Advances in surgical treatment of septic arthritis of the distal interphalangeal joint in cattle: A review

Welfare of dairy cows

This Scientific Opinion addresses a European Commission's mandate on the welfare of dairy cows as part of the Farm to Fork strategy. It includes three assessments carried out based on literature reviews and complemented by expert opinion. Assessment 1 describes the most prevalent housing systems for dairy cows in Europe: tie-stalls, cubicle housing, open-bedded systems and systems with access to an outdoor area. Per each system, the scientific opinion describes the distribution in the EU and assesses the main strengths, weaknesses and hazards potentially reducing the welfare of dairy cows. Assessment 2 addresses five welfare consequences as requested in the mandate: locomotory disorders (including lameness), mastitis, restriction of movement and resting problems, inability to perform comfort behaviour and metabolic disorders. Per each welfare consequence, a set of animal-based measures is suggested, a detailed analysis of the prevalence in different housing systems is provided, and subsequently, a comparison of the housing systems is given. Common and specific system-related hazards as well as management-related hazards and respective preventive measures are investigated. Assessment 3 includes an analysis of farm characteristics (e.g. milk yield, herd size) that could be used to classify the level of on-farm welfare. From the available scientific literature, it was not possible to derive relevant associations between available farm data and cow welfare. Therefore, an approach based on expert knowledge elicitation (EKE) was developed. The EKE resulted in the identification of five farm characteristics (more than one cow per cubicle at maximum stocking density, limited space for cows, inappropriate cubicle size, high on-farm mortality and farms with less than 2 months access to pasture). If one or more of these farm characteristics are present, it is recommended to conduct an assessment of cow welfare on the farm in question using animal-based measures for specified welfare consequences.

Hoof lesions in partly housed pasture-based dairy cows

Lameness is a symptom of a painful disorder affecting the limbs, which impacts dairy cow welfare and productivity. Lameness is primarily caused by hoof lesions. The prevalence of different lesion types can differ depending on environmental conditions and farm management practices. The aims of this observational study were to establish the cow-level and herd-level lesion prevalence during both housing and grazing periods in a partly housed, pasture-based system, establish the prevalence of lesions always associated with pain ("alarm" lesion), identify the lesions associated with a higher lameness score, determine relationships between lesions, and identify risk factors for digital dermatitis. On 98 farms during the grazing period and on 74 of the same farms during the housing period, every cow was lameness scored (0-3 lameness scoring scale), and the hind hooves of lame cows (score 2 and 3) were examined (maximum 20 cows per visit) and the prevalence of each lesion type recorded. To gather data on potential predictors for the risk factor analysis, a questionnaire with the farmer was conducted on lameness management practices and infrastructure measurements were taken at each visit. Cow-level data were also collected (e.g., parity, breed, milk yield, and so on). Noninfectious lesions were found to be more prevalent than infectious lesions in this system type. The most prevalent lesion types during both grazing and housing periods were white line separation, sole hemorrhages and overgrown claws; all remaining lesions had a cow-level prevalence of less than 15%. The cow-level prevalence of alarm lesions was 19% during the grazing period and 25% during the housing period; the most prevalent alarm lesion was sole ulcers during both periods. We found significantly more foreign bodies within the hoof sole (grazing = 14%, housing = 7%) and overgrown claws (grazing = 71%, housing = 55%) during the grazing period compared with the housing period. Cows with foul of the foot, sole ulcer, white line abscess, toe necrosis or an amputated claw had higher odds of being more severely lame, compared with mildly lame. The strongest correlation between lesions were between toe necrosis and digital dermatitis (r = 0.40), overgrown claws and corkscrew claws (r = 0.33), and interdigital hyperplasia and digital dermatitis (r = 0.31) at herd level. At the cow level, the strongest correlation was between overgrown claws and corkscrew claws (r = 0.27), and digital dermatitis and heel erosion (r = 0.22). The farmers' perception of the presence of digital dermatitis (and lameness) was significantly correlated with the actual presence of digital dermatitis recorded. Additional risk factors for the presence of digital dermatitis were cow track and verge width near the collecting yard, and stone presence on the cow tracks. Results from this study help further our understanding of the causes of lameness in partly housed, pasture-based dairy cows, and can be used to guide prevention and treatment protocols.

