Joint injections in the horse, likely the most commonly performed procedure in the horse with osteoarthritis, navicular ailments, or other lameness condition. The second most common procedure, likely, is endoscopy for gastric ulcers. How much does a joint injection cost in the horse? Not just financially, but what do they cost your horse regarding future health and soundness? Is there a downside outside of where it hits you in the pocket book? Is there another option or alternative to a joint injection for your horse?
Injecting the horse’s joint is generally an easy procedure to perform for the average veterinarian. The difficulty lies not in getting the needle into the joint, but more often in getting that horse to stand still and be quiet, even with sedation. However, the more often a horse’s joint is injected, and the more time that goes by, it can become increasingly difficult to get the needle to the precise point, which then reduces the efficacy of that injection and actually, increases risk to the patient.
Financial Costs and Response Rate to Joint Injections in the Horse
So, what is the financial cost to the horse owner for a joint injection? That depends on the veterinarian, what joint is injected, and what medications are used or placed into the joint space. I would guess, based on my personal history of injecting joints, the average cost would be around $250-300 per joint. So, if you have a horse with bilateral hock osteoarthritis, then the cost could be upwards of $500.
What is the general response rate to a joint injection in the horse? This is also dependent upon the veterinarian, the horse’s condition, and the medications utilized. I do not have any hard facts, and even those found in research do not reflect the real world, as each horse is different as is the situation. I would guess that for first time joint injections, the response would be around 80% or higher, meaning there is an improvement of at least one grade in lameness. This does not mean the lameness is resolved by any means, but more so just improved. For those ‘repeat offenders’, implying the horses that habitually are injected 2 or more times per year, the response rate likely decreases to 60% or less, dropping with each repeated joint injection event.
What are the risks with injecting a joint in the horse? There are risks to any procedure that is performed in the horse and joint injections are no different. The side effect rates are likely very low, less than 10% of all horses injected, but those negative events can be dependent or variable based on many factors including the medications used, the current status of the horse, and the experience of the veterinarian.
Side effects of joint injections in the horse include:
- Needle breakage in the joint (serious situation)
- Joint infection (serious situation)
- Soft tissue damage (moderately serious situation)
- Medication reactions
These side effects are strictly related to the joint injection itself and do not include any side effects that may come with the act of sedation or repeated dosing of sedatives to get the task accomplished. Now, while those events are ‘rare’, relatively speaking, they do occur and often the end result is not good for the horse or the owner.
Are There Other Costs with Joint Injections in the Horse?
There is a cost to everything and those ‘costs’ are not always financially related. For most owners, they see a lame horse and soon, it may be diagnosed as ‘joint disease’ or more specifically osteoarthritis. The lameness may also involve the heel region and be labeled as ‘navicular syndrome’ or maybe even involving the SI region resulting in back pain. When given this diagnosis, the instant human response is to ‘make it all go away’, which is logical as we don’t like bad things or painful events. This is when the needle comes out and concerns over costs, financial and otherwise, get put on the back burner.
Putting side effects aside, most horses do respond at least initially to a joint injection, which is okay and acceptable in the short-term, but how about the long-term? What about those horses that just keep requiring or needing joint injections month after month, or 2 or more times per year? What are the long-term costs to them?
Well, here again, it is all dependent on the horse and your view points regarding the health of that animal and what are your long-term goals.
The repeated need for joint injections creates problems for the horse, outside of costs. This ongoing need signals that there is a problem present which is not being managed properly. Sure, osteoarthritis may be there with associated joint degeneration, but joint injections are far from being a cure for that condition. More so, they are symptom relievers. If this were not true, then one injection or maybe two injections would cure what ails your horse, right?
There is no apparent change to any joint, regarding degeneration or healing, even after the repeated usage of joint injections, no matter the medication. In fact, I would argue that repeated usage of these medication may actually speed up or accelerate the joint damage, either directly through the actions of the medications, or secondarily through the repeated damage to the joint capsule which triggers the inflammatory response. A point that is heavily debated indeed!
So, one major cost to most horses is that the condition continues to progress and their arthritis advances, despite the injections. In the end, most horses reach a point where the joint injections are simply not providing any further benefit or the owner has reached a financial breaking point. Either way, the horse suffers in the end, that is the cost. Many of these horses are abandoned by their owner because they have outlived their use, or the owner cannot afford further therapy to help them. Some are indeed euthanized due to ongoing lameness and pain.
Given this, are there better options that maybe should be pursued in advance of sticking that needle into a joint and pulling out the credit card to cover the expenses?
Joint Disease in the Horse; Taking a Different Approach
The intention of this article is not to discuss joint disease in the horse, osteoarthritis, and the reasons why these conditions develop. This topic was discussed in depth in another article.
What I can say, as a veterinarian and researcher, is that if you step back from the problem and evaluate the causes, then possible solutions for better management make themselves obvious. This can include:
- Dietary modification
- Proper shoeing, trimming, and foot balance
- Corrective footing to arenas
- Correct body conditioning and strengthening
- Proper herbal therapy and supplementation
Most of the horses that I personally encounter have a history of joint injections, often done 2-3 times per year, and a fading history of response. In most, the joint degeneration evident on radiographs is obvious, being more severe in some than others. The bottom line is that I am presented a horse that is lame, has been lame, and managed superficially with repeated joint injections. My job is to improve the horse’s comfort and restore soundness to the best of my ability. I do not choose to inject that joint because it is not my mode of therapy, and secondly, it has already been done many times.
Outside of creating the proper diet for support of the horse, my focus is on foot balance, health, and proper travel. This goes along with body conditioning and strengthening. This is working with the patient directly, helping their body to get over stiffness, tightness, and often years of compensation.
Then, comes herbal therapy. When properly chosen, the right herbs in combination can greatly assist us with managing the main cause of the joint ailment, which is inflammation. In addition, the right herbs can assist with blood flow, muscle relaxation and strength, and help to counter the stress response that is present as a by-product.
When the right regimen is chosen, sometimes the results can be almost instantaneous, as in less than a week, while most take 10-14 days to see a change. Not bad, really, when you look at it and compare to a joint injection.
Often the cost of a well chosen herbal regimen is less than half of a joint injection, with no side effects, and an improvement in soundness by more than one grade in the same period of time.
Now, what regimen do you choose? What do I do with each horse? That is dependent upon the horse and the current situation, regarding the degree of damage present and also the general condition of the horse.
Formulas that I depend on and use in our equine patients include:
- Cur-OST EQ Pure
- Cur-OST EQ Plus
- Cur-OST EQ Bone
- Cur-OST EQ Collamend
- Cur-OST EQ Topline
- Cur-OST EQ Rejuvenate
Seems like an extensive list, right? It is, but those are the contents of my tool bag when it comes to supplements. When the right combination is chosen, in conjunction with a proper diet and foot care, most horses respond nicely and continue to respond in the months to come. Some, actually, show improvement in their joint health on repeated radiographs, when taken 6 or more months down the road. That’s a nice thing to see, as that is accomplishing our real or ideal goal, which is restoring health in the horse.
How do you know which regimen is right for your horse? That can take some detective work to a degree, but mainly keep in mind two things:
- Target the inflammatory response
- Support the body regarding nutrition and strength
The formulas listed above address those two factors, plain and simple. Which ones are chosen are dependent upon the horse and their initial response rate. The bottom line is that if we, as a rehab facility, can impact a horse’s soundness after the fact, after years of joint injections and joint deterioration, doesn’t it just make sense to try this approach right out of the gate and maybe forgo the joint injection? At least initially?
Author: Tom Schell, D.V.M., CVCH, CHN