Arthroscopic Partial Synovectomy And Joint Lavage In The Treatment Of Septic Arthritis In Bovines

ARTHROSCOPIC PARTIAL SYNOVECTOMY AND JOINT LAVAGE IN THE TREATMENT OF SEPTIC ARTHRITIS IN BOVINES Name of the Student : A. RAMANATHAN Degree for which submitted : Ph.D. in Veterinary Surgery and Radiology Chairman : Dr. R. Suresh Kumar, Ph.D. Professor and Head, Department of Veterinary Surgery and Radiology Madras Veterinary College Department : Veterinary Surgery and Radiology Place : Madras Veterinary College University : Tamilnadu Veterinary and Animal Sciences University Year : 2007 Thirty six clinical cases of bovines with septic arthritis were randomly divided into three groups of 12 animals each and treated by conventional lavage (group I), arthroscopic fibrin debridement and lavage (group II) and arthroscopic debridement, partial synovectomy and lavage (group III). The incidence of septic arthritis was more frequent in crossbred, heifer calves as a sequela to omphalophlebitis. A mean lameness score of 3.58, 3.67 and 3.83 observed on day 1 decreased to 1.83, 1.17 and 1.00 on the 10th day in group I, II and III respectively. The purulent or turbid synovial fluid observed on day 1 became clear and viscous on day 14 in 23.81, 90.48 and 100 per cent samples of group I, II and III respectively. Significantly increased synovial fluid volume and total protein content recorded on day 1 returned to its normal value on day 21 in group I and on day 14 in both group II and III. The raised synovial fluid alkaline phosphatase activity, serum and synovial fluid glucose difference, total nucleated cell count noted on day 1 returned to their base value on days 28, 21 and 14 in group I, II and III respectively. Synovial fluid culture was positive in 58.73 per cent of joints and the bacteria isolated were Streptococcus spp. , Escherichia coli, Pseudomonas spp. , Staphylococcus spp. and Salmonella spp. A combination of amikacin and penicillin or ampicillin provided broad-spectrum coverage against majority of the bacterial isolates. Soft tissue swelling, increased joint space, intra-articular gas shadow and subchondral osteolysis were the salient radiographic findings. Hyperaemia, petechial haemorrhage, degeneration/necrosis in synovial membrane, thickening and clubbing of villi, articular cartilage erosion, and fibrin deposits or free floating fibrin clots were the major arthroscopic findings. Fibrin deposits and bacterial colonies in synovial membrane and articular cartilage were the major histological changes. The outcome was sound, acceptable and unacceptable respectively in 66.67, 14.28 and 19.05 percent joints of group I animals whereas it was sound in 95.24 per cent joints and acceptable in 4.76 percent joints of both groups II and III. The mean time taken for resolution of joint infection was 18.11, 13.33 and 11.13 days in group I, II and III respectively. It is concluded that arthroscopy permits thorough evaluation, appropriate debridement and effective lavage of septic joints with minimal tissue trauma and offers consistently good results in the management of septic arthritis in bovines than conventional lavage. Partial synovectomy is recommended during arthroscopic debridement of septic joints to eliminate colonizing bacteria and as it helps to shorten the recovery period. Needle lavage is recommended for cases that are presented within 5 to 6 days after infection and arthroscopy for cases presented 7 days or more after onset of clinical signs and those which were refractory to conventional treatment.