Autologous platelet-rich plasma effects on Staphylococcus aureus-induced chondrocyte death in an in vitro bovine septic arthritis model

OBJECTIVE

To investigate the chondroprotective effects of autologous platelet-rich plasma (PRP), ampicillin-sulbactam (AmpS), or PRP combined with AmpS (PRP+AmpS) in an in vitro chondrocyte explant model of bovine Staphylococcus aureus-induced septic arthritis.

SAMPLE

Autologous PRP and cartilage explants obtained from 6 healthy, adult, nonlactating Jersey-crossbred cows.

ProcedureS

Autologous PRP was prepared prior to euthanasia using an optimized double centrifugation protocol. Cartilage explants collected from grossly normal stifle joints were incubated in synovial fluid (SF) alone, S aureus-inoculated SF (SA), or SA supplemented with PRP (25% culture medium volume), AmpS (2 mg/mL), or both PRP (25% culture medium volume) and AmpS (2 mg/mL; PRP+AmpS) for 24 hours. The metabolic activity, percentage of dead cells, and glycosaminoglycan content of cartilage explants were measured with a resazurin-based assay, live-dead cell staining, and dimethylmethylene blue assay, respectively. Treatment effects were assessed relative to the findings for cartilage explants incubated in SF alone.

RESULTS

Application of PRP, AmpS, and PRP+AmpS treatments significantly reduced S aureus-induced chondrocyte death (ie, increased metabolic activity and cell viability staining) in cartilage explants, compared with untreated controls. There were no significant differences in chondrocyte death among explants treated with PRP, AmpS, or PRP+AmpS.

CLINICAL RELEVANCE

In this in vitro explant model of S aureus-induced septic arthritis, PRP, AmpS, and PRP+AmpS treatments mitigated chondrocyte death. Additional work to confirm the efficacy of PRP with bacteria commonly associated with clinical septic arthritis in cattle as well as in vivo evaluation is warranted.

Septic Tenosynovitis of the Digital Flexor Tendon Sheath in 83 Cattle

Septic tenosynovitis of the digital flexor tendon sheath (DFTS) is the second most prevalent infection of deeper structures of the distal limb in cattle, after septic arthritis of the distal interphalangeal (DIP) joint. Depending on the type of infection and the involvement of adjacent anatomical structures, various surgical techniques may be used for therapy: Incising the DFTS to resect one or both digital flexor tendons (RDFT), additional resection of the DIP joint (RDIP) or additional digital amputation (RAMP). Our goal was to describe clinical findings and outcome in cattle patients (euthanasia vs. treatment) and the success of surgical methods including improvement of locomotion and postoperative survival time (POST). Data of eighty-three cattle with a mean age of 4.3 years were reviewed in this retrospective study. Overall, 57.7% of tenosynovitis cases were in the lateral DFTS of a hind limb. Fifty-five cattle were treated surgically; the remaining 28 cattle were euthanized following diagnosis. The median cumulative POST was 17.3, 83.1, and 11.9 months for RDFT, RDIP, and RAMP, respectively. Fatal postoperative complications occurred in three cattle. We conclude that the applied methods were successful and allowed the animals to almost reach the average life expectancy of an Austrian dairy cow.

Long-term radiographic and histological follow-up after resection of the distal interphalangeal joint using a plantar approach in German Holstein cows

Resection of the distal interphalangeal joint (DIJ) is a claw-preserving method for treatment of septic arthritis. This study presents the radiographic and histological findings of the surgically-treated area after resection of the DIJ using a plantar approach in seven German Holstein cows. Histological postmortem evaluation 439 to 710 days after surgery showed that there was extensive proliferation of connective tissue rich in collagen fibres in the space left after resection in three cows; this was classified as fibrous ankylosis. In the remaining four cows, histological evaluation 1010 to 1756 days after surgery showed extensive new bone formation in the joint cavity consistent with osseous ankylosis. Radiographs of the resected DIJ region obtained at the time of histological examination revealed no osseous ankylosis in two cows, partial ankylosis in one cow and complete osseous ankylosis in four cows. Formation of complete osseous ankylosis after resection of the DIJ did take longer than 1-2 years in three of our specimens indicating a longer time span compared to earlier studies.

