Use of ethanol in the treatment of distal tarsal joint osteoarthritis: 24 cases

Reasons for performing this study: Intra-articular ethanol has been described to promote distal tarsal joint ankylosis. Its use and results in clinical cases affected by osteoarthritis (OA) have not been reported.

Objectives: To describe and evaluate the results of treatment of distal tarsal joint OA by facilitated ankylosis stimulated by intra-articular ethanol injection.

Methods: Twenty-four horses met the inclusion criteria of tarsometatarsal and centrodistal joint OA diagnosed by a positive response to intra-articular analgesia, radiographic evaluation and recurrence of lameness ≤4 months after intra-articular medication with a corticosteroid. Horses were sedated and, following a radiographic contrast study of the tarsometatarsal joint, medication with 2–4 ml of either 100% pure ethanol (G100) or a 70% ethanol (G70) solution was applied. Horses were classified as improved based on a 50% reduction from initial lameness grade combined with an increase in exercise level.

Results: Of the 24 horses included in this study, 20 had the treatment performed bilaterally and 4 unilaterally. All horses were available for initial follow-up examination and 21 for a second one 6–9 months after treatment. This represented a total of 44 treated limbs and 35 available for long-term follow-up. Of these, 21/35 (60%) were considered improved, which corresponds to 11/21 horses (52%). Of 21 horses, 4 (19%) deteriorated and 2 of these developed significant complications related to treatment.

Conclusions: Distal tarsal joint ankylosis with ethanol should be considered a safe and economic treatment in cases of distal tarsal joint OA that fail to show long-term improvement with intra-articular corticosteroid treatment.

Potential relevance: Ethanol should be considered in the treatment of certain cases of distal tarsal joint OA. The importance of performing an adequate radiographic contrast study of the tarsometatarsal joint prior to treatment is highlighted.

