Orthopedics

Our Orthopaedic department is managed by Cedric Bocqué. The Orthopaedic department examines and treats horses with a suspected locomotory problem. We often see horses with vague complaints ranging from irregular gait to feeling less fit during training or a competition. A thorough clinical examination is the first step. Our highly specialised equipment and unique laboratory further support our vets to make the correct diagnosis. A customised treatment path is then proposed with the aim of enabling the horse to make a full return to his previous level of activity. By identifying injuries at an early stage, we prevent worsening of the complaints and injuries. If an injury is found, we can treat it immediately. We are happy to involve your own vet in this process if you desire! The aim of the clinic is to use the most innovative and regenerative treatments.

Below you can read about the examinations and treatments our vets offer within our Orthopaedic department.

Pre-purchase examination

A pre-purchase examination aims to assess the horse’s health and to check that the horse fulfils the physical requirements of the intended purpose. As no horse is perfect, it is not simply a matter of approval or rejection. An attempt is made to make a correct as possible risk estimate of the abnormalities found. A pre-purchase examination consists of a detailed clinical examination, followed by a radiographic examination and here it is important to take an adequate number of X-rays. The examination may be supplemented with echography of the main tendons and an endoscopic examination to exclude cornage.

 

Lameness examination

A lameness examination starts by looking at the horse’s previous medical history and a more detailed look is taken at the nature and duration of the existing problem. It is important that we have all the information from previous examinations and treatments. After studying the medical history, a static clinical examination is carried out consisting of a visual inspection and palpation of the joints and soft tissue. A dynamic clinical examination is then carried out and the animal’s gait inspected. This is done both in a straight line and in a circle on a hard and soft surface. Flexion tests are then generally carried out. In the case of a subtle lameness, examination while the horse is being ridden has considerable added value. Finally, in most cases nerve blocks and/or intrasynovial anaesthesia are carried out to anaesthetise certain structures. This takes away the pain in a specific region, enabling more specific localisation of the pathology. A lameness examination takes on average 1 to 2 hours. After the region of pain has been identified, further medical imaging can be carried out to arrive at a diagnosis. Once the diagnosis has been made, a treatment pathway can be proposed and this should always be combined with a movement and/or rehabilitation plan.

Radiography

 

X-ray imaging is used to create pictures of a number of bone pathologies such as arthritis, bone cysts, OCD (osteochondritis dissecans) and fractures/fissures. We have the most advanced equipment at our disposal; this includes a mobile wireless system and also an extremely powerful, fixed machine that is used specifically for the back and neck.

Ultrasonography

An ultrasonographic examination is mainly used to obtain images of the soft tissue such as ligaments, tendons and muscles using ultrasonic sound waves. It can also be useful to assess cartilage or bone surface. Another important application of echography is the delivery of ultrasound-guided injections; using this method we can inject medication very precisely at the required location.

Ultrasound Tissue Characterisation (UTC)

UTC is the latest application within the field of ultrasonography. With this technique a specialised program makes an analysis of the scanned tendon to evaluate its quality. Currently this technology is only used in the cannon bone region. It provides added value when following up tendon injuries so that during rehabilitation we can determine when the load on the tendon can be increased. UTC also plays a role in preventive medicine as weaker zones in the tendon can be identified at an early stage and injuries can then be prevented. It can also provide additional insight into the horse’s health in a pre-purchase examination.

Stem cells

Stem cells are undifferentiated cells that have the capacity to transform themselves into different kinds of cell types. Mesenchymal stem cells offer the most advantages within orthopaedics as they can form cartilage, bone, muscle and tendon tissue. This does, however, involve a risk as the required tissue may not be created at a certain place. To avoid this we only work with predifferentiated stem cells that are tissue specific. Therefore, we use chondrogenic induced stem cells, with a view to formation of cartilage in joints, while tenogenic induced stem cells are used to transform themselves into tendon tissue. We only use the latest generation of allogeneic mesenchymal stem cells. These are isolated from the blood of strictly selected donor horses and stored in liquid nitrogen at a temperature of -196°C so that they are available at any time.

picture: Boehringer Ingelheim

Tendon treatments

Because of the poor circulation in the tendons, if the tendon fibres are damaged, insufficient healing substances reach the injury. This means that a tendon will heal more slowly in comparison with other tissue such as muscle. Moreover, the quality of the newly formed tendon tissue will be poorer as a part of the injury is filled with lower-quality scar tissue. This reduces elasticity and therefore the strength of the tendon in the long term.

