What to use for hock injections in metabolic horse?

[TWH_Girl]

Options given by lameness vet for lower hocks in 20 yr old pleasure horse are:

• Arthramid (675- discounted as she has not used much and would waive injection fee- she has used Noltrex quite a bit more but it’s too thick or lower hocks)
• Prostride (1000- hit or miss with hocks per vet; I’ve used in stifles and it was meh so doubtful of how much it may help hocks)
• Alpha 2 (1500 but would have enough product left to freeze for next time he needs his stifles done so that is sort of a nice benefit)
  This is a newer product so I had to look into it: [Alpha2EQ – Active Biologic Therapy for Lameness and Osteoarthritis](https://alpha2eq.com/

WWYD?

[No1]

Alpha 2. While I have not yet used it in my personal horses, I have spoken to others who have used it very successfully.

It’s my understanding that Noltrex is for high motion joints, so not really the hocks. I’m not sure if Arthramid is the same.

[Roni4444]

I use PRP and have had great results

[theresak]

Just be aware and make sure your vet is that the Arthramid might need to be repeated within 3 months to get the most benefit. If it works, it is supposed to really work and hold for a long time.

[SolarFlare]

Noltrex was originally recommended for high motion joints, but after further research they are now recommending it for low motion joints as well.

I used Noltrex last year for lower hocks, and we’re waiting to see how long it will last. This horse regularly gets 1 year from HA injections. He’s now been 16 months with Noltrex and vet says he thinks we can wait until early spring before show season to redo them.

I’ve asked my vet about Prostride (expensive up here in Ontario) and he says he sees no reason to use it since he and I are seeing such good results with the Noltrex. He’s used it quite a lot for his clients for years because of the results.

[OneDayMore]

My 20 year old retiree got Alpha 2 EQ for his hocks and coffin joints back in May and it’s worked well for him so far.

[TWH_Girl]

Interesting…did you have enough product left to do future injections if needed? I could do his hocks now and stifles in spring if I went this route.

I was not wowed by ProStride (in stifles) though, so I am a bit hesitant on trying another biologic. It has helped to some degree in the stifle, but I can’t wrap my analytical head around how PRP type products like Alpha 2 can help joints like hocks, though I am leaning towards trying the Alpha 2…

[TWH_Girl]

How old is your horse? I imagine age/joint space would be a factor for using a thicker hydrogel like Noltrex in hocks. I did like Noltrex for stifles though. I was told no to Noltrex for my guy for his hocks

[TWH_Girl]

Definitely not up to repeat in a few months…ugh no to that

[SolarFlare]

@TWH_Girl

How old is your horse? I imagine age/joint space would be a factor for using a thicker hydrogel like Noltrex in hocks. I did like Noltrex for stifles though. I was told no to Noltrex for my guy for his hocks

He’s a 16 year old OTTB and has needed his hocks done since he was 8. I don’t have recent xrays but he’s got enough space to inject the Noltrex based on the fact that my vet didn’t have any problems

Arthramid is a similar product so I don’t know if that would be any less viscous than the Noltrex - not sure why your vet is saying one is fine while the other isn’t (although I haven’t used Arthramid so maybe it is thinner).

[TWH_Girl]

Yeah idk- here is her complete message:

'The Noltrex product is a bit too thick to really get in the lower hock joints. The Arthramid is much easier to inject in small joints and is an option. I have to confess that I have not personally used arthramid in the lower hock joints (I don’t think anyone from our clinic has), but clinics elsewhere in the country are using it and reporting good success. If you wanted to try it, I would discount the injection fee ($199.50) since I don’t know truly what response to expect. With that, cost to treat both hocks would be ~$675.

Prostride I think is hit or miss for helping with lower hock joints, so up to you if you think it helped when it was used previously. Cost on that would be ~$1000. The alpha 2 I think works well, and gives you a large volume that can be stored up to 6 months for future injections, but the upfront cost for processing is higher. Cost on the alpha 2 for the processing kit and injection of hocks only would be ~$1500. If you elect to try the alpha2, he needs to be off Equioxx for 5 total days before his appointment as this medication affects the quality of the product once processed from his blood. Additionally, this takes about 45 minutes of processing time alone, just to be aware of from a timing standpoint. ’

[No1]

Alpha 2 is not a PRP product, although it is a blood product. It’s much more like IRAP, if you’re familiar with that?

It’s a protein that inhibits inflammation and helps protect cartilage.

[OneDayMore]

Yes, his vet said she had enough to do a second round if needed. He’s got a re-check coming up at the end of the month and we’ll see if he needs to use the rest then.

The vet did say that it’s only good for about six months, though, so if he doesn’t need more at the upcoming appointment I think we’ll have to start from scratch in the spring. I’ve happy with the results and I’d use it again.

[TWH_Girl]

The description on their website makes it sound somewhat comparable to PRP but yes, I understand the anti inflammatory portion is different- just similar in being a blood product and methodology.

How does Alpha2EQ compare to other PRP (platelet-rich plasma) or stem cell therapies?

AlphaActive is a highly improved process leveraging PRP methodology derivative of Platelet Poor Plasma (PPP) that concentrates plasma proteins from the equine patient’s own blood. Alpha2EQ provides the highest level of concentration of α2M in plasma available on the market today — up to five times more than naturally occurring levels.

[TWH_Girl]

Thanks for the insight!