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General Arthroscopy

Arthroscopy or “key hole” surgery has revolutionized joint surgery in both humans and horses. In horses it is routine to remove chip fractures, OCD lesions, lavage and evaluate infected joints and evaluate synovial structures in general (e.g. joints and tendon sheaths). This type of surgery is in a majority of cases performed under general anaesthesia but in selected cases the surgery can be performed in standing horses under intravenous sedation.

Laparoscopy is an exciting new ‘key hole’ surgery technique to allow access to the abdomen and chest cavities without the need for large incisions.

Laparoscopy is perfect for:

  • Cryptorchids (rigs) – the testicle is removed using small portals and don’t require a large surgical incision. They return to work often in as little as a weeks’ time after surgery and avoid a vast majority of potential complications associated with rig surgery in general (infection, bleeding, swelling etc.)
  • Colic – In select cases further investigation of abdominal pain can be aided with a lapraroscopic exam rather than a large abdominal incision. The benefit of using laparoscopy is that often the problem can be identified and potentially remedied without the cost and recovery time associated with a full routine colic surgery. In a certain type of colic (nephrosplenic entrapment of the large colon) the space in which the colon becomes entrapped can be closed and prevent the colic from ever re-occurring.
  • Barren Mares – Occasionally in mares (especially older mares) they become inexplicably barren even after previously being successfully bred. If a routine breeding soundness examination is normal then it may be that laparoscopy can hold the key to returning them to pregnancy. The fallopian tubes (connect ovary to uterus) can become blocked with cellular debris that prevents the embryo from entering the uterus and as a result prevents mares from becoming pregnant. There is an excellent treatment option for this problem involving laparscopic application of a hormone to the tubes that has a very high success rate. Alternatively, in some mares (again often older mares) the ligament that suspends the uterus in the abdomen can become stretched allowing fluid and debris to accumulate preventing pregnancy. In these cases imbricating (shortening) the ligament by a laparoscopic procedure can return them to fertility.
  • Hernia repair – scrotal hernias and incisional hernias are amenable to laparscopic techinques for repair.

A variety of procedures are performed that improve breathing in horses with airway abnormalities. The procedures commonly performed include tie-backs (Figure 1), arytenoidectomies, tie-forwards and a variety of laser assisted surgeries. The laser surgeries of the respiratory tract are performed in either a standing sedated horse or under general anesthesia. Surgery of the head, nasal cavities, guttural pouches and sinuses are also regularly performed.


Figure 1: tieback pre and post-surgery evaluated using DRS.

Fractures

Fractures in horses have historically been considered life ending injuries. This is no longer the case at all in a majority of situations. It is still unfortunately true in a few situations where there a large open fractures with severe contamination but fractures that were considered hopeless even 5-10 years ago can now be repaired successfully. These improvements have been due to continued advances in techniques and equipment available that are designed to be used in horses.

Repair of long bone fractures or break down injuries are common examples where with careful pre-operative planning and appropriate case selection surgery can be successful in salvaging horses lives and in some cases their athletic careers. There are often multiple options available and due to the availability of three specialist surgeons there is a wealth of clinical and research experience available and these options can be clearly and simply explained to you if in the unfortunate case your horse sustains a fracture. It is a simple matter to call and ask for advice and rest assured the veterinarians at REC will do discuss the best possible options and ensure the quality of care you want for your horse.


Figure 1: Repair of a spiral medial condylar fracture of a cannon bone with lateral plate and lag screws.
Figure 2: Repair of a third carpal bone slab using key hole techniques.

Severe cases of arthritis also have benefited from recent advances in surgery. Horses with severe degenerative joint disease can have most joints in the limb (and spine) fused. As an elective procedure the prognosis is much better than for open fractures and in some cases the horses can even return to very successful performance. Arthritis of the pastern joint, fetlock knee and lower hock joints are all candidates for arthrodesis (fusion) of the joint.


Figure 3: An example of a pastern arthrodesis where screws and plates have been used to fuse the joint.

Foals Angular Limb Deformities

Angular limb deformities range from mild (that often only requires conservative treatment) to more severe potentially life or career threatening deformities. There are different options for treating these young horses and the choices made can make serious differences in the outcome and the cosmetic appearance of the rapidly maturing horse. It is essential and often quite a difficult decision regarding the most appropriate course of action. Often a phone call and discussion between your veterinarian and any of the three surgeons will give you the most up to date and accurate information so that you can make an informed decision.


Figure 4: Radiograph during surgery of a transphyseal screw placed across the growth plate to straighten the leg.

Colic is the major cause of death in horses after old age. It is often an extremely traumatic and life threatening problem for your horse. It is essential that this emergency situation is seen by your veterinarian immediately after you notice any signs of colic (pawing, rolling, not eating etc.). This early prompt evaluation will often be a relatively minor clinical examination and often requires minimal and occasionally no treatment. However, in a minority of cases this clinical examination can be the difference between life and death for your horse. Your veterinarian or the veterinarian from REC with extensive experience is trained to detect the situations were further monitoring or treatment may be indicated and in the even smaller number of cases when emergency lifesaving surgery is required. As for fractures the prognosis for colic surgery in horse has dramatically improved over the last 10-15 years. There are numerous reasons for horses to have colic ranging from spasmodic colic to large colon twists (volvulus) which are all associated with different outcomes. However, with surgery today approximately 70-80% of horses that need surgery are discharged from hospital to resume a normal life with routine activity in a large percentage of these cases. The full range of staff from surgeons, clinicians, residents, interns and nurses provide around the clock intensive care as required to ensure every possible comfort and care is provided for your horse.


Figure 1: Horse during colic surgery and after surgery on intravenous fluids.

Including cryptorchidectomy, neurectomy, dentigerous cyst removal, guttural pouch and esophageal surgery are regularly performed by our surgeons. Surgery of the mares’ reproductive tract for selected breeding problems are also available.

REC provides a full equine ophthalmology service. From clinical assessments, ophthalmic ultrasound & medical management of common eye problems to surgical repair of deep corneal ulcers, abscesses, lacerations and ruptures as well as tumour resection. We also have an excellent working relationship with two registered specialist veterinary ophthalmologists who can provide further expert opinion if required as well as perform specialist procedures such as cataract removal surgery.

Management of the patient with colic or colitis frequently involves continuous intravenous fluid therapy, and we have the facilities and nursing support to provide this service.

A plethora of other diagnostic procedures are carried out in the clinic including transtracheal aspirates, bronchoalveolar lavage, thoracocentesis, abdominocentesis as well as upper and lower airway endoscopy and computer radiography.

We have the facilities to diagnose neurological disorders and perform myelograms under general anaesthesia to document cervical vertebral malformation or “wobbler” syndrome.

We have a 3m video-gastroscope that can be used to examine all areas of the stomach, including the pylorus and proximal duodenum. A practice based study was published in 2003 where results of gastroscopy in 345 racehorses were documented.