Hematogenous Septic Arthritis in the Coxofemoral Joint of an Adult Horse

Septic coxofemoral joints and hematogenous septic arthritis have rarely been described in adult animals. In this case, a 510 kg, 9-year-old Quarter Horse gelding was found acutely non-weight bearing, right hind limb lame. The limb was cool to the touch. Three veterinarians performed lameness examinations (nerve and joint blocks to the stifle) with no improvement. On presentation 2-weeks post injury, the horse was fourth-fifth right hind lame. The limb was palpably cool. The horse was sensitive to all flexion tests (primarily upper limb manipulation). Pelvic and lumbosacral ultrasound, nuclear scintigraphy, and nerve blocks found no major abnormalities. Arthrocentesis of the coxofemoral joint found a cloudy fluid with 126,000 TNCC/µL (>95% neutrophils; TP 6.3 g/dL). Coxofemoral joint radiographs were normal. Arthroscopy found fibrin but normal appearing cartilage. Culture of the joint fluid yielded no growth. The horse was maintained on broad-spectrum antibiotics, NSAIDs, and gastro-protectants. Based on horse comfort and repeated synovial fluid cytology, eight standing, sedated, ultrasound guided needle lavages (1L fluids) were performed (including intraarticular amikacin, ceftiofur, meropenem, or imipenem). Arthrocentesis 18 days post-operatively was within normal limits (1,100 TNCC/µL; 45% neutrophils). The horse's comfort improved and NSAIDs were discontinued. The horse was walking comfortably and was discharged home for ongoing care 23 days postoperatively. Twelve months postoperatively, the horse was sound and barrel racing. Treatment of hematogenously spread coxofemoral joint infection in adult horses can be successful with aggressive therapy.

Acknowledgements: We acknowledge the owner's dedication to this horse, and the team involved in the horse's care.

Publication History

Article published online:
26 October 2022