Synovial sepsis is rare following intrasynovial medication in equine ambulatory practice.
Authors: Smith L C R, Wylie C E, Palmer L, Ramzan P H L
Journal: Equine veterinary journal
Summary
# Editorial Summary: Synovial Sepsis Following Intrasynovial Injections in Equine Practice Between 2006 and 2011, Smith and colleagues analysed 9456 intrasynovial injections performed across 4331 treatment sessions in an ambulatory equine practice to quantify the risk of post-procedure synovial sepsis, a rare but serious complication that practitioners and owners must understand when consenting to these procedures. The research team cross-referenced medication records against synovial cytology submissions and hospital admissions, stratifying cases by horse age, sex, and product type; corticosteroids, hyaluronate and amikacin sulphate dominated the treatment protocol, used in 89.3%, 83.5% and 93.4% of sessions respectively. Only four horses developed synovial sepsis post-injection (0.04% overall risk), with notably higher proportions following polysulphated glycosaminoglycans and hyaluronate combinations (14.3%), though triamcinolone acetonide (0.1%) and hyaluronate alone (0.06%) showed minimal risk; reassuringly, all four affected horses returned to racing after joint lavage. Whilst this low incidence provides valuable reassurance for both practitioners and clients—particularly racehorses undergoing routine joint medication—the findings are weighted towards that population and may not fully reflect risk in general equine practice, and the small case numbers precluded detailed statistical analysis of risk factors.
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Practical Takeaways
- •Intrasynovial medication in ambulatory practice carries a very low risk of synovial sepsis (0.04%), providing reassurance for owner consent discussions
- •The risk profile appears consistent across commonly used medications (corticosteroids, hyaluronate, amikacin), supporting routine use in general practice
- •When synovial sepsis does occur, appropriate management (joint lavage) can be successful, with treated cases returning to racing
Key Findings
- •Synovial sepsis occurred in 4 of 9456 intrasynovial medication procedures (0.04%, 95% CI 0.0-0.08%)
- •Corticosteroids (89.3%), hyaluronate (83.5%), and amikacin sulphate (93.4%) were the most frequently used medications
- •Two cases (14.3%) involved polysulphated glycosaminoglycans and hyaluronate, two (0.1%) involved triamcinolone acetonide, and two (0.06%) involved hyaluronate
- •All four horses with post-medication synovial sepsis returned to racing following joint lavage