Endoscopic surgery in the treatment of contaminated and infected synovial cavities.
Authors: Wright I M, Smith M R W, Humphrey D J, Eaton-Evans T C J, Hillyer M H
Journal: Equine veterinary journal
Summary
# Editorial Summary Synovial cavity contamination and infection represent serious clinical emergencies in horses, with outcomes ranging from complete recovery to career-ending or fatal sequelae if managed inadequately. Wright and colleagues evaluated 121 horses with infected or contaminated joints, tendon sheaths, or bursae treated via arthroscopic surgery over six years, administering systemic and local antimicrobials with minimal additional intervention and primary closure of portal sites where possible. Foreign material was identified during surgery in 41 cases despite being predicted preoperatively in only 6, whilst osteochondral lesions were found in 51 animals—highlighting the diagnostic value of endoscopy—with 81% of the 96 surviving horses returning to their previous performance level. The presence of osteitis, osteomyelitis, or substantial pannus formation were negative prognostic indicators, whilst non-Thoroughbred status and combination cavities compromised performance recovery even when survival was achieved. These findings support early arthroscopic intervention in suspected synovial contamination, as endoscopy provides both critical diagnostic information that predicts outcome and immediate therapeutic access that conventional approaches cannot offer, fundamentally altering case management and prognosis.
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Practical Takeaways
- •Endoscopic surgery should be used early in synovial contamination/infection cases as it identifies foreign material and osteochondral damage missed on clinical examination, significantly improving diagnostic accuracy and treatment outcomes
- •90% survival and 81% return to work rates support endoscopic treatment as the gold standard for contaminated/infected joints, tendon sheaths and bursae in horses
- •Systemic antimicrobial therapy combined with endoscopic debridement is effective; be cautious with regional IV antimicrobials as they were associated with poorer long-term performance outcomes in this cohort
Key Findings
- •121 cases of synovial contamination/infection (70 joints, 29 tendon sheaths, 10 bursae) were treated endoscopically with 90% survival rate and 81% return to preoperative performance
- •Foreign material was identified endoscopically in 41 cases but predicted prior to surgery in only 6 cases, demonstrating diagnostic value of endoscopy
- •Osteochondral lesions present in 51 cases; osteitis/osteomyelitis and marked pannus deposition were associated with nonsurvival
- •Open wounds (n=54) and self-sealing punctures (n=41) were the most common aetiologies; regional IV antimicrobial therapy was associated with reduced postoperative performance in surviving animals