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KEYHOLE SURGERY OF HORSE JOINTS AND TENDON SHEATHS
Keyhole surgery of joints (Arthroscopy) is now a routine procedure in human medicine. The techniques and equipment have rapidly advanced over the last 25 years and arthroscopy has now also become commonly performed in horse practice. The principles of arthroscopy are that by maintaining a joint in distension a small arthroscope (telescope) can be inserted into the joint. A powerful source of light is then transmitted down the arthroscope allowing visualisation of the joint interior. At a position distant to the arthroscope small instruments are then inserted into the distended joint. Instruments originally were limited to rongeurs to grasp and remove debris and fragments from the joint. However with time small hand-held motorised equipment have evolved that have a variety of attachments (usually between 2 - 4.5 mm in diameter). The small attachments are capable of removing areas of damaged cartilage, membrane, and bone and can burr out bone cyst lesions. Most operations now rely on these motorised burrs. The surgery is conducted, similar to in humans, where the surgeon uses a television monitor to guide him/her whilst in the joint. Following the surgery the joint is usually flushed with several litres of the Hartmann’s solution, which in itself is a very useful inflammatory treatment. The surgery is relatively non-traumatic and provides excellent cosmetic results post-operatively. Also there is a decreased convalescence time and an earlier return to work when compared to previous surgical treatments.
Horse joints by their very size are ideal candidates for the keyhole surgery. It is also preferred by vets because of the significantly reduced incidence of post op infection and the reduced need to bandage the limb following the surgery. Over the last 10 years techniques for exploring virtually all joints and tendon sheaths have now been described. joint conditions that were not particular amenable to surgery have been developed. Examples of this include the treatment of OCD of the equine shoulder joint, which previously involved making large incisions over the shoulder and gave very poor inspection of the joint.
Most equine orthopaedic surgeons accept that equine arthroscopy has revolutionised joint and tendon sheath surgery in the horse. Arthroscopy is virtually always conducted with the horse under general anaesthesia. The whole procedure requires a team of an anaesthetist, surgeon and a trained nurse who all work to ensure that the operation works smoothly and quickly. An average joint operation takes about 90 minutes.
Arthroscopy is the preferred treatment of choice for: -
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