Suprascapular nerve decompression for treatment of neuropathy in a bucking bull

CASE DESCRIPTION

A 3-year-old 639-kg (1,406-lb) American bucking bull was examined because of a 4-day history of right forelimb lameness that began after the bull sustained an injury to the right shoulder region while exiting the chute during a rodeo.

CLINICAL FINDINGS

A 10 × 10-cm soft tissue swelling was present over the right shoulder region. Ultrasonographically, the contour of the scapular spine, bicipital bursa, bicipital tendon, and greater tubercle of the humerus appeared unremarkable; the swelling appeared to be a hematoma overlying the distal aspect of the scapula. No external wounds, palpable joint effusion, or swellings were noted on examination of the distal portions of the limbs. The bull developed atrophy of the supraspinatus and infraspinatus muscles with lateral abduction of the shoulder joint when walking. Electromyography revealed decreased innervation to the supraspinatus and infraspinatus muscles consistent with suprascapular neuropathy.

TREATMENT AND OUTCOME

The suprascapular nerve was surgically decompressed by removing the entrapping hematoma and periosteum and performing a notch resection of the scapula; dexamethasone (40 mg) was administered prior to closure. The bull was discharged 5 days after surgery; no lameness was evident at the time of discharge. The owner was instructed to restrict the bull to a stall or small pen for 6 weeks. Four months after surgery, the muscle atrophy had substantially improved, and the bull returned to bucking.

CLINICAL RELEVANCE

Findings suggested that suprascapular neuropathy can develop in bulls secondary to injury and that suprascapular nerve decompression may improve nerve function, muscle atrophy, and gait.

Antinociceptive Effect of Intravenous Regional Analgesia in Horses Underwent Selected Short-Time Distal Limb Surgeries

The aim of the present study was to establish appropriate doses for both lidocaine hydrochloride (Hcl) and mepivacaine in intravenous regional analgesia (IVRA) and to assess their intraoperative and postoperative analgesic effects in horses with distal limb surgeries. A total of 55 draft horses were included in the present study. Six clinically healthy horses were selected randomly for establishing the doses of lidocaine Hcl and mepivacaine in IVRA in horse limbs. After selection, 32 horses suffered from various distal limb surgical affections were randomly allocated into three groups: thiopental group (n = 6), animals were operated under general anesthesia using thiopental sodium; IVRA-LID group (n = 12), animals were operated under both general anesthesia and IVRA using lidocaine Hcl; and IVRA-MEP group (n = 14), horses were operated under both general anesthesia and IVRA using mepivacaine. Postoperative pain was measured using both Horse Grimace Pain Scale and multifactorial numerical rating composite pain. The results showed that conjunction of IVRA along with thiopental general anesthesia using either lidocaine or mepivacaine significantly decreased the total required doses of thiopental sodium during the operations and significantly increased the duration of postoperative analgesia to 60 and 150 minutes using lidocaine and mepivacaine, respectively. In conclusion, the uses of local IVRA before distal limb surgery improve the depth of general anesthesia and reduced postoperative pain, despite thiopental anesthesia alone. Mepivacaine is superior to lidocaine in IVRA, with a longer duration of action.

