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EQUINE VETERINARY EDUCATION / AE / july 2022
TABLE 1: Studies on synovial sepsis including treatment technique used, outcome and diagnostic criteria Reference
(Troillet et al., 2020)
(Isgren et al., 2020)
(Findley et al., 2014)
Study population and sample size
University of Leipzig, Germany
42 horses Septic arthritis and tenosynovitis
7 referral hospitals UK 128 horses Septic calcanean bursitis
4 UK equine referral hospitals
95 horses Septic synovial cavities following foot penetration
(Duggan & Mair, 2019)
(Braake, 2002)
1 UK referral hospital 29 horses Septic calcaneal bursitis
Dierenkliniek Emmeloord, Netherlands
71 horses Septic arthritis, bursitis and tenosynovitis
(Meijer, et al., 2000)
(Wereszka et al., 2007)
University of Utrecht, Netherlands
27 horses Septic arthritis
Marion du-Pont Scott Equine Medical Center
51 horses Septic tenosynovitis
(Wright et al., 2003)
1 UK referral hospital 121 horses Septic arthritis, bursitis and tenosynovitis
‡ §
Retrospective (May 1996–August 1999)
Retrospective (Jan 1986–July 2003)
Through-and-through needle lavage
Tenoscopy (20) Through-and-through needle lavage (26)
81%§ NR NR Study design
Retrospective (Nov 2008–Aug 2019)
Retrospective (2002–2016)
Treatment used
Arthroscopy/ tenoscopy (31) Through-and-through needle lavage (10)
Survival to discharge
77% 77%
Return to soundness/ exercise
NR
Diagnostic inclusion criteria
NR. See Discussion.
Endoscopic lavage 87.8%
91.2%†
≥1 of: TNCC ≥ 10 9 109 cells/L
PMN > 80% TP > 30 g/L
Retrospective (Jan 2000-Dec 2011)
Endoscopic lavage 56% 36%‡
TNCC > 20 9 109 cells/L AND/OR TP > 20 g/L
Retrospective (2005–2019)
Bursocopic (13) Through-and-through needle lavage(16)
Retrospective (1996–2001)
69.2% 93.7%
44.4% 55.5%
≥1 of: TNCC > 20 9 109 cells/L;
TP > 40 g/L >80% PMN
Endoscopic lavage 95%–100% 89% NR. See Discussion.
(Survival at 1 year)
70% 73%
Retrospective (Jan 1996–Dec 2001)
Endoscopic lavage 90% 81%
NR
+’ve bacterial culture
WBC count > 30 9 109/L
>90% PMN TP > 40 g/L
NR. See Discussion
NR, Not recorded; PMN, Polymorphonuclear neutrophils; TNCC, Total nucleated cell count; TP, Total protein. †
Return to same or higher level of competition before the injury. Return to pre injury athletic function. Joint recovery rate.
designs and implementation. The choice of treatment modality in these retrospective studies was not controlled in any way and therefore likely to have been subject to selection bias. This could be improved by running randomised controlled trials. However, the reported survival rates in the studies were comparable in horses treated with needle lavage (77%–84%) and those treated with arthroscopic lavage (56%–90%). There are not enough data to compare treatments in specific synovial structures (e.g. bursae or tendon sheaths vs. joints). It is important to note that the studies often measured
different outcomes. The headings in Table 1 summarise this, and a key is used to further clarify the terms used. It is therefore challenging to directly compare these studies based on the outcome.
© 2021 EVJ Ltd
Arthroscopic/bursoscopic/tenoscopic lavage The technique of using endoscopy for the treatment of synovial sepsis has anecdotally become increasingly popular. The clear advantages of the procedure include full visualisation of the synovial cavity allowing identification of soft tissue, cartilage and osseous damage, removal of foreign material and debridement if required (Wright et al., 2003). Furthermore, this treatment allows a large volume of fluid to be flushed through the synovial cavity. The procedure is usually performed under general anaesthesia; therefore, the risks associated with anaesthesia are increased, and it likely has a higher financial implication for the owner. The technique requires appropriate surgical skills as well as the facilities and endoscopic equipment to be available to the practising clinician (Ludwig & Harreveld, 2018). By comparing
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