The recovery time from a tendon injury, and in particular the quality of the newly formed tendon tissue, can be improved in many cases by injecting certain products such as PRP and stem cells. An ultrasound-guided injection can be used to deliver this medication with the utmost precision.

To achieve an optimum result, in many cases this is supplemented (at a later stage during rehabilitation?) with shock wave therapy (click for more information) and laser therapy (click for more information).

Neck, back and sacroiliac problems

The neck, back and sacroiliac region play a very important role in the horse’s motion mechanism. The anatomy in this region is complex as the sacroiliac joint forms the connection between back, pelvis and therefore the rear legs. Pain in these areas often results only in vague disorders of general performance reduction, making it difficult to give an exact diagnosis. Moreover, pain in these regions may be both the cause and result of lameness. In addition, the large muscle mass of the horse makes it difficult to obtain an image of the neck, back and sacroiliac region. Fortunately, we have a powerful X-ray machine that can be used specifically for this. Both an external examination and a transrectal ultrasound examination can also be carried out. The latter is used more specifically to obtain an image of the sacroiliac joint. Finally, a highly detailed image of the neck can be obtained with a CT scan.

Treatment options include mesotherapy (click here for information on mesotherapy), intramuscular injection, ultrasound-guided injection of the facet joints and sacroiliac joint, shock wave therapy (click for more information), laser therapy (click for more information) and physiotherapy.

Joint treatments

Inflammation in a joint causes pain in the first instance and results in lameness. If this inflammation continues, it can cause further damage to the joint. It is therefore important to act as soon as possible. A number of products are available, each with their specific properties that have both an anti-inflammatory and a healing function.

Hyaluronic acid

In joints the cartilage acts as a shock damper, while synovial fluid has a lubricating and hydrating function. Hyaluronic acid is an important component for both cartilage and synovial fluid. The injection of hyaluronic acid into a joint can contribute to repair as it promotes production of the body’s own hyaluronic acid and has an anti-inflammatory effect. It also has analgesic properties.

Steroid anti-inflammatories

This is a group of very strong anti-inflammatories. However, these should be used with the necessary caution. With repeated use or in the incorrect dose, they can damage the cartilage in the joint or cause laminitis.

IRAP

IRAP (Interleukin 1 Receptor Antagonist Protein) is used as an anti-inflammatory in joints. It is a natural inhibitor for Interleukin 1, a cytokine that plays an important role in the inflammation process that can result in damage to the cartilage.

Blood is drawn from the horse in a sterile manner. This is incubated in a special kit for 24 hours which results in the release of a high concentration of Interleukin 1 Receptor Antagonist protein by the white blood cells. After centrifugation, the IRAP-rich serum is collected and introduced into the joint to be treated by means of intra-articular injection. The rest of the serum can be stored in the freezer and used again later in any follow-up treatments.

PRP

PRP (Platelet-Rich Plasma) contains a high concentration of blood platelets. When these platelets are activated, they release large amounts of growth factors that promote the natural healing of tendons, ligaments and joints

Pro-Stride

Pro-Stride combines the anti-inflammatory properties of IRAP with the repairing effect of PRP. By means of a short procedure that only takes 20-25 minutes, Pro-Stride can be created on site. After drawing blood, the blood is collected in a special kit and centrifuged twice. In this way a high concentration is collected of the body’s own substances such as blood platelets, growth factors and anti-inflammatory proteins that contribute to tissue repair.