Hard-luck horse Kit in recovery after complex orthopedic surgery at Equine Medical Center and long rehabilitation
September 15, 2023
One morning, Kit was turned out in a field as a perfectly sound horse. But when he was brought back into the barn that evening, he was severely lame.
Kit, owned by Michael Hillman from Emmitsburg, Maryland, was brought to Leesburg, Virginia, to the Marion duPont Scott Equine Medical Center (EMC), a teaching hospital of the Virginia-Maryland College of Veterinary Medicine, last December for an emergency lameness evaluation.
The evaluation would be the start of a long journey for Kit, including two stays at the EMC for surgery and treatment lasting over 50 days combined, and an ongoing rehabilitation. But Kit is expected to return to his home pastures later this month.
A handsome 16-year-old chestnut off-the-track thoroughbred, Kit raced regularly from ages 2 to 4, taking a toll on his limbs. At 6, Kit changed careers and was ridden by an advanced-level event rider as a project horse. Kit performed well for a while but developed painful arthritis in his pastern joint, ultimately resulting in his retirement from ridden work.
Kit was in the excellent care of veterinarian Haley Kostinas from Horizon Equine Veterinary Practice, Frederick, Maryland, and was doing well with routine shockwave therapy to treat his pastern arthritis, until the fateful day when he became severely lame on his right front limb.
After an in-depth evaluation, Jennifer Barrett, the Theodora Ayer Randolph Professor of equine surgery, diagnosed Kit with a much higher level of injury.
In addition to his chronic and now severe pastern osteoarthritis, Kit had severely damaged the tendons and ligaments at the back of the pastern joint, also called the proximal interphalangeal joint, that helps to support the joint from too much motion. In addition, his pastern joint was no longer straight because the structures at the back of the pastern joint were failing.
Osteoarthritis of the proximal interphalangeal joint (PIPJ) causes chronic lameness with treatment options limited when the cartilage has worn away and pain can no longer be controlled with medical management. Fortunately, there is a surgical treatment for severe pastern arthritis, namely arthrodesis or fusion of the joint. Furthermore, horses can even achieve soundness after this procedure, because the pain of arthritis is due to the motion of the joint, and taking away that motion takes away the pain. Plus, there is very little motion in the pastern joint in normal horses, so it is an excellent candidate for fusion. The surgical procedure involves removing the rest of the cartilage to allow the bone to grow across the joint and stabilizing it with a bone plate and screws.
But, for Kit, this was only part of the therapy. Even after his pastern joint was fused, he needed his tendons and ligaments to heal. So, in addition to surgery, Barrett recommended stem cell and platelet-rich plasma therapy to aid with the healing of Kit’s injuries.
“I sat in numbed silence as Dr. Barrett laid out her plan,” Hillman said. “From what I got out of her briefing, without the support of the tendons that had ruptured, Kit’s pastern joint, which usually has a three-degree range of motion, now had a 20-degree bend in it, and it was only going to get worse.
“Unless and until the joint was stabilized, any effort to repair the torn tendons would be a waste of time, because, with the bend in the joint, Kit would simply re-tear them and we would be back to square one.
“I did like the horse and wanted to give him a fighting chance to live out his life. So, Jen drew up her battle plan, and I checked my bank account.”
Under general anesthesia Barrett performed a standard pastern arthrodesis, removing the cartilage. Two large-sized screws were placed across the joint using a lag technique to compress across the joint. Then, a three-hole locking compression plate with three bone screws was applied in the middle across the joint as well, to give maximum stability. The leg was carefully sutured, and the limb was set in a cast. Kit recovered slowly after surgery.
Back in the stall, Kit was given antibiotics and painkillers, and a boot was placed on his foot for cushioning. Overnight he showed signs of discomfort, with involuntary muscle twitching, weight-shifting, and obvious muscle soreness. Bloodwork analyzed in the EMC laboratory revealed a markedly elevated muscle enzyme level which could potentially lead to kidney damage. Kit was started on fluid therapy and supportive medical care and by the morning his comfort and hydration had improved.
Although Kit remained comfortable, his appetite and manure output decreased. He was offered alfalfa, hay and water with electrolytes and gradually began to pass more manure. Fluid therapy and antibiotics were discontinued six days after surgery.
Over the next few days, cast soreness issues persisted which needed close monitoring and treatment. Repeat blood work confirmed a normal creatine kinase (CK), kidney value, liver value, electrolytes, and white blood cell count.
Kit was doing well and feeling even better due to the medical treatment he was receiving, but he didn’t help matters by exuberantly jumping up and down in his stall when he saw other horses in the barn!
After three weeks of intensive care Kit was discharged from the hospital. Barrett felt confident that Hillman and his wife, a retired head of nursing for the University of Pennsylvania’s New Bolton Center, would be able to take good care of him.
“My wife’s time was spent tending to Kit’s wounds from the cast rubs,” Hillman said. “I spent my time throwing grain at him to help him regain some of his lost weight. He was doing very well, he was as sound as he had been in months, and he had recovered some of his spunk. Until Kit rolled and reared awkwardly to a standing position and came up lame.”
Hillman called his primary care veterinarian Haley Kostinas. who took X-rays on the farm. The X-rays revealed that Kit had managed to damage two of the three screws in his leg. Two weeks after returning home, Kit was on his way back to the EMC.
“I was greeted by grim faces which got grimmer as new X-rays were taken,” Hillman said.
Barrett ruled out another surgery due to Kit’s slow recovery from the initial surgery but did fit a new cast.
“I can’t remember a single instance when I was in his stall grooming him, that one of the staff members didn’t drop in to say ‘Hi’ to us. Everyone had something positive to say about his demeanor and caught up with me or caught me up on them.”
-Michael Hillman
“Horses that come to the center for treatment typically don’t stay long; most come in and leave on the same day,” Hillman said. “A week is considered a long stay. Kit’s second stay, at 30 days, proved to be one of the longest in many staff members’ memory. With horses coming in and out, staff members rarely develop a bond with the horse under their care. Sure, they treat them well, but that’s a far cry from developing a bond. But in Kit’s case, the staff clearly developed a bond with him.
“I can’t remember a single instance when I was in his stall grooming him, that one of the staff members didn’t drop in to say ‘Hi’ to us. Everyone had something positive to say about his demeanor and caught up with me or caught me up on them.”
Surgery fellow, Bruno Malacarne, who assisted with Kit’s surgery, kept a close eye on the cast. At this point, Kit had progressed enough for the cast to be split into two halves and used as a splint.
Kit’s progress was slow but eventually his X-rays began to show that the joint was beginning to fuse, and the conversation turned to Kit’s long-term rehabilitation. Barrett recommended that Hillman consider sending Kit to veterinarian Stephanie Davis at Virginia Equine Rehabilitation and Performance Center in Warrenton, Virginia. An opening had just come up and Barrett was confident that Kit would be well cared for there.
Davis shared Kit’s slow progress with Hillman via daily remote updates. After two months, Kit was shipped to the EMC for a pre-scheduled progress checkup and Hillman was delighted to see Kit walking out well and clearly happy.
Radiographs and ultrasound at the EMC revealed not only that Kit’s joint had fused but also that the tendons were well on their way to healing. Barrett decided not to do any additional treatments in order to allow the natural healing process to continue. She instructed Davis that rehabilitation protocols could now begin in earnest/
Daily hand walking and grazing, massage, grooming, and a host of other treatments were performed daily to occupy mind and body, and slowly but surely, Kit began to heal.
Kit is now at the point where he can be turned out in a small paddock and Hillman is planning to bring him home this month.
