Experience with PIP (pastern joint) arthrodesis?

[intrepidfox]

Hi everyone. I lurk more than I post, but I have no experience with this and wondered if any of you might have? Any insight, recommendations or comments are most welcome!

X-rays just confirmed high ringbone in the left hind of my coming-4 year old OTTB. He was sound when I pulled him off the track in late September; ran the best race of his life (granted, still not very good) the day before I bought him. He'd only run 3 times and not until 3, so I didn't do much PPE - he flexed sound and came home. However, within a few weeks of his arrival something aggravated the pastern joint and he's been off for a few weeks. The films show both articular and peri-articular bony changes. My vet is tentatively recommending fusing the joint; the joint team at Cornell is evaluating the film to give a second opinion, and recommend an approach. (2 screws vs screws and plate vs spoon plate).

The prognosis is apparently quite good for a hind limb, but I have no idea what to expect. I've got major medical on him, but since the bony changes didn't happen overnight I half-expect the insurance company to try to claim it's a pre-existing condition, though he's never manifested any lameness or been diagnosed with ringbone. Anyone ever filed a claim like this on a horse they'd only owned a few months??

Anyone encountered lameness-inducing pastern DJD and taken some other course of action that worked? My vet thinks it would take eons to fuse on its own and the horse is clearly uncomfortable.

I love this horse to death, and want to do all I can for him, though I've only owned him a few months. He's got an awesome mind, and my ambitions are limited, so his low-motion joint isn't likely to be the limiting factor in his career with me. However, I lost an uninsured filly to colic this summer, so I just don't have the resources to do the surgery if my insurance company declines the claim...

Oy. I am feeling so sad about this... but at least it's something that can be addressed.

[jenarby]

Any chance doing IRAP on him would help?
We did it on one of our horses (the hock) and it has done wonders for him. His films were clean but he had a ton of swelling all around the joint. He had cast himself in the stall so we don't exactly know what he did. The result was massive amounts of fliud in and around the joint and he's lock up (straight legged). It was not the stifle....the vets were baffled. KNocking wood, so far so good and the amount of fluid as decreased.

[intrepidfox]

Thanks, Jenarby -- I think because the films are not clean (bony changes in and out of the joint), and he's been off for weeks now and getting worse even on stall rest/hand walking, both my vet and the head of joint surgery at Cornell believe that fusing the joint is his best, and fastest, chance to come back to useful soundness. Apparently the Cornell vet saw what she thinks is a small fracture near the joint, which accelerated the calcification and aggravated the joint.

So he's going in on Monday for final evals, and surgery is scheduled Tuesday. Then six to eight weeks in a cast and 3 to 4 months of stall rest. Yahoo -- we all know how 4 year old TBs love stall rest. But the prognosis for him to return to full work within 6 to 12 months is good. Based on recent studies, his chances are between 90 and 95%, probably on the high side since he's young and it's a hind limb. And this is a specialty at Cornell, so I am lucky to have a top surgeon in the field to do the procedure.

Thank goodness for insurance (they've approved the surgery), and if it was going to happen at any time of year now is the time. We've been below zero for days now, with 3 feet of snow on the ground and accumulating daily, so not much riding is going to happen any time soon regardless...

[jenarby]

I'm glad your insurance is going to cover the surgery. Thnka goodness for it!
I can only remember one horse we had here in the past with something similar to what your horse has. It was a front ankle and when we claimed her she was already ruined and we didn't know it. She had won that night and looked sound....but after a week or two we realized she wasn't sound and got worse each day. Films showed severe djd, an ulcer in the joint and very little cartilidge left in the ankle. The vet said a screw could be placed in the ankle but felt she'd do better with turn out and letting it fuse on it's own. He felt the healing time and confort of the horse would be the same. It took 8 months and she fused. I think everyone was shocked when we heard what was going on in the joint. She was broodmare sound and went to be a momma out west.

[intrepidfox]

The trajectory with my boy was similar, although he developed a nasty thrush infection a couple of weeks off the track that masked/augmented the pastern symptoms. We didn't really explore the pastern until we'd cleared up the thrush and he still wasn't sound. I contemplated trying to let it fuse on its own, but since the joint is low motion and the bony changes limited to one side of the joint, both vets think there's a good chance it wouldn't fuse, not at least for a few years.

I still believe the owner and the trainer didn't know; they were both wonderful, and the owner offered to take him back any time. It's even possible that the inflammation from the thrush aggravated the soft tissue around the joint and caused the flare up. But we'll never know.

My vet recommended this procedure for a 10 year old hunter he cares for, and 12 months after he's back on the circuit. I'm keeping my fingers crossed for a similar outcome.