Endoscopic surgery in the treatment of contaminated and infected synovial cavities.
Abstract: Contamination and infection of synovial cavities are a common occurrence in clinical practice and, if inadequately treated, may have career or life threatening consequences for affected horses. Objective: The objectives in treating contamination and infection of joints, tendon sheaths and bursae are most effectively met by endoscopic surgery. Methods: Over a 6 year period, cases of synovial contamination and infection admitted to a referral clinic were evaluated and treated endoscopically. The horses received local and systemic antimicrobial drugs with minimal nonsteroidal anti-inflammatory medication but no other medical or surgical treatment. All arthroscope and instrument portals and, whenever possible, all traumatic wounds were closed. Diagnostic information, endoscopic observations and results of treatment were evaluated retrospectively. Results: A total of 140 affected animals were referred and 121 cases were treated endoscopically. These involved 70 joints, 29 tendon sheaths, 10 bursae and in 12 cases a combination of synovial cavities. The most common aetiologies were open wounds (n = 54) and self-sealing punctures (n = 41). Foreign material was identified endoscopically in 41 but predicted prior to surgery in only 6 cases. Osteochondral lesions were evident at surgery in 51 and recognised before surgery in 25 cases; 32 horses had intrathecal tendon or ligament defects. Follow-up information was obtained for 118 animals; 106 (90%) survived and 96 (81%) returned to their preoperative level of performance. The presence of osteitis/osteomyelitis, other osteochondral lesions and marked deposits of pannus were associated with nonsurvival. For those animals which survived, non-Thoroughbred horses, a combination of synovial structure involvement and regional i.v. antimicrobial administration were associated with reduced post operative performance. Marked pannus, regional i.v. antimicrobial administration and duration of systemic antimicrobial administration were associated with a group combining nonsurviving animals and those with reduced post operative performance. Conclusions: Endoscopic surgery makes a valuable contribution to the management of synovial contamination and infection. Conclusions: The information obtained from and therapeutic options offered by endoscopy justify its early use in cases of synovial contamination and infection.
Publication Date: 2003-10-01 PubMed ID: 14515964DOI: 10.2746/042516403775467225Google Scholar: Lookup
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- Journal Article
Summary
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The research article discusses the use of endoscopic surgery in the treatment of synovial cavity contamination and infection in horses, indicating that it serves as an effective method for handling such cases and proves beneficial for the patients’ recovery.
Objective and Methodology
- The aim of the research was to investigate whether endoscopic surgery can effectively treat contamination and infection in joints, tendon sheaths, and bursae of horses.
- A total of 140 animals were referred for synovial contamination or infection and 121 were treated endoscopically over a six-year period. The various affected areas covered 70 joints, 29 tendon sheaths, 10 bursae, and 12 cases where multiple synovial cavities were involved.
- Systemic and local antimicrobial drugs were administered to these horses with minimum nonsteroidal anti-inflammatory medication alongside the surgical intervention. No other medical or surgical treatments were employed.
- All arthroscope and instrument portals were sealed post-surgery, with all traumatic wounds also being closed where possible. The resultant diagnostic data, endoscopic findings, and treatment results were evaluated retrospectively.
Result Analysis
- The most common cause of the infections were found to be open wounds and self-sealing punctures. Prior to surgery, only in 6 cases was it predicted that foreign material would be present in the synovial cavity; however, endoscopy revealed foreign material in 41 cases.
- Osteochondral lesions were present at surgery in 51 patients and were recognized only in 25 of these cases before the operation. 32 of the horses treated had tendon or ligament defects.
- Follow-up information was available for 118 animals, revealing that 106 horses (90%) survived post-surgery and 96 (81%) regained their preoperative level of performance.
- Horses that did not survive generally had other complicating factors such as osteitis/osteomyelitis, other osteochondral lesions, and significant deposits of pannus.
- Non-Thoroughbred horses, those with multiple synovial structures affected, and those administered regional intravenous antimicrobial had a lower rate of post-operative performance.
- Significant pannus, regional intravenous antimicrobial administration, and long-term systemic antimicrobial administration were common factors among horses that did not survive and those with lowered post-operative performance.
Conclusion
- Endoscopic surgery was found to be extremely valuable in managing synovial contamination and infection.
- Given the results, the research supports early utilization of endoscopy in cases of synovial contamination and infection due to the valuable diagnostic information it offers and the extensive treatment options it provides.
Cite This Article
APA
Wright IM, Smith MR, Humphrey DJ, Eaton-Evans TC, Hillyer MH.
(2003).
Endoscopic surgery in the treatment of contaminated and infected synovial cavities.
Equine Vet J, 35(6), 613-619.
https://doi.org/10.2746/042516403775467225 Publication
Researcher Affiliations
- Reynolds House Referrals, Greenwood Ellis & Partners, 166 High Street, Newmarket, Suffolk CB8 9WS, UK.
MeSH Terms
- Animals
- Anti-Bacterial Agents / therapeutic use
- Arthroscopy / methods
- Arthroscopy / veterinary
- Debridement / veterinary
- Female
- Horse Diseases / drug therapy
- Horse Diseases / pathology
- Horse Diseases / surgery
- Horses
- Male
- Prognosis
- Retrospective Studies
- Synovectomy
- Synovial Fluid / microbiology
- Synovial Membrane / pathology
- Synovitis / drug therapy
- Synovitis / surgery
- Synovitis / veterinary
- Tendinopathy / pathology
- Tendinopathy / surgery
- Tendinopathy / veterinary
- Treatment Outcome
Citations
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