Clinical use of antimicrobial regional limb perfusion in horses: 174 cases (1999-2009).
Abstract: To describe the clinical use of regional limb perfusion with antimicrobials (A-RLP), complications, and outcome in a large series of patients. Methods: Retrospective case series. Methods: 174 horses. Methods: Medical records of horses treated with A-RLP between 1999 and 2009 were reviewed. Signalment, primary complaint, horse use, etiology, duration of clinical signs, previous treatment, structures involved, concurrent conditions, A-RLP characteristics, additional treatments, complications, and outcome were recorded. At long-term follow-up, 2 outcomes were investigated: survival rate and return to previous use at the same or higher level. Univariate and multivariate logistic regression analyses were conducted. Results: Group 1 (96 horses) included septic synovitis. Group 2 (50 horses) included extrasynovial lacerations (23 horses) and fresh, minimally contaminated intrasynovial lacerations without evidence of established synovial infection (27 horses). Group 3 (28 horses) included miscellaneous other conditions. Only minor complications were reported in 12.26% of horses that received IV (n = 155) and 33% of horses that received intraosseous (27) A-RLP. Horses with septic synovitis had a lower survival rate (53.43%) than did horses with lacerations (91.89%). Within group 2, no significant differences in short- or long-term outcomes were found between horses with extrasynovial and fresh, minimally contaminated intrasynovial lacerations. For the horses returning to previous use, 80% of horses with septic synovitis and 72.72% of horses with lacerations were performing at the same or higher level at the time of follow-up. Conclusions: The results of the present study indicated that A-RLP is a safe technique with minimal adverse effects. The IV route presented fewer complications than intraosseous injection. Horses with infection of synovial structures had a lower survival rate than did those with acute, minimally contaminated intrasynovial lacerations. The latter had a similar prognosis for horses with extrasynovial lacerations treated with A-RLP.
Publication Date: 2012-12-12 PubMed ID: 23216042DOI: 10.2460/javma.241.12.1650Google Scholar: Lookup
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Summary
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This research article details an investigation into the use, complications, and outcomes of regional limb perfusion with antimicrobials (A-RLP) in horses, using data from 174 cases collected over a decade. The results suggest A-RLP is a safe technique with minimal side effects, but horses with synovial structure infections had lower survival rates.
Overview of Study and Methodology
- The study is retrospective, meaning it looks back on past cases. The researchers examined the medical records of 174 horses treated with A-RLP between 1999 and 2009 to evaluate the effectiveness and safety of this treatment.
- Among these records, the research team accounted for numerous factors including signalment (a description of the horse), primary complaint, horse use, etiology (cause of the condition), duration of clinical signs, previous treatment, involved structures, concurrent conditions, A-RLP characteristics, additional treatments, complications, and the final outcome.
- The horses were categorized into three groups: Group 1 (septic synovitis), Group 2 (extrasynovial lacerations and fresh, minimally contaminated intrasynovial lacerations with no established synovial infection), and Group 3 (other miscellaneous conditions).
Findings of the Study
- Only a small portion of cases resulted in minor complications. 12.26% complications were reported for horses that received IV A-RLP and 33% for those that received intraosseous A-RLP, although still indicating the IV route had fewer complications.
- Horses with septic synovitis (infection of synovial structures) had a lower survival rate of 53.43%, compared to horses with lacerations, who had a much higher survival rate of 91.89%.
- Within group 2, the study did not find significant differences in short- or long-term outcomes between horses with extrasynovial and fresh, minimally contaminated intrasynovial lacerations.
- For the survivor horses that returned to previous use, 80% with septic synovitis and 72.72% with lacerations were performing at the same or higher level at the time of follow-up.
Conclusions Drawn from the Study
- Based on these findings, the researchers conclude that A-RLP is a safe and effective treatment technique for horses with no major adverse effects.
- However, the study also underscores that horses with synovial structure infections have a lower survival rate than those with acute, minimally contaminated intrasynovial lacerations, indicating a greater risk associated with this specific condition.
- Ultimately, the research suggests A-RLP is a viable treatment option with mostly positive outcomes, though further research could help identify why horses with septic synovitis have lower survival rates and how to improve these outcomes.
Cite This Article
APA
Rubio-Martínez LM, Elmas CR, Black B, Monteith G.
(2012).
Clinical use of antimicrobial regional limb perfusion in horses: 174 cases (1999-2009).
