inflammatory disease processes, such as those involved in arthritis.

Studies of joint injections of HA show that they are helpful sometimes. When I originally started using it when HA was relatively new, my vet told me that it helps sometimes, and sometimes it does not. That has to be factored in to the equation of ‘risk vs benefit’. It not working would be a risk. He told me it works about fifty to sixty percent of the time. ‘Works’ means the horse performs better when the medication takes effect. It never said for how long or what effect on the overall outcome.

What is being sold today is the same thing I bought then. It has not changed, and I see no indication that the percentage has changed either.

I am interested in how it may be involved in cancer (read pubmed 18450475, showing HA concentration in tumors, and other articles about the possibility of using it to transport drugs to tumors because it appears to have an affinity for tumors). How that research goes would influence whether I would use HA or not specifically.

If HA would interact with some or all cancerous cells and encourage their growth(when not coupled with a chemotherapy drug), or if using HA would interfere with tests for cancer, or treatment of cancer, I would avoid it.

If no clear guidelines had yet emerged, but there were indications that HA had a yet unclear role in cancer, treatment or detection, I would also avoid it until the situation were more clear.

I see three basic situations in which people inject joints:

1. horse reaches ‘a certain age’, he ‘needs injections’. No problem with resistance, stiffness or lameness. Just needs it because he has reached that age.

I would not inject his joints with HA. Joint injection always involves some risk. The risk-benefit balance in this situation does not make sense to me, especially since HA injections may do nothing.

2. Horse is resistant in training, a little stiff sometimes.

I would not necessarily use HA. I would try to address the problem through changes in training.

Perhaps the horse is not fit enough, and is resistant or stiff because he is muscle sore or his saddle puts his rider in a bad position on his back. HA does not improve muscle soreness or fitness or saddle fit. The horse would need more progressive work and to reach a higher level of fitness, a new saddle, etc.

Perhaps resistance is due to poor riding or training. HA will not address that. Horses easily get bad habits if the rider makes little mistakes or isn’t correct in his riding and position.

If xrays showed mild age-related changes in his joints, I might consider HA. I have never seen any studies that actually show how much routine HA injections over a longer time change the eventual outcome in this sort of situation, or the QOL along the way to the eventual outcome.

3. Horse has an actively progressing joint disease with major changes in the horse’s xrays - bones fusing, articular surfaces changing and causing obvious pain and lameness.

I have never seen any studies that indicate HA has any ability to change the overall outcome of an actively progressing disease process.

If it were to delay a horse’s retirement, I might consider it, but I have no proof that a delay would be substantial.

I also have no proof that it would not lead to more disability and discomfort of the horse after it was retired and the injections ceased.

Perhaps the horse would be comfortable if it were maintained the rest of its life on HA injections - but that is an expensive proposition over many years for a retired horse, and again, no research on long term effects or results.

Especially with no indication as to what percentage of the time it works, what types of cases it works with, or what the likelihood of adverse effects is, or what type of adverse effects there might be, the risk benefit balance on this particular treatment for me, is heavy on the risk side. Especially with older horses more frequently getting cancer, I would be reluctant to give a retired older horse HA injections for a long period of time until that research gives clear guidelines.

[butlerfamilyzoo]

I talked with my vet extensively about this early this year about a 12yr old horse that had been used hard in life and put away wet (prior to me). She said NO NO NO. Not at his age. Try everything else first, better joint supplement, adequan, legend, all day turn-out, keep him moving, really good warm up before asking him to really work, etc.

Her reason of saying no is that (her words here) you can only stick them so many times. She said it hardens the cartiledge over time. You cant stick a needle in a rock. IF you do it at all, wait until the horse is at least 16 so you can keep it going into its 20s. Of course, that is if it even gave you the desired results.

So after my discussion with her, i wont inject until MUCH later in life if at all. She was really against it. Said its handed out as a miracle cure and its not, it has more risk than “cure”. That being said, she does a ton of barrel and cutting horses around here, and its only confirmed her reasoning.

I think its really sad that so many horses are injected today before they even hit their teens. It would be interesting to watch these horses and see if they have to retire by mid teens.

Now, has anyone had knee injections THEMSELVES? You want to talk about one of the most painful things i’ve ever experienced. I’ll equate it to child birth. And we do this to our horses?! What good souls they are to not just kill us and get it over with.

[alicen]

I was just going to ask about human joint injections. Do they work? What are long range consequences? Are they desperate measures prior to joint replacements?

[slc2]

HA was approved for use in humans some time after it started being used in horses. There are a lot of ads, and very little actual research on either humans or horse.

19889285:

With the aging of the baby boomer generation, the number of patients with osteoarthritis (OA) is expected to swell, posing treatment challenges. Viscosupplementation, in which hyaluronic acid (HA) is injected into the knee joint, has evolved into an important part of our current therapeutic regimen in addressing the patient with knee pain due to OA.

