# Does anyone have experience with ethanol for fusing hocks?



## Leanne1980 (9 May 2014)

My boy has bad arthritis in his hock.  This has led to PSD.  The PSD has now been treated, but the hock is stil causing problems resulting in us needing the chiro out once a month to keep soften the muscles in his back as he rotates his pelvis.

Steriod injections dont appear to do much for him, very short lived.  He is struggling with canter and is showing problems in trot.  I have tried Tildren with minimal success, so Ethanol is probably the next option.

Any success?


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## applecart14 (9 May 2014)

Leanne1980 said:



			My boy has bad arthritis in his hock.  This has led to PSD.  The PSD has now been treated, but the hock is stil causing problems resulting in us needing the chiro out once a month to keep soften the muscles in his back as he rotates his pelvis.

Steriod injections dont appear to do much for him, very short lived.  He is struggling with canter and is showing problems in trot.  I have tried Tildren with minimal success, so Ethanol is probably the next option.

Any success?
		
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I can really recommend this form of treatment.

My horse had the joint injections and then about two years later a course of three Tildren infusions.  It staved off the spavin pain for a while but then he developed a suspensory branch injury on his near fore and as his off hind was worse with the spavin he kept overcompensating with his diagonal opposite (as horses do) and putting all his weight onto his bad near foreleg.
My friend had the fusion with her horse some two months before and I spoke to my vet about it and he said he thought it would be useful for Bailey to have it to stop him throwing all his weight onto his front end.

And so we went to the clinic and he was sedated and had contrast dye injected into each hock and this was then x-rayed and the x-rayed came up in seconds on a screen and the vet could tell that the contrast dye lay in the correct  space in the hock joint to enable the alcohol (ethanol) to be injected into the joint space.  If the dye goes upwards then the procedure cannot be carried out (I think this is the case is some 40% of horses but I might be wrong  I am going from memory there).

The ethanol was injected and the horse on box rest for that day and turned out the following day.  Again from memory (dont quote me) he had walking for a week, trotting for a week and then back to normal again.  He could be turned out the following day as there is no steroid involvement in the procedure , therefore no requirement to keep them in for a few days.
About 14 months later the horse was x-rayed and the x-rayed showed fusion had taken place in both hocks.  The horse was able to resume jumping and dressage as before.

I am very happy with the procedure and can honestly say it worked for me as it has for lots of others.  It wasnt as successful for my friend whose young horse is riddled with arthritis anyway.

Had I have known then what I know now I would have bypassed the tildren and joint injections and gone for the fusion.

One thing you must know and that wasnt spelt out to me at the time.  If the fusion doesnt work you can never go back into the joint space and inject with steroid or anything else for that matter as there is no space in the joint space left.  So bear this in mind.  Its worth the gamble in my opinion but still think about it.


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## Leanne1980 (9 May 2014)

Thank you for your reply.  Its very helpful.  I am limited in options so i think its worth the risk.  My only concern is that the hock is damaged in two joints as such, can they inject both?
Could I ask what the costs involved were? as i am not insured.
Thanks


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## Noble (10 May 2014)

Had both my old boys hock injected the vets did the first one and then a few months later went in for the second, while in they nerve blocked the second leg and he was completely sound all round so therefore sound on the the first leg.  They also x rayed the first leg and it had pretty much fused in that short space of time. Now 18 months later he is still sound and at 23 taking it easy but still schooling and hacking regulary.  Couldn't be happier.


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## applecart14 (12 May 2014)

Leanne1980 said:



			Thank you for your reply.  Its very helpful.  I am limited in options so i think its worth the risk.  My only concern is that the hock is damaged in two joints as such, can they inject both?
Could I ask what the costs involved were? as i am not insured.
Thanks
		
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Hi Leanne, no they cannot inject the top joint of the hock.  If they did that the horse would need to be PTS as it would be in considerable pain and drag the leg as it would be unable to use the joint properly.  That's why they use contrast dye and xray first to ensure the dye doesn't go into the upper joint spaces.

It cost me £300 for both hocks (my vets are quite expensive and it may be cheaper elsewhere).  They both need to be done at the same time.  At the end of the day if you have an unusable horse, or a significantly lame horse its the best and only course of action.  Just be warned though that not all horses can have the procedure due to the make up of their particular hock.

As far as I know (I am not a vet) the only risk is like with any injection into the joint, i.e. infection and that's why its best to have it done at a hospital rather than at your yard (and it saves you money on the 'travelling' element of your bill - in my case £44, and more importantly its safer as its a more sterile environment!


