Page 1389 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

1364 CHAPTER 14

VetBooks.ir Management the joint following lavage and/or drainage (e.g.
150–300 mg gentamicin or amikacin) and sub-
Early instigation of treatment is essential because
of the rapid and progressive degenerative changes
collagen sponges can be left in the joint to pro-
in an infected joint and the life-threatening nature sequently repeated, or antibiotic-impregnated
of some of these infections. There are consider- vide sustained release of the drug over a period
able economic implications regarding treatment of of time. Intra-articular catheters for continu-
these cases, and these should be discussed at the ous infusion of antibiotics may be considered in
outset. severe cases of single joint septic arthritis with
concurrent epiphyseal osteomyelitis. Intravenous
Antibiotics regional limb perfusion with antibiotics and/or
Broad-spectrum, bactericidal antibiotics that intraosseous medication is a useful technique in
reach adequate concentrations in joints and bone the treatment of septic arthritis and osteomyeli-
should be administered systemically at suitable tis in foals, particularly in non-responsive cases.
dose rates. The choice of antibiotic(s) should be If amino glycosides are used both systemically
based on culture and sensitivity results if avail- and locally, it is important to consider the total
able, but there should be no delay in their use daily dose to reduce the risk of nephrotoxicity.
while awaiting results. It is important that anti- Therapeutic drug monitoring for aminoglycosides
biotics are administered for at least a week after should be considered.
resolution of the septic focus, lameness and hae-
matological improvement. Intra-articular anti- Lavage
biotics are used regularly by some clinicians to Joint lavage is essential to remove infectious and
achieve very high local levels, but some antibiotics inflammatory material. There are a variety of tech-
are irritant to the joint and may cause increased niques to achieve this, with different advantages,
inflammation. Antibiotics may be injected into disadvantages and costs. The joint may simply be
drained with a needle. Distension and irrigation
of the affected joint is often achieved with needles
and a through-and-through lavage technique using
14.29 3–5 litres of sterile polyionic fluid per joint in the
sedated or anaesthetised foal (Fig. 14.29).

Surgery
Lavage can most effectively be accomplished via
an arthroscope. The added diagnostic advan-
tages of this technique are the retrieval of sam-
ples of infectious/inflammatory material from
within the joint and the ability of take synovial
biopsies for culture. Arthroscopy also allows a
clearer prognostication for the future of the foal.
Therapeutically, the advantages include a more
thorough removal of abnormal material/synovium
and the opportunity to debride cartilage and bone
lesions in the joint. Postoperative drainage can be
established. In chronic non-responding or poorly
Fig. 14.29 The tarsocrural joint of a young responding cases, arthrotomy and open drainage
Thoroughbred foal with septic synovitis undergoing have been used very effectively, but the postop-
through-and-through lavage of the joint under heavy erative management of these cases is expensive
sedation and local regional analgesia. and prolonged. Surgical curettage of septic physes