Assessment of a multimodal analgesia protocol in goats undergoing claw amputation

Objective: To evaluate the anti-nociceptive, sedative and behavioral effect of multimodal analgesic drugs in goat's undergoing unilateral claw amputation. Design: A randomized experimental design. Animals: Sixteen goats were randomly assigned into 4 groups (4 bucks per group). Procedure: Animals used in this study were randomly assigned into 4 groups, four animals for each group. All goats were anaesthetized by intravenous regional anesthesia (IVRA) of the right forelimb cephalic vein with 2% lidocaine in a dose of 3mg/kg body weight (BW) before surgery. Administration of carprofen (50 mg/ml) at a dose 0.1 mg/kg BW took place before surgery on day 0 and was then repeated once daily for another 3 consecutive days postoperatively in groups Lidocaine (L), carprofen_lidocaine (CL), carprofen – romifidine - lidocaine (CRL), and carprofen – romifidine - butorphenol - lidocaine (CRBL). Heart rate (HR), respiratory rate (RR), rectal temperature (RT), serum IL-6 level, sedation score, and lameness score were determined at preset time intervals and the animals’ behavior was recorded. Results: The mean average of HR, RR and RT in IVRA treated animals was significantly increased until the end of surgery followed by gradual decrease up to 90 min post-surgery. In CRL and CRBL it showed a significant decrease compared to controls. There was a significant decrease in lameness score in CRL and CRBL treated animals from 30 min until 2 hours and for 3 days post-surgery. After injection of romifidine it showed a significant decrease of IL-6 levels compared to lidocaine and CL treated animals. Conclusion and clinical relevance: It was concluded that, the use of romifidine and buterphanol in the analgesic protocol during claw amputation in goats, alleviate pain response and potentiate the analgesic effects of IVRA. Addition of carprofen to the analgesic protocol can be used for long- term treatment of orthopedic pain in goats without complications.

Bacterial osteomyelitis in veterinary orthopaedics: Pathophysiology, clinical presentation and advances in treatment across multiple species

Bacterial osteomyelitis in veterinary patients can be challenging to diagnose and treat, given limited therapeutic options and reported success rates. Osteomyelitis is frequently associated with surgical implant devices, including those required to optimise stability and healing of fractures. However, management of osteomyelitis sometimes necessitates the removal of these surgical implant devices in order to eradicate infection or limit implant-related osteolysis. The goal of this article is to provide a general and species-specific review of bacterial osteomyelitis in a selection of domestic veterinary species, including cats, dogs, horses, cattle and camelids, with a focus on classification, clinical presentation, aetiologic agents, and common therapeutic interventions reported in the literature. New treatment options emerging from research and human medicine will be also discussed, as they also apply to current or future care of veterinary patients with osteomyelitis.

Modified abaxial approach for resection of the distal sesamoid bone and distal interphalangeal joint while preserving the digital flexor tendons of three Angus bulls with septic arthritis

CASE DESCRIPTION 3 Angus bulls, aged 2 to 3 years, with severe lameness of 2 to 4 weeks' duration and swelling proximal to the coronary band of the affected limb were evaluated after failing to respond to antimicrobial treatment. CLINICAL FINDINGS Septic arthritis of a distal interphalangeal joint (DIPJ) was diagnosed in all 3 bulls on the basis of results of a physical examination, radiographic and ultrasonographic evaluations of the affected foot, and cytologic evaluation of synovial fluid from the affected DIPJ. TREATMENT AND OUTCOME A novel modified abaxial approach was used to resect the infected distal sesamoid bone (navicular bone) and DIPJ of all 3 bulls. A window was created in the abaxial hoof wall that was lateral to and of sufficient size to extract the navicular bone. Following removal of the navicular bone, the DIPJ was debrided and resected and an orthopedic block was applied to the contralateral claw to minimize weight bearing on the infected digit. Two bulls also had a fiberglass cast applied to the affected limb to help immobilize the DIPJ. All 3 bulls recovered without complications, and 2 bulls were no longer lame, whereas the remaining bull was only mildly lame, at 4 to 5 weeks after surgery. CLINICAL RELEVANCE The modified abaxial approach described for surgical resection of the DIPJ allowed extraction of the infected navicular bone without damage to the digital flexor tendons, something that cannot be achieved with other abaxial approaches. This approach is best used for patients without septic tenosynovitis.

