Comparing racing performance following arthroscopic surgery of metacarpophalangeal/metatarsophalangeal and carpal joints in Thoroughbred racehorses rehabilitated using conventional and underwater treadmill therapies.

BACKGROUND: Rehabilitation of horses using underwater treadmill therapy has been shown to improve joint range of motion, joint mobility, stride length and proprioceptive parameters with experimental studies. However, studies investigating the prognosis and return to function following rehabilitation are lacking. METHODS: A retrospective study of Thoroughbred racehorses treated with arthroscopic surgery for osteochondral fragments of the metacarpophalangeal (MCP) or metatarsophalangeal (MTP) joints or carpal joints undergoing conventional rehabilitation or underwater treadmill assisted rehabilitation at the same facility were included. The objective of the current study was to investigate if underwater treadmill assisted rehabilitation following arthroscopy in the Thoroughbred racehorse was positively associated with returning to racing, time to return to racing and postoperative racing performance including Beyer Speed Figures. RESULTS: Surgery was performed on 165 horses on 174 surgical occasions; 70 (40.2 per cent) underwent underwater treadmill rehabilitation, with the remainder undergoing conventional rehabilitation. The time to return to racing was a median of 227 (IQR 185-281) days and 239 (IQR 205-303) days for underwater treadmill and conventional rehabilitation, respectively (P=0.16). Of the horses that raced presurgery, 83 per cent (58/70) of underwater treadmill rehabilitated horses and 61 per cent (63/104) of horses undergoing conventional rehabilitation returned to racing following surgery (P=0.02). CONCLUSION: Underwater treadmill rehabilitation is superior in returning a Thoroughbred racehorse to racing following arthroscopic surgery of the carpus and/or MCP/MTP joints.

The Use of Pneumatic Impact Lithotripsy in a Laparoscopic Retrieval Pouch for Removal of Large Cystoliths in Two Female Horses.

Two mares, aged 15 and 21 years, were examined because of urinary incontinence, intermittent hematuria, and urine scalding. On admission of both horses, physical parameters were within normal limits and urine scalding of the skin at the ventral perineum was noted. Transrectal palpation and cystoscopy revealed a large type I cystolith (>10 cm) with associated hyperemia and focal ulceration of the bladder mucosa. In horse 1, hemogram, serum biochemical analysis, and renal ultrasound were not performed because of owner finances. In horse 2, results from hematological and serum biochemical analysis were unremarkable and renal ultrasonography did not reveal any abnormalities. Pneumatic impact lithotripsy in a laparoscopic retrieval pouch was performed under cystoscopic guidance after caudal epidural anesthesia, with the horses standing and under sedation. A laparoscopic retrieval device was passed alongside a flexible endoscope into the urinary bladder and the cystolith was manipulated into the pouch. A customized single stainless-steel rod scaler attached to an air compressor was used for fragmentation of the cystolith contained within the retrieval pouch. Lithotripsy time was 42 minutes for horse 1 and 31 minutes for horse 2. Both horses were released from hospital the day of surgery. Both horses were continent and voided normal streams of urine for the duration of the follow-up periods of 27 and 19 months for horse 1 and horse 2, respectively. Pneumatic impact lithotripsy in a laparoscopic retrieval pouch provided a time-efficient and minimally invasive surgical treatment option for removal of large cystoliths in mares.

A survey of work-related musculoskeletal disorders associated with performing laparoscopic veterinary surgery.

OBJECTIVE: To assess the prevalence of work-related musculoskeletal disorders (WRMD) associated with laparoscopy in veterinary surgery. STUDY DESIGN: Cross-sectional survey. SAMPLE POPULATION: Veterinary surgeons who perform laparoscopy. METHODS: Responses were collected with data regarding laparoscopic activities and experience as well as whether the respondents experienced pain as a result of laparoscopy and, if so, additional information on this topic. Variables associated with the risk of experiencing pain were determined by using χ2 tests and odds ratios (OR). RESULTS: There were 149 respondents, an estimated 6% response proportion. Forty percent experienced pain that they attributed to the use of laparoscopic instruments during or after laparoscopic surgery. Surgeons who perform laparoscopic surgery frequently (at least monthly) were more likely to experience pain as a result of laparoscopic surgery compared with those who perform laparoscopic surgery infrequently (OR 2.25; 95% confidence interval 1.07-4.75; P = .033). Pain during or after laparoscopic surgery was most often experienced in the neck (81%), back (77%), and shoulders (75%), with 90% of respondents reporting that surgery exacerbated their pain. Fifty-four percent of respondents experienced the pain at home, 64% had taken painkillers for the pain, and 46% had sought other treatment for the pain such as physiotherapy, chiropractic treatment, or seeing a doctor. CONCLUSION: Laparoscopic surgery was a potential source of pain in a proportion of surgeons. Surgeons who frequently perform laparoscopic surgery were more likely to experience a WRMD. CLINICAL SIGNIFICANCE: Work-related musculoskeletal disorders may occur as a result of performing laparoscopic surgery.

Use of non-contrast-enhanced computed tomography to identify deep digital flexor tendinopathy in horses with lameness: 28 cases (2014-2016).