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## Leanne1980 (12 May 2014)

Thanks all.  I have booked my horse in for the ethanol injections in both his hocks.  Could you advise on what work you have returned to atfterwards? thanks


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## Joules1966 (25 August 2014)

Hi Leanne, I'm interested to know how you got on with the treatment as I am considering having it done. The Tildren only seems to work for 4 months then we have to have another one...thanks


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## TURBOBERT (9 March 2016)

Joules1966 said:



			Hi Leanne, I'm interested to know how you got on with the treatment as I am considering having it done. The Tildren only seems to work for 4 months then we have to have another one...thanks
		
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My chap has had since July last year two steroid and two Tildren treatments.  The vet is suggesting Alcohol injections to fuse the joints.  Leanne and Joules how did it go?  My chap is 15 and was working at Medium Dressage.  I am reconciled to the fact he may not compete again but would like to be able to still have some fun on him.


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## applecart14 (9 March 2016)

TURBOBERT said:



			My chap has had since July last year two steroid and two Tildren treatments.  The vet is suggesting Alcohol injections to fuse the joints.  Leanne and Joules how did it go?  My chap is 15 and was working at Medium Dressage.  I am reconciled to the fact he may not compete again but would like to be able to still have some fun on him.
		
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My horse went on to jump 1m unaff sJ classes, dressage up to elementary level, fun rides, etc, etc.  He had on injury prior to that, and two following that none of which were related to the hock fusion. However some 3.5-4 years later  he has had another problem as a direct result of the ethanol fusing.  This is common in 5-8% of horses that have this treatment, and the timescale is typically 3.5-4 years following.  He had inflammation as the top joint became inflammed, due to the forces of concussion going through the leg and because the two joints are fused the concussive energies are transferred upwards into that top joint.  He had a course of bute and also had lateral extensions as his foot placement had altered due to the inflammation involved and he was bringing his foot midline.  This has remedied and he would be going back to jumping and dressage as the vet feels he has more than recovered from that problem, but  for a new injury to make an appearance (again due to something unrelated).

My horse is expected to make a full recovery and go back to SJ and dressage although I've mulled things over for a while now and may do the odd small sj competition, fun ride (and pop the odd log) or a tiny combined training course, but his days of SJ classes on a regular basis are over now (not that they have been regular for 18 months or so anyway).  Nothing to do with his suspensory branch injuries as none were as a direct result of SJ (the last one was due to spinning at something that caught his eye at the end of dressage test!!) but I feel its maybe time to slow down a little and enjoy hacking a bit more as much for me as him.  If it were up to him he would be XC, galloping and SJ every day, he feels fit as a fiddle, maybe a bit too much so at times!   He's even gone on a bute trial as I was told by certain people he was spooky as a result of pain but he was even worse on the bute trial!

I can deffo recommend the ethanol fusing as a last resort following steroid injections and tildren.


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## whiteflower (9 March 2016)

my horse had this done, however it did not work and his hocks have not fused (re xraying has confirmed this) its not known why it hasnt worked. however he is more comfortable now but we believe that is due to having psd surgery and that the spavins were not causing the original lameness. i dont believe it did him any harm having it done but just to give another perspective in our case it did not cause the hocks to fuse.


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## TURBOBERT (13 March 2016)

Thank you for your replies.  Unbelievably my chap has now manage to injure the same leg but unrelated.  He has ruptured the inside strap holding his tendons in place over the point of the hock so the tendon is now flicking from side to side!  He is now on a six months field rest to see if scar tissue stabilises the tendon to one side and he can come sound. As he is insured for his original problem until June the vet feels it is still worth giving the alcohol injection into the lower joints to try to get rid of that problem anyway.   Blooming horses!


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## applecart14 (15 March 2016)

TURBOBERT said:



			Thank you for your replies.  Unbelievably my chap has now manage to injure the same leg but unrelated.  He has ruptured the inside strap holding his tendons in place over the point of the hock so the tendon is now flicking from side to side!  He is now on a six months field rest to see if scar tissue stabilises the tendon to one side and he can come sound. As he is insured for his original problem until June the vet feels it is still worth giving the alcohol injection into the lower joints to try to get rid of that problem anyway.   Blooming horses!
		
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A ruptured patella ligament is fixable but can heal with lots of rest.  The ethanol fusion will be of benefit because if the horse doesn't have this treatment, presumably he will remain uncomfortable and then either overcompensate elsewhere (which he will already be doing slightly because of the rupture) or move his leg in such a way to avoid the pain in the joint that he will cause problems in a overcompensatory way again!

Good luck with the procedure, after a year xrays showed complete fusion in the one hock and about 90% in the other.  Fusion can take up to 18 months with this method, but it is really effective in most cases.  This is a good paper on the subject, although its some 10 years old.  Shame they were all euthanised after the study  http://www.ncbi.nlm.nih.gov/pubmed/16649921


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## applecart14 (15 March 2016)

http://www.horsesandpeople.com.au/article/ethanol-treatment-hock-arthritis-shows-promising-results
This is a better link to a paper from 2012


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## TURBOBERT (15 March 2016)

Thanks for that Applecart...really interesting..


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## applecart14 (18 March 2016)

TURBOBERT said:



			Thanks for that Applecart...really interesting..
		
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No problems, glad to help.  Good luck.


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