# Do the majority of hocks fuse over time on their own?



## Achinghips (10 April 2011)

Obviously it depends on the individual case. How long's a piece of string?

BUT, I am considering my own options and need more data on which to make a decision - in general, I am interested in the what is the evidence/statistical base numbers for fusion with no medical intervention.

Can anyone help please?


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## Achinghips (12 April 2011)

bump


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## kitface (13 April 2011)

About 6 years ago my ID mare had Spavin in her hocks, she was put on bute for 3 months and kept in light work and the hocks fused, she suffered no further lameness. I was told by the Vet at the time that it depended which bones were involved as to how good/quick the outcome was.


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## cptrayes (13 April 2011)

My horse did in around three years and my friend's TB took around the same time. Mine was worked through, on meds when necessary, and the other was put in foal for two years.  Both  horses now sound to ride, mine competing at dressage and winning (in the US - he emigrated!) . I currently own a never-been-lame dressage horse with the most enormous bone growths you've ever seen. He apparently fused really quickly before we even noticed he had any problems. He competes Medium, currently and training much higher movements than that.

I understand that the higher up the hock the joint affected, the worse the prognosis.


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## superpony (13 April 2011)

My pony was on bute and worked for approx a year, after this he was sound and has been fine with it ever since.

This was before the injection/medical interferance options really became widely available.


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## Achinghips (18 April 2011)

Thanks for responses


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## applecart14 (18 April 2011)

Achinghips said:



			Obviously it depends on the individual case. How long's a piece of string?

BUT, I am considering my own options and need more data on which to make a decision - in general, I am interested in the what is the evidence/statistical base numbers for fusion with no medical intervention.

Can anyone help please?
		
Click to expand...

Here is an article about bone spavin
http://www.ed.ac.uk/polopoly_fs/1.23110!fileManager/bone_spavin.pdf

Regarding fusion, its my understanding from what I've read that fusion is unpredictable and not always sucessful. In some cases tildren which prevents fusion from occuring is much more useful.  This is a quote from an article from Sue Dyson about BS on H&H - Joint fusion 


_For horses with major bone destruction, this leaves joint fusion as currently the most appropriate treatment. Joint fusion can be achieved surgically, by drilling into the joint spaces under X-ray control. The aim is to remove some of the cartilage and stimulate accelerated fusion of the joint. 


The speed of response and the efficacy of fusion seem to vary hugely; some tend to develop a lot of bone around the surgical sites, which is probably not good. Generally, fusion takes six to nine months to develop and, at most, 65% of treated horses are able to return to some work. 


An alternative means of fusion is to inject a chemical called sodium moniodoacetate (MIA) into the joints. This destroys the cartilage and probably local nerve endings as well. It is only feasible if the joint spaces are not already narrowed to such an extent that injection is not physically possible. 


The treatment is often associated with quite severe pain within the first 15hr of treatment, but with appropriate painkillers this can usually be managed satisfactorily. Chemical fusion can be very effective and in my experience, if successful, tends to be quicker than surgical fusion. 


However, if the horse has some communication between the lower and uppermost moving hock joints, it is not a suitable candidate for chemical fusion. 


Whichever method of joint fusion is used, the biomechanics of the hock alter. Some horses that were successfully treated initially have gone on to develop recurrent lameness associated with osteoarthritis in the upper hock joints, or a fracture of the fused lower bone unit. _

this is another quote about fusion off the internet:

_Natural fusion (ankylosis) of the two lower joints can be allowed when cartilage degeneration is already underway. "While this should eventually eliminate the pain, for various reasons it is not successful or appropriate for many horses with spavin," Dechant warns. "It is a slow and unpredictable process that only happens successfully in a small number of horses with bone spavin."_Here is a fact sheet about Tildren:  http://www.georgevetgroup.co.uk/pdf's/equine_factsheets/TILDRENFACTSHEET.pdf


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## Achinghips (20 April 2011)

Thanks applecart. 

Now, vets are injecting ethyl alcohol - a preferred, much less painful approach, well researched and recommended above other methods, such as drilling or injection of chemicals. It's supposed to have fantastic results and horse is back in work quicker. This is one of my options I have been offerred, though even after the injection, the horse wouldn't pass a vetting, other options offered were "do nothing" or" long term bute and wait and see if they'll fuse on their own" (steroid injections results for my girl were, unfortunately, short lived).

This is a quote from somewhere:
A New Technique for Fusing the Lower Hock Joints: Ethyl Alcohol Arthrodesis 

Arthritis of the lower hock joints is a very common cause of lameness and stiffness. This condition may be called spavin, degenerative joint disease of the tarsal joints or hock arthritis. Common treatments for hock arthritis include phenylbutazone, topical applications of Surpass ointment, and intravenous or intramuscular joint medication such as Legend or Adequan. A more direct method for treatment is joint injections of hyaluronic acid and steroids. Injection of medications into the joints is probably the most common method of treating hock joint arthritis. The treatment goal is to reduce inflammation and pain so that the horse may continue full, comfortable activity. With continued use the affected hock joints will often fuse. When the joints no longer move, there is no longer any pain. The lower hock joints do not open and close like the fetlock joint, they are low motion joints that only "vibrate" on each step. When the joints are fused injections and other support measures for lower hock arthritis may cease as the pain has been resolved.

Natural fusion of arthritic joints of the lower hock may take years so various techniques previously used for arthrodesis of the lower hock joints include: drilling of the joints followed by bone graft placement or application of a bone plate, destruction of joint cartilage using a surgical laser, and injection of a chemical that causes destruction of the cartilage called monoiodoacetate (MIA). Most of these techniques speed natural arthrodesis, but also many cause at least short periods of severe pain. Also, the speed of joint fusion is not uniform from horse to horse. For example, drilling the joints may cause fusion in about 4 months on one horse, yet require over 10 months on another horse.

A new technique that destroys the cartilage and does not cause any significant level of pain is injection of the lower hock joints with ethyl alcohol. A research paper from the Western College of Veterinary Medicine in Saskatoon, Alberta describes preliminary work done on horses with this new technique (Shoemaker RW, et al. Am J Vet Res 2006;67(5):850-857). Researchers injected ethyl alcohol into 16 tarsometatarsal joints (lowest hock joint) of normal, sound horses. They injected 4 mL of either 70% or 95% ethyl alcohol. Horses had minimal or no lameness following the injections. One-half of the injected joints were fused by 4 months, with more joints fused in the 70% alcohol group. Fifteen of 16 joints were considered fused at 12 months post-injection. Radiographic follow-up revealed active boney response in the injected joint 4 months after injection. 

Although the Saskatoon study was preliminary in nature and only involved research horses, with sound technique this protocol may be readily applied to clinical cases. Horses with marked osteoarthritis of the lower hock joints that are no longer responding to traditional treatments such as joint injections or young horses with juvenile onset arthritis (juvenile spavin) are candidates for ethyl alcohol facilitated arthrodesis. Our protocol includes performing the injections under general anesthesia and using radiography to confirm needle placement and to determine that the lower two hock joints do not communicate with the upper two joints. After several days of hospitalization, the horse is released and may be turned out. Follow-up examination and repeat radiographs would be taken four months after alcohol injection. Progress of joint fusion would be determined at that time and a rehabilitation exercise protocol would be recommended.


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