J Am Vet Med Assoc, 241(12), 1650-1658.
https://doi.org/10.2460/javma.241.12.1650 Publication
Researcher Affiliations
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Canada. luis.rubiomartinez@hotmail.com
MeSH Terms
- Animals
- Anti-Bacterial Agents / administration & dosage
- Anti-Bacterial Agents / therapeutic use
- Catheters, Indwelling / veterinary
- Drug Administration Routes
- Female
- Horse Diseases / drug therapy
- Horses
- Lacerations / drug therapy
- Lacerations / veterinary
- Male
- Osteomyelitis / drug therapy
- Osteomyelitis / veterinary
- Retrospective Studies
- Synovitis / drug therapy
- Synovitis / veterinary
Citations
This article has been cited 16 times.- Guillot M, Mespoulhes-Rivière C, Bousquet-Mélou A, Lacroix MZ, Roques BB, Lallemand EA. Pharmacokinetics, pharmacodynamics, and local tolerance at injection site of penicillin and gentamicin administered by intravenous regional limb perfusion in standing horses: comparison between weightbearing and flexed limbs. BMC Vet Res 2025 Nov 7;21(1):650.
- Beggan CP, Panizzi L, Oliver LJ. Efficacy of needle and endoscopic lavage on the recuperation of microspheres from the adult equine metacarpo-/metatarsophalangeal joint and digital flexor tendon sheath. Vet Surg 2025 Aug;54(6):1157-1166.
- Loppnow Z, Kersh K, Wang C, Spaethe S, Troy J. Clinical use of antimicrobial regional limb perfusion in adult horses diagnosed with synovial sepsis or penetrating synovial wounds at a single equine referral hospital in the Midwest United States-163 cases (2010-2020). Front Vet Sci 2025;12:1504486.
- O'Brien M, Mochel JP, Kersh K, Wang C, Troy J. Phenylbutazone concentrations in synovial fluid following administration via intravenous regional limb perfusion in the forelimbs of six adult horses. Front Vet Sci 2023;10:1236976.
- Celani G, Straticò P, Albano P, Petrizzi L, Mortellaro CM, Varasano V. Clinical Efficacy of a Single Intravenous Regional Limb Perfusion with Marbofloxacin versus Ceftiofur Sodium to Treat Acute Interdigital Phlegmon in Dairy Cows. Animals (Basel) 2023 May 10;13(10).
- Jacobsen S, Mortensen CD, Høj EA, Vinther AM, Berg LC, Adler DMT, Verwilghen D, van Galen G. Neutrophil Gelatinase-Associated Lipocalin in Synovial Fluid from Horses with and without Septic Arthritis. Animals (Basel) 2022 Dec 21;13(1).
- Mizuguchi Y, Kato A, Aizu M. Regional antibiotic perfusion through the lateral saphenous vein in two horses with septic calcaneal osteitis. J Vet Med Sci 2023 Jan 6;85(1):55-61.
- Redding LE, Elzer EJ, Ortved KF. Effects of regional limb perfusion technique on concentrations of antibiotic achieved at the target site: A meta-analysis. PLoS One 2022;17(4):e0265971.
- Vajs T, Nekouei O, Biermann NM. A Descriptive Study of the Clinical Presentation, Management, and Outcome of Horses with Acute Soft Tissue Trauma of the Tarsus and the Association with Synovial Involvement. Animals (Basel) 2022 Feb 21;12(4).
- Bonilla AG, Causeret L, Torrent-Crosa A. Pharmacokinetics of ceftiofur in the metacarpophalangeal joint after standing intravenous regional limb perfusion in horses. Can Vet J 2021 Sep;62(9):975-981.
- Gustafsson K, Tatz AJ, Dahan R, Abu Ahmad W, Britzi M, Sutton GA, Kelmer G. Synovial Concentration of Trimethoprim-Sulphadiazine Following Regional Limb Perfusion in Standing Horses. Animals (Basel) 2021 Jul 13;11(7).
- Crosby DE, Labens R, Hughes KJ, Nielsen S, Hilbert BJ. Factors Associated With Survival and Return to Function Following Synovial Infections in Horses. Front Vet Sci 2019;6:367.
- Isgren CM, Salem SE, Singer ER, Wylie CE, Lipreri G, Graham RJTY, Bladon B, Boswell JC, Fiske-Jackson AR, Mair TS, Rubio-Martínez LM. A multi-centre cohort study investigating the outcome of synovial contamination or sepsis of the calcaneal bursae in horses treated by endoscopic lavage and debridement. Equine Vet J 2020 May;52(3):404-410.
- Anderson JR, Smagul A, Simpson D, Clegg PD, Rubio-Martinez LM, Peffers MJ. The synovial fluid proteome differentiates between septic and nonseptic articular pathologies. J Proteomics 2019 Jun 30;202:103370.
- Dahan R, Oreff GL, Tatz AJ, Raz T, Britzi M, Kelmer G. Pharmacokinetics of regional limb perfusion using a combination of amikacin and penicillin in standing horses. Can Vet J 2019 Mar;60(3):294-299.
- Celani G, Tulini SMR, Montesano C, Zezza D, Sergi M, Varasano V, Mortellaro CM, Compagnone D, Amorena M, Petrizzi L. Pharmacokinetics of marbofloxacin administered via intravenous regional limb perfusion in dairy cows: evaluation of two different tourniquets. Vet Rec Open 2017;4(1):e000227.
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