Objective assessment of lameness in cattle after foot surgery

Assessment of lameness in cattle after foot surgery is important to monitor the recovery period, to improve the long-term success and the cows` welfare. This longitudinal multicenter retrospective study was carried out to evaluate the usefulness of automated tools of weight bearing and gait analysis following foot surgery to support the clinician to monitor lameness in cattle. For this purpose, the effect of involvement of different anatomical structures and the use of different surgery methods on gait parameters of post-operative recovery was assessed. The study consisted of 2 experiments and included cattle with unilateral foot pathologies located in the digital region which needed 1 (experiment 1; n = 30) or 2 (experiment 2; n = 4) surgical interventions. The surgical techniques were debridement, joint lavage, partial resection of bones, tendons or synovial structures, total resection of the sesamoid bone and digit amputation. Two accelerometers (400 Hz; kinematic outcome = stance phase duration; kinetic outcome = foot load and toe-off), a 4-scale weighing platform (difference of mean weight distribution across the limbs; Δ_weight) and a subjective locomotion score were used to evaluate gait parameters every 3 to 4 days after surgery. A repeated measures ANOVA was used in experiment 1 and a receiver operator characteristic analysis was used to determine the optimal cutoff values in experiment 2. Results showed that the differences across limbs for the pedogram variables of stance phases and peaks of foot load and toe-off, Δ_weight and the locomotion score were highest if joints or sesamoid bones were involved, suggesting that these cattle were more severely lame compared to cattle with more superficial foot pathologies. There was a significantly lower degree of lameness after surgical debridement and after digit amputation compared to partial and total resection of anatomical structures of the foot. The use of accelerometers and a 4-scale weighing platform represent promising objective tools for post-operative monitoring of lameness and can support the clinician in gait assessment to improve the long-term success of surgical interventions in the area of the foot.

Factors associated with septic arthritis of the distal interphalangeal joint in beef cattle: A case-control study

Lameness in cattle is a welfare concern and is associated with important economic losses in beef cattle operations. Infection of the distal interphalangeal joint (DIJ) results in severe lameness and if left untreated carries a poor prognosis. Diagnosis of DIJ infection is challenging in the field. The aim of this study was to determine factors associated with septic arthritis of the DIJ in beef cattle. Thirty-nine beef cattle with a complaint of single-foot lameness were used in this study. History and lameness examination data were recorded and analyzed. Radiographic changes and cytology of synovial fluid of the affected DIJ were used to define the presence (cases) or absence (controls) of DIJ infection. Asymmetric swelling at the coronary band of the affected foot and a lameness score of ≥4/5 significantly increased the odds (odds ratio [OR]=63.2 and OR=120, respectively) of diagnosis of septic arthritis of the DIJ in beef cattle with a single-foot lameness compared to cattle with no asymmetry of the coronary band or lameness scores <3. Routine lameness examination findings could be used in the field to rapidly recognize infection of the DIJ in lame beef cattle.

Evaluation of intravenous regional anaesthesia and four-point nerve block efficacy in the distal hind limb of dairy cows

Background

Intravenous regional anaesthesia (IVRA) and hindfoot four-point nerve block anaesthesia (NBA) are recommended for local anaesthesia (LA) in the distal limb of dairy cows. Two studies were conducted to compare the efficacy, time until onset and stress responses to IVRA and NBA in dairy cows. In the first cross-over designed study, eight healthy unsedated German Holstein cows, restrained in lateral recumbency (LR) on a surgical tipping table, were treated with IVRA and NBA using procaine 2% as a local anaesthetic. Distal limb desensitization was tested by electrical (e-), mechanical (m-) and thermal (t-) nociceptive stimulation 10 min before and 15 and 30 min after LA. Hormonal-metabolic (blood concentrations of cortisol, lactate, non-esterified fatty acids, and glucose) and cardio-respiratory (heart and respiratory rate, mean arterial blood pressure) stress responses to treatment were assessed at predetermined intervals. In the second study, six healthy, unsedated German Holstein cows in LR were treated (crossover design) with IVRA and NBA. Short-interval e-stimulation was measured by the time until complete distal limb desensitization.