Supporting Information

References

1 Wyn-Jones, G. and May, S. (1986) Surgical arthrodesis for the treatment of osteoarthrosis of the proximal intertarsal, distal intertarsal and tarsometatarsal joints in 30 horses: A comparison of 4 different techniques. Equine vet. J. 18, 59-64.
10.1111/j.2042-3306.1986.tb03539.x
CASPubMedWeb of Science®Google Scholar
2 Labens, R., Mellor, D.J. and Voute, L.C. (2007) Retrospective study of the effect of intra-articular treatment of osteoarthritis of the distal tarsal joints in 51 horses. Vet. Rec. 161, 611-616.
10.1136/vr.161.18.611
CASPubMedWeb of Science®Google Scholar
3 Bjornsdottir, S., Ekman, S., Eksell, P. and Lord, P. (2004) High detail radiography and histology of the centrodistal tarsal joint of Icelandic horses age 6 months to 6 years. Equine vet. J. 36, 5-11.
10.2746/0425164044864679
CASPubMedWeb of Science®Google Scholar
4 Branch, M.V., Murray, R.C., Dyson, S.J. and Goodship, A.E. (2005) Is there a characteristic distal tarsal subchondral bone plate thickness pattern in horses with no history of hindlimb lameness? Equine vet. J. 37, 450-455.
10.2746/042516405774479951
CASPubMedWeb of Science®Google Scholar
5 Branch, M.V., Murray, R.C., Dyson, S.J. and Goodship, A.E. (2007) Alteration of distal tarsal subchondral bone thickness pattern in horses with tarsal pain. Equine vet. J. 39, 101-105.
10.2746/042516407X166756
CASPubMedWeb of Science®Google Scholar
6 Baxter, G.M., Dechant, J.E. and Southwood, L.L. (2003) Treatment of horses with distal tarsal osteoarthritis. Comp. cont. vet. Educ. 25, 148–155.
Web of Science®Google Scholar
7 Dechant, J.E., Baxter, G.M., Southwood, L.L., Crawford, W.H., Jackman, B.R., Stashak, T.S., Trotter, G.W. and Hendrickson, D.A. (2003) Use of a three-drill-tract technique for arthrodesis of the distal tarsal joints in horses with distal tarsal osteoarthritis: 54 cases (1990-1999). J. Am. vet. med. Ass. 223, 1800-1805.
10.2460/javma.2003.223.1800
PubMedWeb of Science®Google Scholar
8 Zubrod, C.J., Schneider, R.K., Hague, B.A., Ragle, C.A., Gavin, P.R. and Kawcak, C.E. (2005) Comparison of three methods for arthrodesis of the distal intertarsal and tarsometatarsal joints in horses. Vet. Surg. 34, 372-382.
10.1111/j.1532-950X.2005.00057.x
PubMedWeb of Science®Google Scholar
9 Imschoot, J., Steenhaut, M., De Moor, A. and Verschooten, F. (1995) Partial tibial neurectomy and neurectomy of the deep peroneal nerve as a treatment of bone spavin in 24 horses. Equine Pract. 17, 8-13.
Web of Science®Google Scholar
10 Bohanon, T.C., Schneider, R.K. and Weisbrode, S.E. (1991) Fusion of the distal intertarsal and tarsometatarsal joints in the horse using intraarticular sodium monoiodoacetate. Equine vet. J. 23, 289-295.
10.1111/j.2042-3306.1991.tb03720.x
CASPubMedWeb of Science®Google Scholar
11 Dowling, B.A., Dart, A.J. and Matthews, S.M. (2004) Chemical arthrodesis of the distal tarsal joints using sodium monoiodoacetate in 104 horses. Aust. vet. J. 82, 38-42.
10.1111/j.1751-0813.2004.tb14636.x
CASPubMedWeb of Science®Google Scholar
12 Shoemaker, R.W., Allen, A.L., Richardson, C.E. and Wilson, D.G. (2006) Use of intra-articular administration of ethyl alcohol for arthrodesis of the tarsometatarsal joint in healthy horses. Am. J. vet. Res. 67, 850-857.
10.2460/ajvr.67.5.850
PubMedWeb of Science®Google Scholar
13 Carmalt, J. and Wilson, D. (2009) Alcohol facilitated ankylosis of the distal intertarsal and tarsometatarsal joints in the horse. In: ACVS Symposium, Washington DC. p 30.
Google Scholar
14 Bell, C.D., Wilson, D.G., Wolker, R.W.E., Panizzi, L., Bracamonte, J.L. and Carmalt, J.L. (2009) How to perform ethyl alcohol arthrodesis of the tarsometatarsal joint in the standing horse. Proc. Am. Ass. equine Practnrs . 55, 63-66.
Google Scholar
15 Arkell, M., Archer, R.M., Guitian, F.J. and May, S.A. (2006) Evidence of bias affecting the interpretation of the results of local anaesthetic nerve blocks when assessing lameness in horses. Vet. Rec. 159, 346-349.
10.1136/vr.159.11.346
CASPubMedWeb of Science®Google Scholar
16 Dyson, S.J. and Romero, J.M. (1993) An investigation of injection techniques for local analgesia of the equine distal tarsus and proximal metatarsus. Equine vet. J. 25, 30-35.
10.1111/j.2042-3306.1993.tb02897.x
CASPubMedWeb of Science®Google Scholar
17 Myers, R. (2007) Ethyl alcohol (ethanol). In: The 100 Most Important Chemical Compounds: A Reference Guide, Ed: R. Myers, Greenwood Press, Westport. p 120.
Google Scholar
18 Gracies, J.M., Elovic, E., McGuire, J. and Simpson, D.M. (1997) Traditional pharmacological treatments for spasticity. Part I: Local treatments. Muscle Nerve Suppl. 6, S61-91.
10.1002/(SICI)1097-4598(1997)6+<61::AID-MUS6>3.0.CO;2-H
CASPubMedGoogle Scholar
19 Wang, T., Tian, F.Z., Cai, Z.H., Li, X., Cheng, T., Shi, L. and Cheng, Q. (2006) Ultrasonic interventional analgesia in pancreatic carcinoma with chemical destruction of celiac ganglion. World J. Gastroenterol. 12, 3288-3291.
10.3748/wjg.v12.i20.3288
PubMedWeb of Science®Google Scholar
20 Lauretti, G.R., Trevelin, W.R., Frade, L.C. and Lima, I.C. (2004) Spinal alcohol neurolysis for intractable thoracic postherpetic neuralgia after test bupivacaine spinal analgesia. Anesthesiology 101, 244-247.
10.1097/00000542-200407000-00037
PubMedWeb of Science®Google Scholar
21 Ali, Y., Dolan, M., Fendler, E.J. and Larson, E.L. (2001) Alcohols. In: Disinfection, Sterilization, and Preservation, 5th edn., Ed: S.S. Block, Lippincott Williams & Williams, Philadelphia. p 229.
Google Scholar
22 Penraat, J.H., Allen, A.L., Fretz, P.B. and Bailey, J.V. (2000) An evaluation of chemical arthrodesis of the proximal interphalangeal joint in the horse by using monoiodoacetate. Can. J. vet. Res. 64, 212-221.
CASPubMedWeb of Science®Google Scholar
23 Sammut, E.B. and Kannegieter, N.J. (1995) Use of sodium monoiodoacetate to fuse the distal hock joints in horses. Aust. vet. J. 72, 25-28.
10.1111/j.1751-0813.1995.tb03471.x
CASPubMedWeb of Science®Google Scholar
24 Dyson, S. (2011) Can lameness be graded reliably? Equine vet. J. 43, 379-382.
10.1111/j.2042-3306.2011.00391.x
CASPubMedWeb of Science®Google Scholar
25 Byam-Cook, K.L. and Singer, E.R. (2009) Is there a relationship between clinical presentation, diagnostic and radiographic findings and outcome in horses with osteoarthritis of the small tarsal joints? Equine vet. J. 41, 118-123.
10.2746/042516408X345107
CASPubMedWeb of Science®Google Scholar
26 Gough, M.R., Munroe, G.A. and Mayhew, G. (2002) Diffusion of mepivacaine between adjacent synovial structures in the horse. Part 2: Tarsus and stifle. Equine vet. J. 34, 85-90.
10.2746/042516402776181088
CASPubMedWeb of Science®Google Scholar
27 Serena, A., Schumacher, J., Schramme, M.C., Degraves, F., Bell, E. and Ravis, W. (2005) Concentration of methylprednisolone in the centrodistal joint after administration of methylprednisolone acetate in the tarsometatarsal joint. Equine vet. J. 37, 172-174.
10.2746/0425164054223778
CASPubMedWeb of Science®Google Scholar

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Use of ethanol in the treatment of distal tarsal joint osteoarthritis: 24 cases

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