Arthrotomy versus arthroscopy and partial synovectomy for treatment of experimentally induced infectious arthritis in horses

Alicia L. Bertone From the Departments of Veterinary Clinical Sciences (Bertone, Davis), Veterinary Microbiology (Cox), Veterinary Pathology (Roberts, Gossett), and Veterinary Physiology and Pharmacology (Kamerling, Caprile), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803.

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D. Michael Davis From the Departments of Veterinary Clinical Sciences (Bertone, Davis), Veterinary Microbiology (Cox), Veterinary Pathology (Roberts, Gossett), and Veterinary Physiology and Pharmacology (Kamerling, Caprile), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803.

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Hollis U. Cox From the Departments of Veterinary Clinical Sciences (Bertone, Davis), Veterinary Microbiology (Cox), Veterinary Pathology (Roberts, Gossett), and Veterinary Physiology and Pharmacology (Kamerling, Caprile), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803.

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Steven S. Kamerling From the Departments of Veterinary Clinical Sciences (Bertone, Davis), Veterinary Microbiology (Cox), Veterinary Pathology (Roberts, Gossett), and Veterinary Physiology and Pharmacology (Kamerling, Caprile), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803.

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Edward D. Roberts From the Departments of Veterinary Clinical Sciences (Bertone, Davis), Veterinary Microbiology (Cox), Veterinary Pathology (Roberts, Gossett), and Veterinary Physiology and Pharmacology (Kamerling, Caprile), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803.

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Kelli A. Caprile From the Departments of Veterinary Clinical Sciences (Bertone, Davis), Veterinary Microbiology (Cox), Veterinary Pathology (Roberts, Gossett), and Veterinary Physiology and Pharmacology (Kamerling, Caprile), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803.

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Kent A. Gossett From the Departments of Veterinary Clinical Sciences (Bertone, Davis), Veterinary Microbiology (Cox), Veterinary Pathology (Roberts, Gossett), and Veterinary Physiology and Pharmacology (Kamerling, Caprile), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803.

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Summary

To evaluate the clinical, laboratory, and histologic effects of 2 methods of treatment for infectious arthritis in horses, Staphylococcus aureus (3.4 to 3.9 × 103 colony-forming units) was inoculated into the tarsocrural joints of 8 horses on day 0. Each horse was treated with phenylbutazone (2 g, po, q 24 h) and gentamicin sulfate (2.2 mg/kg of body weight, iv, q 8 h) for 14 days. On day 2, general anesthesia was induced, and each horse had 1 tarsocrural joint treated by arthrotomy, with removal of accessible fibrin and lavage with 3 L of sterile balanced electrolyte solution. An indwelling plastic drain was placed in the standing horse to provide a means for lavage with 3 L of balanced electrolyte solution twice daily for 72 hours. The contralateral tarsocrural joint was treated via arthroscopic debridement, synovectomy, and lavage with 3 L of balanced electrolyte solution. Arthrotomy and arthroscopic portals were allowed to heal by second intention. Lameness and thermographic examinations, analysis and bacteriologic culture of synovia, cbc, and wbc differential count were performed prior to inoculation and on days 1, 3, 6, 8, and 13. On day 14, each horse was euthanatized, and the joints were measured, opened, and photographed. Synovium and articular cartilage were obtained for semiquantitative histologic (H&E stain) and histochemical (safranin O fast green stain) evaluation. Lameness and joint circumference were significantly (P < 0.05) greater in limbs treated by arthroscopy, synovectomy, and lavage. Arthrotomy with lavage eliminated the S aureus infection significantly (P < 0.05) earlier than arthroscopy, synovectomy, and lavage; however, both treatments eliminated the infection in all but a single joint. Contamination with other organisms (Streptococcus spp and Enterobacter spp) developed significantly (P < 0.05) more often in joints treated by arthrotomy. These results suggested that arthrotomy with lavage was more effective in eliminating joint infection by providing better drainage than arthroscopy, synovectomy, and lavage; however, arthrotomy had a higher risk of ascending bacterial contamination of the joint.

Summary

To evaluate the clinical, laboratory, and histologic effects of 2 methods of treatment for infectious arthritis in horses, Staphylococcus aureus (3.4 to 3.9 × 103 colony-forming units) was inoculated into the tarsocrural joints of 8 horses on day 0. Each horse was treated with phenylbutazone (2 g, po, q 24 h) and gentamicin sulfate (2.2 mg/kg of body weight, iv, q 8 h) for 14 days. On day 2, general anesthesia was induced, and each horse had 1 tarsocrural joint treated by arthrotomy, with removal of accessible fibrin and lavage with 3 L of sterile balanced electrolyte solution. An indwelling plastic drain was placed in the standing horse to provide a means for lavage with 3 L of balanced electrolyte solution twice daily for 72 hours. The contralateral tarsocrural joint was treated via arthroscopic debridement, synovectomy, and lavage with 3 L of balanced electrolyte solution. Arthrotomy and arthroscopic portals were allowed to heal by second intention. Lameness and thermographic examinations, analysis and bacteriologic culture of synovia, cbc, and wbc differential count were performed prior to inoculation and on days 1, 3, 6, 8, and 13. On day 14, each horse was euthanatized, and the joints were measured, opened, and photographed. Synovium and articular cartilage were obtained for semiquantitative histologic (H&E stain) and histochemical (safranin O fast green stain) evaluation. Lameness and joint circumference were significantly (P < 0.05) greater in limbs treated by arthroscopy, synovectomy, and lavage. Arthrotomy with lavage eliminated the S aureus infection significantly (P < 0.05) earlier than arthroscopy, synovectomy, and lavage; however, both treatments eliminated the infection in all but a single joint. Contamination with other organisms (Streptococcus spp and Enterobacter spp) developed significantly (P < 0.05) more often in joints treated by arthrotomy. These results suggested that arthrotomy with lavage was more effective in eliminating joint infection by providing better drainage than arthroscopy, synovectomy, and lavage; however, arthrotomy had a higher risk of ascending bacterial contamination of the joint.

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