Results

In the first study, four of eight cows responded to e-stimulation 15 min after IVRA, while none of the cows treated with NBA responded until the safety cut-off level was reached. E-stimulation revealed complete desensitization of the distal limb 30 min after LA in all cows. Half of the cows did not respond to m- and t-stimulation before LA, so no further evaluation was performed. Stress reactions to IVRA and NBA treatment were similar, but differences may have been masked by stress response to LR restraint. In the second study, complete desensitization was achieved 12.5 min after NBA, while one of the six cows still responded to e-stimulation 20 min after IVRA.

Conclusion

Hindfoot nerve block anaesthesia and intravenous regional anaesthesia induced complete desensitization of the distal hind limb in dairy cows. However, the anaesthesia onset after NBA was significantly faster than that of IVRA, which may be clinically relevant in the field, particularly when distal limb anaesthesia is required for major claw surgeries under time constraints.

Surgery of the Distal Limb

Diseases of the bovine digit remain the major cause of painful lameness in cattle and commonly constitute a diagnostic and therapeutic challenge for clinicians. Prompt surgical wound revision is critical in acute injuries. Deep infections may be treated with debridement, resection of tendons, synovioscopy, joint lavage, arthrotomy and facilitated joint ankylosis. Postoperative care is more involved, lameness persists longer, and cost of treatment is higher after salvage techniques than after amputation of the digit. Luxations and fractures of the digits often are amenable to conservative treatment but may be treated surgically if indicated.

Ultrasonography of the distal limbs in Nellore and Girolando calves 8 to 12 months of age

BACKGROUND

Ultrasonography can be used anywhere and allows rapid, noninvasive differentiation of soft tissue structures of the musculoskeletal system. The objectives of this study were to describe the ultrasonographic appearance of the structures of the metacarpo-/metatarsophalangeal and the interphalangeal joints, the appearance of the growth plates of the distal metacarpus/metatarsus and of the proximal phalanx and to measure the cross-sectional dimensions of the DDFT and SDFT in Nellore and Girolando calves eight to 12 months of age.

RESULTS

In the longitudinal dorsal view the common digital extensor tendon and the digital extensor tendon were depicted as echogenic parallel fiber bundles located directly under the skin. The joint spaces appeared as anechoic interruptions of the hyperechogenic bone surfaces. The normal amount of synovial fluid could not be depicted. The growth plates were seen as anechoic interruptions of the bone surface proximal and distal to the fetlock joint space. In transverse sonograms of the distal palmar/plantar regions, the flexor tendons and branchs of the suspensory ligament were imaged as echogenic structures. The lumen of the digital flexor tendon sheath could not be imaged in these normal cattle. The thin digital distal annular ligament and the reversal of positions of the DDFT and SDFT could be appreciated. No significant differences were found between the cross-sectional measurements of the DDFT and the SDFT from Nellore and Girolando in any age, thoracic/pelvic limbs, right/left sides and lateral/medial digits.

CONCLUSIONS

The results of this study establish important ultrasonographic reference data of the normal structures of the distal limbs and the normal dimensions of the flexor tendons in Nellore and Girolando calves for use in clinical practice.

Clinical management of septic arthritis in cattle

Synovial fluid, ultrasound, and radiographic imaging are common diagnostic tools for septic arthritis. Mycoplasma septic arthritis is suspected in calves with clinical signs of otitis and pneumonia. Commonly affected joints are carpus, stifle, and tarsus. Treatment strategy must include long-term antibiotics, anti-inflammatories, and joint lavage. Knowledge of communication and boundaries for commonly affected joints is essential to perform joint lavage and arthrotomy.

Limb amputation and prosthesis

Limb amputation is an alternative to euthanasia when catastrophic injury prevents successful restoration of the limb or when cost is an issue. Proximal limb disarticulation for amputation is preferred if a prosthesis is not considered. Distal amputations are needed to accommodate exoskeletal prosthesis. This article reviews the considerations and describes techniques for this surgery.