OBJECTIVE: To describe the use of non-contrast-enhanced CT to identify deep digital flexor (DDF) tendinopathy in horses with lameness attributed to pain in regions distal to the metatarsophalangeal or metacarpophalangeal joints. DESIGN: Retrospective case series. ANIMALS: 28 client-owned horses. PROCEDURES: Medical records were searched to identify horses that underwent non-contrast-enhanced CT with or without high-field MRI as part of an evaluation for lameness localized to areas distal to the metacarpophalangeal or metatarsophalangeal joint in ≥ 1 limb. Horses were included in the study if they had ≥ 1 DDF tendon lesion (DDF tendinopathy) identified. Signalment, lameness examination findings and response to perineural anesthesia, imaging modality, anesthetic agents and duration of anesthesia, and imaging findings were recorded. Data were summarized descriptively. RESULTS: Bilateral imaging was performed for all horses, irrespective of unilateral or bilateral lameness. Nine of 28 horses underwent both CT and MRI, and all DDF tendon lesions identified by one modality were identified by the other. Of 48 limbs with DDF tendinopathy, 46 (96%) had core lesions and 35 (73%) had dorsal border irregularities. Median anesthesia time for CT and CT followed by MRI was 15 and 110 minutes, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that non-contrast-enhanced CT was useful for identifying DDF tendinopathy in horses with lameness localized to the phalangeal regions, and this was supported by consistency of findings in a subset of horses that underwent MRI. Further research is needed to confirm these results.

A Standing Percutaneous Technique for Proximal Interphalangeal Joint Arthrodesis in Twelve Horses (2014-2017).

OBJECTIVES: This report describes the use of a minimally invasive standing pastern arthrodesis technique for the treatment of osteoarthritis in horses and documents its clinical outcome in 12 horses. MATERIALS AND METHODS: Medical records and radiographs of horses diagnosed with proximal interphalangeal joint osteoarthritis that underwent standing pastern arthrodesis using transarticular screws were reviewed. Follow-up information for determination of outcome was obtained via phone interview with the owners. RESULTS: Twelve horses (15 limbs) were included in the study. Radiographical findings revealed severe osteoarthritis in 12/15 limbs and moderate osteoarthritis in 3/15 limbs. Follow-up information was available for 11/12 cases (13/15 limbs). Phone surveys with the owners revealed that 8/11 horses were performing at their previous activity level or higher. Two horses remained lame. One horse developed a surgical site infection and was euthanatized. The average time for horses to return to their previous level of activity was 6.5 months (range: 1-18 months). CLINICAL SIGNIFICANCE: Stabilization of the proximal interphalangeal joint in horses with moderate-to-severe osteoarthritis can be performed using this minimally invasive standing technique. This procedure can be performed safely and provides a similar outcome when compared with other described techniques.

A minimally invasive surgical technique for ureteral ostioplasty in two fillies with ureteral ectopia.

CASE DESCRIPTION 2 fillies, aged 3 months and 1 month, were examined because of urinary incontinence and urine scalding. CLINICAL FINDINGS In horse 1, ultrasonography did not reveal any structural abnormalities of the kidneys; however, unilateral ureteral ectopia was diagnosed cystoscopically. In horse 2, CT revealed bilateral nephropathy, bilateral distended ureters (up to 3.6 cm in diameter), and bilateral ureteral ectopia. Cystoscopy revealed intramural ureteral ectopia with abnormally caudally positioned ureteral ostia in both horses. TREATMENT AND OUTCOME Ureteral ostioplasty was performed under cystoscopic guidance. Laparoscopic scissors (horse 1) or a vessel-sealing device (horse 2) was introduced, and the tissue separating the intramural portion of the ureter from the urethra and bladder was cut longitudinally in a cranial direction toward the trigone. After surgery, both horses were continent and voided normal streams of urine for the duration of the follow-up periods of 20 and 9 months for horse 1 and horse 2, respectively. CLINICAL RELEVANCE Cystoscopically guided ureteral ostioplasty provided an effective and minimally invasive surgical treatment option for correction of ureteral ectopia in 2 fillies.

Laparoscopic evaluation of the small intestine in the standing horse: Technique and effects.

OBJECTIVE: To evaluate the feasibility and clinical outcomes after laparoscopic evaluation of the small intestines via laparoscopy. STUDY DESIGN: Prospective pilot study. ANIMALS: Healthy adult horses (n = 5). METHODS: Horses were restrained in standing stocks and received an infusion of detomidine. One port was placed in the left last intercostal space and 3 ports were placed in the right paralumbar fossa. The small intestine was run with atraumatic laparoscopic grasping forceps, from the duodenocolic plica to the ileocecal plica. Postoperative pain was scored every 4 hours for the first 48 hours. Horses were monitored via physical examinations for 2 weeks. Second look laparoscopy was repeated at 2 weeks, to run the small intestine and assess iatrogenic changes. An exploratory celiotomy was performed in 2 horses, 2 months later and long-term follow-up was recorded in 3 horses. RESULTS: Laparoscopic evaluation of the entire small intestine was successfully completed twice in every horse. This evaluation lasted 39 ± 21.2 minutes (mean ± SD), while total surgery time was 73 ± 34.1 minutes. Postoperative physical examinations remained normal in all horses, and pain scores were scored as mild. The only abnormalities at second look laparoscopy consisted of multifocal petechiae and ecchymoses in all horses, resolved by 2 months in the 2 horses explored via celiotomy. Three horses with long-term follow-up were healthy 8 months after the study. CONCLUSION: Running the small intestine laparoscopically is a feasible procedure in standing normal horses, and does not cause significant discomfort nor complications.