Comparison of three methods for arthrodesis of the distal intertarsal and tarsometatarsal joints in horses.
Authors: Zubrod Chad J, Schneider Robert K, Hague Brent A, Ragle Claude A, Gavin Patrick R, Kawcak Chris E
Journal: Veterinary surgery : VS
Summary
# Arthrodesis of the distal tarsal joints: comparing laser, drilling, and chemical methods Fusion of the distal intertarsal and tarsometatarsal joints is a recognised treatment for lower tarsal lameness in horses, but the optimal surgical technique remains unclear. Researchers compared three fusion methods—diode laser surgery, surgical drilling, and intraarticular sodium monoiodoacetate injection—in 15 sound horses over periods ranging from 2 weeks to 12 months, assessing postoperative comfort, lameness, and bony bridging of the joints using radiography, microradiography, and histology. Diode laser surgery produced the least postoperative morbidity and the greatest functional improvement, with 4 of 6 horses in the laser group showing reduced lameness in treated limbs compared to contralateral limbs at 6 months, and 5 of 6 showing improvement at 12 months. Conversely, sodium monoiodoacetate and surgical drilling produced substantially more bony bridging (51.4% and 46.2% joint space bridged respectively) than laser treatment (28.5–30.6%), though these differences did not correlate with superior clinical outcomes. For practitioners managing tarsal arthralgia, these findings suggest diode laser surgery may offer superior short-term comfort and functional recovery despite incomplete radiographic fusion—raising the possibility that pain relief occurs through mechanisms beyond complete bony ankylosis. However, the clinical relevance of incomplete fusion remains uncertain, and further research on naturally osteoarthritic joints is essential before drawing definitive conclusions about which technique best serves long-term soundness.
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Practical Takeaways
- •Laser surgery offers superior comfort and faster return to function in the immediate postoperative period, though it achieves less radiographic bony fusion than alternative techniques
- •Surgical drilling and monoiodoacetate injection achieve more complete bony fusion but with greater postoperative morbidity; consider patient tolerance and timeline when selecting method
- •The disconnect between radiographic fusion and clinical soundness with laser surgery warrants further investigation—improved lameness may occur without complete bony fusion, changing how you counsel clients on expected outcomes
Key Findings
- •Laser surgery caused the least postoperative morbidity and lameness compared to surgical drilling and sodium monoiodoacetate injection
- •Sodium monoiodoacetate and surgical drilling produced significantly more bone bridging (51.4% and 46.2% respectively) than laser surgery (28.5-30.6%) at 6-12 months
- •Horses treated with laser surgery were less lame in 5/6 limbs at 12 months despite inferior radiographic fusion compared to other methods
- •Laser surgery may produce pain relief and improved function through mechanisms beyond bony fusion