Multicenter study investigating long-term survival after synovial lavage of contaminated and septic synovial structures in horses presented to 10 UK referral hospitals.

OBJECTIVE: To report the long-term survival of adult horses that were subjected to synovial lavage for treatment of contaminated and septic synovial structures. STUDY DESIGN: Multicenter, prospective observational trial. ANIMALS: Horses (n = 240) presented for synovial sepsis at 10 UK referral centers. METHODS: Data for horses presented for treatment of synovial sepsis were collected over a 15 month recruitment period. Owners were contacted a minimum of 365 days after surgery using a structured client interview to assess long term survival. Descriptive statistics, and univariable and Cox proportional hazards models for postoperative survival time were developed. RESULTS: Survival to discharge was 228/240 (95%) and overall long-term survival was 89.4% (185/207). Unknown cause of injury (p = .017), increasing duration of surgery (p = .003), increasing weight (p = .008), forelimb injuries (p = .027), and type of synovial structure (p = .008) were found to be associated with death using Cox proportional hazards models. CONCLUSION: This study provides information on risk factors associated with survival and death after treatment for synovial sepsis at referral hospitals in the UK. Survival to discharge and long-term survival was excellent. Heavier horses, injuries affecting the forelimbs, tendon sheaths and bursae were associated with poorer long term outcomes. Longer duration of surgery was also found to be associated with a worse prognosis. CLINICAL SIGNIFICANCE: These findings help to provide prognostic information for owners and veterinarians treating horses with synovial sepsis.

Minimally invasive cranial ostectomy for the treatment of impinging dorsal spinous processes in 102 standing horses.

OBJECTIVE: To describe a minimally invasive cranial ostectomy for the treatment of impingement of dorsal spinous processes (DSPs) in the standing horse. STUDY DESIGN: Retrospective study. ANIMALS: One hundred two horses with impinging DSPs. METHODS: The case records of all horses that had the described technique between 2011 and 2019 were reviewed. All sites of impinging DSPs were treated under standing sedation and local anesthesia. The minimally invasive cranial ostectomy of the caudal DSP was performed with bone rongeurs through multiple small incisions. RESULTS: Of the 102 horses treated with this technique, no surgical complications were recorded. Median (range) long-term follow-up for all horses was 18 months (12-50 months) postoperatively. Of the 66 horses available for follow-up that were still alive, 53 horses (80%) had complete resolution of clinical signs and returned to the intended work. There were 36 horses with a concurrent orthopedic issue presurgery, and 25/36 (69%) returned to the same level of intended work; of the horses with no evidence of another orthopedic issue presurgery, 28/30 (93%) returned to the same level of intended work. CONCLUSION: Minimally invasive cranial ostectomy of the caudal DSP had a good success rate in horses with impingment of DSPs. CLINICAL SIGNIFICANCE: The described minimally invasive ostectomy technique in standing horses is a low-risk procedure that provides success rates similar to other techniques.

A scoping review of the current evidence on treatment and outcomes following synovial sepsis.

BACKGROUND: Synovial sepsis is a frequent cause of morbidity and mortality in horses. Despite advances in diagnostics and treatments, persistent infection or chronic lameness can occur. OBJECTIVES: To perform a scoping review to identify and evaluate the current evidence on the factors implicated in the success of treatment for synovial sepsis. STUDY DESIGN: Joanna Briggs Institute scoping review. METHODS: A protocol was registered, and a systematic literature search was performed on CAB abstracts, Medline, Scopus and Embase. Inclusion and exclusion criteria were developed and studies systematically reviewed against this. Studies relating to factors affecting treatment success following synovial sepsis were retained and data was extracted on study method, population characteristics and factors significantly associated with treatment outcome. RESULTS: In total, 2338 studies were identified, and 61 were included to full paper analysis. Eight papers reported significant factors, identifying 15 risk factors associated with two measurements of outcome, either survival and/or return to athletic function. The 15 factors were identified and categorised into pre-, intra- and post-operative factors. Risk factors that were identified included the number or type of synovial structures involved, the presence of pannus, tendon and bone pathology, and the use of systemic antimicrobials. There were many discrepancies in inclusion criteria of cases of synovial sepsis as well as measurement and description of outcome variables. MAIN LIMITATIONS: Non-English language studies or conference proceedings were not included. Only small numbers of papers had similar findings. CONCLUSIONS: Standardisation of inclusion criteria is essential to enable comparisons and analysis between studies on synovial sepsis. Future studies should use methodologies to reduce bias including multicentre and multinational studies, prospective study design and robust statistical modelling.