Endoscopic surgery in the treatment of contaminated and infected synovial cavities

Abstract

Summary Reasons for performing study: 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. Hypothesis: 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, when ever 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. Potential relevance: The information obtained from and therapeutic options offered by endoscopy justify its early use in cases of synovial contamination and infection.

Clinical use of antimicrobial regional limb perfusion in horses: 174 cases (1999–2009)

“…It was our purpose to be as specific as possible when defining sepsis in a synovial structure and to evaluate septic synovitis and nonseptic contaminated intrasynovial lacerations separately. Previous studies 15,24,[33][34][35][36][37][38][39] evaluating septic synovitis in horses have found survival rates of 62% to 92% in adults and 42% to 85% in foals. In our study, 72% of horses with septic synovitis were discharged from the hospital, and 53.43% of the horses with follow-up information available were alive at long-term follow-up.…”

Treatment of a severe distal forelimb wound presenting with extensive laceration and distal interphalangeal joint luxation in a donkey

“…In contaminated synovial cavities the objectives of surgical treatment are the removal of foreign material, debridement of contaminated and devitalised tissue, elimination of microorganisms, removal of destructive enzymes and free radicals, promotion of tissue healing and restoration of a normal synovial environment (Wright et al 2003). Lavage of the synovial cavity is the treatment of choice.…”

“…There is also general consensus in the veterinary literature that the keys to successful treatment of horses with septic synovitis are early recognition and prompt treatment (Nixon 1990, Chan et al 2000, Fraser and Bladon 2004, Wright et al 2003. In a recent retrospective study, the outcome was considered successful (survival without residual lameness) in 109 of 150 horses (72.7%) with contaminated and infected synovial cavities (Pille et al 2009).…”

Tenovaginoscopic approach to the common digital flexor tendon sheath of adult cattle: Technique, normal findings and preliminary results in four clinical cases

“…In horse, tenovaginoscopy of the CDFTS is used for diagnosis and treatment of aseptic and septic digital tenosynovitis, release of the lig. anulare palmare/plantare, and it is useful in lavage, adherence debridement, removal of foreign material and devitalised tissue (Nixon, 1990;Frees et al, 2002;Nixon, 2002;Wright et al, 2003;Fraser and Bladon, 2004;Edinger et al, 2005;Lopes et al, 2006). The entry portal for routine tenovaginoscopy of the CDFTS is on the palmarolateral/plantarolateral surface immediately distal to the lig.…”

“…In treating joint infection in man, arthroscopy is considered to offer several advantages over lavage and arthrotomy including improved visualization, identification of foreign material and infected or devitalized tissue, and access to a large area of synovial surfaces. Arthroscopy ensures an efficiently evaluated, cleaned, debrided and decompressed joint with minimal morbidity, reduced period of hospitalization and maximal functional recovery compared to other treatments (Wright et al, 2003). Also in cattle, arthroscopy has been described as an alternative minimal invasive diagnostic procedure in complicated arthritis, and it allows treatment of the joint cavity too (Munroe and Cauvin, 1994;Gaughan, 1996;Steiner et al, 1999;Starke et al, 2008).…”