Although suffering from lack of an “evidence-based” approach, and largely funded by industry, there is a growing body of outcome data demonstrating the efficacy of HA in decreasing pain and improving function in patients with knee OA, although no evidence indicates that HA is in any way chondroprotective. The clinical success of HA has led to the ongoing introduction of various forms of HA, although little data are available to justify one over the other.

chondroprotective means protecting cartilage.

[mvp]

Inject with WHAT?

I think vets and researchers worry about the relationship between steroids and cartilage.

There are many chemicals can put into a joint, including different steroids which are the most commonly chosen ingredient. Just what is being injected, for what purpose and with what expected outcome ought to be the question put to your DVM as part of the decision to inject.

[PaddyUK]

[QUOTE=goeslikestink;4581592]
i wouldnt do it just for the sake of doing it

in all my years of horses i have had to have any and in uk as far as i am aware its not a done practice unless the horse needs it for medical reasons[/QUOTE]

GLS is right it’s just not done as a matter of course unless a horse is in need e.g. arthritis or spavins. Then it would not compete.

I have to say it seems a very none UK thing to think of joint injections as maintenance. I know my Vet would refuse, just so I could carry on competing. He’d probably drag me out by the hair and give me a bloody good lecture.

So shoot down us Brits, but that’s the way it is here.

Paddy

[Gloria]

A few months ago my husband had an injection into his shoulder. I can’t remember the specific name of the drug used but it was very similiar to what we injecte horses’ hocks. His doctor also told him that if the effect lasted less than 6 months, it’s not worth repeating. It did help but only for about a month or two.

If it is not worth it if the effect last less than 6 months, why is it worth it for horses to get injected on a regular basis?

[Dressage_Art]

[QUOTE=poltroon;4581556]
I would not mess with the joint unless the horse is showing discomfort.

On the other hand, if the horse is showing discomfort, I wouldn’t hesitate to do injections. It’s wonderful to have these in our tool kit compared to the Bad Old Days.[/QUOTE]ditto. If the horse really needs it, if there is a lack of the lubrication or there is an inflamation/swelling then you really do need to ether help your horse with injections that will provide an additional lubrication of the joint and reduce the swelling/inflamation or you need to reduce the work out of that horse to make it easier on his/her joints.

If you have questions how it feels/works, just ask any human who gets injections in their joints. It really can make a huge difference IF its needed.

PS: I see some nqr horses with flat tire and a very labored gaits that are used for lessons and such. Most of them will benefit from the injections, but are not done since the cost of it. Yet, Im against injecting the sound horse just in case it will give an extra vrrrrooom in extensions and sit in pirouettes - yet those are the most injected horses. I was told by a German pro that they start injecting their horses when they are 7 years old.

[butlerfamilyzoo]

Paddy, i wish we could be like the UK. I swear injections are handed out like candy here! Its just common practice.

Would be interesting to have a human sports DR here get on and say what long term effects for humans it has. Do they inject their top $$$ athletes? Or is it a risk they wont do.

I dont get a whole lot of info from my military doctors about my knees. To be honest, i’ve given up on them and have gone on my own trying to maintain soundness. I’ve done a far better job. What works? Joint suppliment and STAY MOVING.

I think so many horses are lame too early from being stuck in stalls. I know some cant help it due to lack of turn-out. But those that try to pamper and protect their horses, the internal damage of standing is just as bad as the risk of injury in the field. Let them be horses!

[Dressage_Art]

[QUOTE=alicen;4581672]
I was just going to ask about human joint injections. Do they work? What are long range consequences? Are they desperate measures prior to joint replacements?[/QUOTE]Not quite, they work for soft tissues injuries as well. After an acute injury, I wasnt able to flex or unflex my right hand fingers much for about 6 months. They were frozen. I was in the weekly, 3 day per week PT for more than a year. My choices were to do the surgery to permanently cut some of my nerves and tendants on my hand or try injections and more PT. Injections reduced the swelling so I was able to continue PT for the range of motion. I avoided the surgery. But I did do anything to reduce swelling/pain in my hand - even if its only temporary. My doctor told me to quit riding, since its too much strain on my hand. My hand never will be the same, I have a clinically diagnosed permanent injury on it with limitation of what I can do, but I think since I tried about everything to make it work, and I was able to continue riding.

PM:Those injections were VERY painful for me.

[AllWeatherGal]

Showing or not, I’d support my elderly horse however necessary to keep him or her comfortable.

A vet encouraged me to use Legend (IV) a few years ago with my last elderly horse and the difference was well worth the regular maintenance. He just seemed happier and more comfortable throughout his body. I learned to do the shots myself (which was the worst part of it all) and we both enjoyed his last working years together.