my experience with joint injections

I wrote yesterday about getting Charlie "up to date on his annual maintenance," and figured it might as well merit a dedicated post about what that actually means: Joint injections.

First, some background: Like many off track thoroughbreds, Charlie started receiving joint injections (typically some form of hyaluronic acid, more below) during his racing career. To my knowledge, he had his hocks and stifles done on the track.

the fields are so pretty at dusk!

My understanding is that these injections manage joint dysfunction (especially in cases of horses with arthritic changes) by increasing fluid viscosity and lubrication of the joint. (A joint being: any place in the body where two bones meet.)

Conventional wisdom suggests that once horses start this degree of intervention in joint care, it often commonly becomes a necessary "routine maintenance" for them to remain comfortable. Tho, my impression is that this depends on which joint you're treating.

amazing how quickly the ground has dried out this spring

Hocks, for instance, are commonly treated joints -- frequently you're injecting the joints between small bones within the larger structure, joints that have small gaps with minimal range of motion (Purdue has a nice diagram in this pdf) -- and Charlie's been on about a yearly schedule with them. I've also done his stifles once, and his front coffin joints too. 

Personally, the stifle injections didn't do much to address what I felt in Charlie's way of going -- whereas the hocks make a big difference. The coffin injections also made a big difference, and might be something we repeat in the future. Tho that treatment had less to do with 'routine maintenance' and was more circumstantial (drought year / very hard ground).

ugh i'm the absolute worst at scheduling, apparently. it's gorgeous out right now while charlie's stuck in his stall :(

I'm also not ruling out additional areas of treatment in the future: for instance, at some point we may take a closer look at Charlie's SI joint or neck. At present, however, the vet does not feel like there are any compelling presentations in the horse to justify further diagnostics. 

his field had been temporarily relocated onto grass too while a fence is repaired. sorry buddy, i kinda blew it for ya ugh

But --- it's important to note here: This is all based in my own personal approach to medical interventions in horses. Joint injections inherently carry enormous risk. Any time you open a joint capsule and introduce a foreign body (needle, drugs), you also risk introducing infection.

And joint infections are extremely serious. At their worst, they can threaten the long-term soundness or even the horse's life by creating inflammation and surface roughening within the joint itself -- an extremely painful and often permanent injury.  

marching in to meet his fate

I've also heard in conversations with trusted horse people (who, as we all know, are always FULL of opinions) that there's somewhat of a limit to how many times you can inject any single joint. 

That, after a certain point, you face diminishing returns and may find you're having to inject more and more often to keep the horse comfortable for work. Eventually, the horse may need to step down from the work when treatment is no longer sufficient or even humane.

drunk charlie gets scrub-a-dub-dubbed

So... Even tho joint injections are 'normal' and 'common,' they're not something to be taken lightly or without full deliberation of the associated risks. There are folks I respect immensely who avoid injections at all costs. 

Personally, I'm a little more comfortable with them (acknowledging my limited experience). The key is that: your mileage may vary and it's important to talk through options with your team if you're considering injections. 

the "sterile field" of instruments, drugs, scrubs etc... plus random unrelated grooming spray lol

I've owned Charlie for about 4.5 years at this point (how time flies!) and have used three different vets for his hock injections. It's interesting to me that each vet has a slightly different approach and practice. 

Differences can include the actual chemical substance injected (which has the most direct bearing on price and potential longevity of the injection), whether there's also an antibiotic included in the injection compound, and after-care as it relates to stall rest or turn out timing. 

i spy with my little eye, a feline interloper drawn as if by magnets toward said sterile field

For Charlie's most recent treatment, the primary injected drug (by a factor of about x10) was Hyvisc, a hyaluronate sodium compound. Secondary injection ingredients were MPA (an intra-articular (IA) corticosteroid), and amikacin (an antibiotic used as a preventative in this case).  

Obviously, the injection sites (inside and outside of each hock, TMT and DIT joints) were scrubbed aggressively and continuously for many minutes using a couple different antimicrobial solutions in preparation.  

each hock had two sites - making for somewhat precarious positioning 

The horse also received a number of drugs intravenously -- including sedation, obviously, to keep both horse and vet as safe as possible during this highly precise task. 

Other IV drugs included a shot of gentamicin (another antibiotic as added protection against infection) and bute for any pain relief. Charlie will get bute orally in his meals the next two days.

a rare moment of charlie standing on nearly all four legs.... he's the kinda drunk mess that likes to teeter and totter around on a tight rope. makes me hella nervous lol

This vet prefers to bandage the hocks post-injection with elastikon, and have the horse remain in stall rest for ~3 days. Previous vets have used Alushield as a liquid bandage over the injection sites and allowed Charlie to return to turnout immediately post-treatment. 

Personally, having seen Charlie do just fine with minimal post-treatment limitations... I tend to think that for this type of injection it's probably fine for them to go right back out again. However, I'm also a big believer in using the advice I buy from the professionals on my team. So if this current vet wants stall rest, that's exactly what we'll do.

She also recommends hand walking during the ~3 day stall rest period, then returning to turn out and resuming light work under saddle. Then, you're basically good to go! 

random shot of the beginning of this season's hoof woes. trying to get an early start this year!

Honestly, the most important part of post-care is observing the horse for any signs of septic joints. This would include a sudden change in the horse's behavior (lethargy, fever, loss of appetite), and extreme lameness and swelling. 

I've been told by a couple different vets that the lameness from joint infection is so obvious even Stevie Wonder could see it. In other words, you really don't need to guess if you're dealing with injection complications -- it's generally pretty clear and presents in the first day or two. Personally, I haven't experienced this myself -- it's just what I've been told. 

sad lonely pony prisoner

This whole process is fairly interesting to me -- tho (as always!) it's important to note I'm not a professional and Charlie is my first horse, and therefore the horse from which I learn the ins and outs of this type of treatment and care. I'll be curious in 5 or 10 or 15+ years, or with a future horse, when I look back on how I handled Charlie's care... Will I wish I had been more aggressive? More conservative? Or will Charlie be the model for how I approach all future creatures? Who knows!

Most of what I've learned about this type of maintenance has been learned through conversations with friends and barn mates and various professionals, or read on other blogs or forums or in articles etc. And so much of it.... kinda depends on who you ask, as seems true with so many aspects of horse care. 

So I'm curious -- have you ever done joint injections? Were your experiences similar to what I described? Or are there meaningful differences in drugs used or post-care treatment? Have you had to deal with a joint infection? Or maybe you avoid injections entirely, or in retrospect regret going down that route with a horse? Are there alternative treatments you turn to first? Or maybe a simple injection was a game changer for your horse in making them more comfortable and happy in the work?