A multi-centre cohort study investigating the outcome of synovial contamination or sepsis of the calcaneal bursae in horses treated by endoscopic lavage and debridement.
Authors: Isgren C M, Salem S E, Singer E R, Wylie C E, Lipreri G, Graham R J T Y, Bladon B, Boswell J C, Fiske-Jackson A R, Mair T S, Rubio-Martínez L M
Journal: Equine veterinary journal
Summary
# Calcaneal Bursa Infection: Early Antimicrobials Improve Survival with Endoscopic Treatment This multi-centre retrospective analysis examined 128 horses treated endoscopically for contaminated or septic calcaneal bursae across seven equine hospitals, establishing baseline prognostic factors and outcomes for this challenging condition. Most horses (84.4%) survived to hospital discharge, though long-term follow-up at a median of 30 months revealed that 7.1% were subsequently euthanised due to the calcaneal injury itself. Systemic antimicrobial administration *before* referral emerged as the single most protective factor—reducing mortality risk by 75% in the multivariable model—whilst significant tendon involvement (≥30% cross-sectional area) increased mortality risk nearly eightfold; bone fracture or osteomyelitis, longer anaesthetic duration, post-operative synoviocentesis, and wound dehiscence were also associated with poorer outcomes. Encouragingly, 91.2% of the 57 horses with athletic follow-up data returned to their previous level of work or higher, suggesting that survival horses generally achieve functional recovery. For practitioners managing acute calcaneal bursa contamination, the data underscore the critical importance of initiating broad-spectrum antimicrobials immediately—before referral rather than waiting for culture results—and carefully assessing the extent of soft-tissue involvement, as significant tendinopathy substantially worsens prognosis even with endoscopic intervention.
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Practical Takeaways
- •Early systemic antibiotic therapy before referral substantially improves survival outcomes—ensure antimicrobials are initiated promptly at the referring facility
- •Tendon involvement of ≥30% cross-sectional area is a major negative prognostic indicator; assess tendon damage thoroughly on imaging before committing to surgical treatment
- •Most horses (91%) that survive to discharge and have follow-up records return to athletic work at pre-injury levels, making aggressive early treatment justified in suitable cases
Key Findings
- •Survival to hospital discharge was 84.4% following endoscopic lavage and debridement of contaminated/septic calcaneal bursae
- •Systemic antimicrobial administration prior to referral reduced mortality (HR 0.25, P=0.002) in multivariable analysis
- •Tendinous involvement (≥30% cross-sectional area) significantly increased mortality (HR 7.92, P<0.001)
- •At median 30-month follow-up, 87.1% of horses were alive and 91.2% of those with athletic performance data returned to same or higher exercise level