My week on the Sports Medicine service was exciting: lots of lameness evaluations, lots of bone scans and ultrasounds, and lots of beautiful horses. One of my patients was a Dutch warmblood stallion, who wowed the clinicians with his calm attitude and good manners. An acute injury occurred during pasture turnout over a year ago, and due to his allergies, his owners didn’t want to stall rest him. Consequently, the stallion’s acute injury became a chronic injury as he continued getting turned out with his pasture mates.
Upon evaluation, he had a grade 4/5 lameness on his left hindlimb, meaning he was obviously lame at a walk. The stallion had no heat or swelling of his limb or joints and no joint effusion. But upon gentle hip swaying, I could feel a slight click on his left hip, which was more of a sensation than a sound. This hip click became more obvious when he was sedated for an ultrasound exam, making us suspicious of a hip subluxation (partial hip dislocation). The ultrasound of his hip joint revealed bony changes consistent with arthritis and confirmed the hip subluxation after comparing still images of the joint (weight bearing vs. non-weight bearing).
Unfortunately, the treatment options are limited when arthritis has been established, because the stallion’s lameness will never get any better. There was a discussion of a greater trochanter transposition surgery, which would pull the gluteal muscles tighter over the hip joint, helping prevent the femoral head from partially dislocating. However, any equine orthopedic surgery has a high risk of failure during anesthetic recovery. So with this horse, we decided on an anti-inflammatory hip injection regimen and send him home to be a pasture pet.
This case was really interesting because it impressed on me the importance of a full physical exam and diagnostic workup soon after the initial injury. In this case, time can’t heal all ills. Sometimes waiting too long is one of the worst things you can do.