Use of ethanol in the treatment of distal tarsal joint osteoarthritis: 24 cases.
Authors: Lamas L P, Edmonds J, Hodge W, Zamora-Vera L, Burford J, Coomer R, Munroe G
Journal: Equine veterinary journal
Summary
# Editorial Summary: Ethanol Treatment for Distal Tarsal Joint Osteoarthritis Intra-articular ethanol injection represents a potential alternative pathway for managing distal tarsal osteoarthritis in horses that have failed to respond adequately to corticosteroid therapy, operating through a mechanism of facilitated joint ankylosis rather than anti-inflammatory action. Lamas and colleagues treated 44 limbs (from 24 horses) with either 100% or 70% ethanol solution following radiographic contrast confirmation of tarsometatarsal and centrodistal joint involvement; inclusion required documented lameness recurrence within four months of prior intra-articular corticosteroid administration. At six to nine months' follow-up, 60% of available treated limbs (21/35) demonstrated clinically meaningful improvement—defined as ≥50% reduction in lameness grade coupled with increased exercise tolerance—representing a 52% success rate at the individual horse level. Four horses (19%) deteriorated, two of which experienced significant treatment-related complications, suggesting careful case selection and precise injection technique are essential. For practitioners managing chronic distal tarsal joint disease unresponsive to conventional therapies, ethanol injection warrants consideration as a cost-effective option, though rigorous pre-treatment radiographic contrast study remains non-negotiable to confirm appropriate joint involvement and injection feasibility.
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Practical Takeaways
- •Intra-articular ethanol injection is a relatively safe and economical option for distal tarsal OA when corticosteroid therapy provides only temporary relief, with ~50% of horses showing meaningful improvement
- •Success requires proper case selection—ensure diagnosis is confirmed via intra-articular analgesia, radiography, and corticosteroid failure before attempting ethanol treatment
- •Careful radiographic contrast study of the tarsometatarsal joint is essential before treatment to avoid complications; monitor treated horses closely for deterioration in the first 6-9 months post-injection
Key Findings
- •60% of treated limbs (21/35) showed improvement defined as ≥50% reduction in lameness grade with increased exercise tolerance at 6-9 month follow-up
- •52% of horses (11/21) were considered improved following intra-articular ethanol injection for distal tarsal joint OA
- •19% of horses (4/21) deteriorated after treatment, with 2 developing significant complications
- •Ethanol injection was effective in cases that failed to respond long-term to intra-articular corticosteroid treatment