Prognosis Following of Carpal Arthroscopy in Thoroughbred Racehorses - Abstract
The published evidence related to the success of carpal arthroscopy is of lower levels, and sometimes conflicting. To determine the prognosis and investigate which surgical variables significantly affect clinical outcomes and race day performance., a retrospective cohort study was carried out on 251 carpal arthroscopies at the Singapore Turf Club between October 2008 and May 2011, a unique environment with detailed accurate unbiased records and without loss of cases to follow up. Exposure variables studied were limb, joint, intra articular medication, degree of pre-existing osteoarthritis, size of fragment, and grade of cartilage damage. Outcome variables measured were race day performance and clinical outcome. Veterinary histories were obtained from management software, the pre-surgery x-rays read from stored images by a single blind observer, and the race records obtained from the club website. Horses race performance post-surgery was as per previous studies (77% return to race), but complications such as ongoing lameness (60%) severe osteoarthritis (27%), and repeat of the bone chips requiring a 2nd surgery (20%) were more common. Radiocarpal lesions had a much better prognosis than intercarpal lesions (p<0.01). Grades 1 and 2 cartilage lesions also had a better prognosis than 3 and 4 lesions. Radiological findings of the size of fragment and degree of pre-existing arthritis were not related to outcomes. Horses undergoing a repeat surgery had a slightly reduced but overall acceptable prognosis. Post-surgical administration of intra articular cortisone appears to be contra-indicated, and more attention should be given to post surgery rehabilitation.