Quantitative assessment of intravenous regional limb perfusion of tiludronate as an adjunctive treatment for lameness caused by navicular syndrome in horses.
Authors: Schoonover, Whitfield, Young, Sippel, Payton
Journal: American journal of veterinary research
Summary
# Intravenous Regional Limb Perfusion of Tiludronate for Navicular Syndrome: Limited Additional Benefit Demonstrated Navicular syndrome remains a significant cause of chronic forelimb lameness in horses, with treatment typically involving therapeutic farriery, anti-inflammatory medication, and intra-articular injections. Researchers at five institutions sought to establish whether intravenous regional limb perfusion (IVRLP) of tiludronate—a bisphosphonate with bone-protective properties—could enhance outcomes beyond standard management alone in fifteen horses with bilateral navicular disease. All horses received corrective shoeing and distal interphalangeal joint (DIPJ) corticosteroid injection on day 0, then were randomised to receive either low-dose tiludronate (0.1 mg/kg), high-dose tiludronate (0.2 mg/kg), or placebo administered via IVRLP on three separate occasions over 34 days, with lameness assessed subjectively and via force plate analysis (measuring peak vertical ground reaction force) at multiple timepoints over 120 days. Neither tiludronate protocol provided statistically significant improvements in lameness severity or objective gait parameters compared to placebo throughout most of the follow-up period; however, the high-dose group demonstrated objectively better forelimb function than both low-dose and placebo groups at day 120, suggesting a potential late-stage benefit not apparent earlier in recovery. For practitioners considering adjunctive therapies for navicular syndrome, these results indicate that therapeutic shoeing and DIPJ injection remain the foundation of treatment, with tiludronate IVRLP offering at best modest additional benefit and only detectable at extended timepoints—a finding that warrants cautious interpretation when weighing costs against outcomes in clinical practice.
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Practical Takeaways
- •Proper therapeutic shoeing combined with intra-articular anti-inflammatory injection provides substantial lameness improvement in navicular cases; tiludronate IVRLP does not meaningfully enhance these established treatments in the short-to-medium term.
- •If considering tiludronate IVRLP as adjunctive therapy, high-dose protocols (0.2 mg/kg) may offer marginal advantage over low-dose or placebo by 120 days, though clinical significance of this finding is unclear.
- •Focus your navicular management on optimizing farrier work and DIPJ injection protocols rather than expecting additional benefit from regional perfusion techniques.
Key Findings
- •Tiludronate IVRLP at low-dose (0.1 mg/kg) or high-dose (0.2 mg/kg) protocols provided no additional lameness improvement over therapeutic shoeing and DIPJ anti-inflammatory injection alone.
- •All horses showed improved peak vertical ground reaction force by day 14 regardless of treatment group.
- •High-dose tiludronate-treated horses demonstrated objectively lower lameness scores at 120 days compared to low-dose and placebo groups.
- •No significant differences in subjective lameness scores or PVGRF were detected between treatment groups at any timepoint except day 120.