EQUINE VETERINARY JOURNAL 79

Equine vet. J. (2007) 39 (1) 79-83

doi: 10.2746/042516407X153093

Ultrasound-guided coxofemoral arthrocentesis in horses

F. DAVID*, M. ROUGIER, K. ALEXANDER and S. MORISSET

Département des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, C.P. 5000, Saint-Hyacinthe, Québec J2S
7C6, Canada.

Keywords: horse; coxofemoral; hip; coxal; arthrocentesis; ultrasonography; joint

Summary joint disease (Bergfeld 1978; Trent and Krook 1985; Lamb and
Morris 1987; Nixon 1994), osteochondrosis (Rejno and Stromberg
Reason for performing study: Coxofemoral joint pain is 1978; Rose et al. 1981; Miller and Todhunter 1987; Nixon et al.
probably underestimated due to difficulties in identifying hip 1988; Nixon 1994), fractures (Little and Hilbert 1987; Hunt et al.
pain. The deep location of the joint and proximity of the sciatic 1990; Nixon 1994; Blaik and Hudson 1999), dysplasia (Haakenstad
nerve make arthrocentesis based on external landmarks a 1953; Jogi and Norbery 1962; Speirs and Wrigley 1979), partial tear
difficult and potentially risky procedure in mature horses. or rupture of the intra-articular ligaments (Rejno and Stromberg
Objectives: To describe an ultrasound-guided injection 1978; Rose et al. 1981; Trent and Krook 1985; Lamb and Morris
technique of the coxofemoral joint in standing horses and to 1987; Nixon 1994; Hendrickson 2002) and septic arthritis (Clegg
evaluate its accuracy and potential difficulties/complications. 1995; Hance 1998). Hip pain is particularly difficult to assess, partly
Methods: Nine mature horses had both pelvic areas prepared because of the limitations of traditional diagnostic tools available
for sterile ultrasound examination (3.5 MHz curvilinear for coxofemoral evaluation. Therefore, hip lesions still represent a
probe). Coxofemoral joints were located and penetrated at diagnostic challenge for equine veterinarians and this may explain
their craniodorsolateral aspect under ultrasonographic why the true incidence of coxofemoral injuries remains unclear.
guidance and injected with sterile contrast medium. A Anatomically, the acetabulum is a large cavity, limited
standing ventrodorsal radiographic view of each hemipelvis dorsally by a round rim and prolonged laterally by a
centred on the hip was obtained for each horse to assess the fibrocartilaginous labrum that allows close apposition to the
injection site. Horses were evaluated for 10 days following femoral head (Barone 2000). The strong joint capsule is tensed
injection for possible complications. and extends from the acetabular rim to the femoral head and neck
Results: Intra-articular injection was successful in all junction, over the labrum (Barone 2000). Although the equine hip
18 joints. The procedure was well tolerated by horses under is a relatively large joint, its deep positioning, the fact that it is
minimal restraint. Mean ± s.d. needle repositionings required surrounded by a large muscle mass making landmark
before accurate placement was 1.5 ± 1.3 per joint. Once the identification difficult, and the caudolateral proximity of the
needle was in the joint, synovial fluid was obtained in 7/18 sciatic nerve make its approach difficult and potentially risky.
joints. Minimal periarticular contrast medium was detected The traditional arthrocentesis technique for the coxofemoral
in 2/18 joints. Mean ± s.d. ultrasonographic examination time joint is based on external anatomical landmarks (Mueller and Hay
required for coxofemoral localisation, accurate needle 1999; Stashak 2002; Bassage and Ross 2003). Specifically, a
positioning and injection was 4.3 ± 2.1 min. No complications 16–18 gauge 15 cm spinal needle is inserted in the trochanteric
were observed in the 10 days following injection. notch, a cleft between the short cranial and the long caudal
Conclusion: The ultrasound-guided coxofemoral arthrocentesis prominences of the greater femoral trochanter. Once the needle is
is an accurate, reliable and safe technique that offers a real inserted, it has to be oriented in a slightly craniomedial and distal
time evaluation of needle introduction into the deep and direction, just dorsal to the femoral neck until penetration of the
narrow coxofemoral joint space. joint capsule (more than 10 cm deep in mature light breed horses).
Potential relevance: Although this technique remains to be Synovial fluid is retrieved spontaneously or by aspiration.
tested on clinical cases, it is a promising tool to facilitate However, attempts to aspirate synovial fluid often yield only air
diagnosis of coxofemoral pain, septic arthritis or and, therefore, cannot confirm needle positioning (Mueller and
administration of intra-articular medication. Hay 1999). Furthermore, it is sometimes hard to palpate the
trochanteric notch in heavily muscled or stressed horses (Stashak
Introduction 2002; Bassage and Ross 2003). Sedation can facilitate palpation
but potentially interferes with lameness examination. Because
Coxofemoral or hip injuries are believed to be a rare cause of inadvertent injection around the sciatic nerve can induce
lameness (Hendrickson 2002; Dyson 2003), although various temporary hindlimb paresis, it is recommended that injection of
pathologies have been described such as luxation (Bennett et al. local anaesthetic should not be performed if both trochanteric
1977; Malark et al. 1992; Clegg and Butson 1996), degenerative prominences are not identified with certainty (Stashak 2002), if

*Author to whom correspondence should be addressed.

[Paper received for publication 16.05.06; Accepted 27.06.06]
80 Ultrasound-guided coxofemoral arthrocentesis in horses

any doubt exists in the correct positioning of the needle (Bassage injections using a mix of 30 ml of ionic iodinated contrast medium
II and Ross 2003) or if synovial fluid cannot be aspirated (Bassage (Hypaque M 60%)1 and 5 ml methylene blue. Following
II and Ross 2003). Based on these limitations, the coxofemoral radiographs, injection sites were confirmed by dissection. Intra-
joint has been reported to be one of the most difficult joints to articular injection of contrast medium gave a well-defined,
inject in horses (Lewis 1996; Mueller and Hay 1999). In addition, regularly-marginated outline that followed the joint capsule contour
this procedure is not performed on a regular basis, making it hard (Fig 1a). A small area with decreased opacity compared to the rest
to gain experience with the technique (Bassage II and Ross 2003). of the joint was typically identified medially. This particular area
The transcutaneous ultrasonography of the coxofemoral joint corresponds to the ligament of the femoral head and the accessory
has been described in clinically normal horses and ponies using a ligament that emerge medially and run through the incomplete
3.5 MHz sector transducer (Tomlinson et al. 2001). Only the ventral aspect of the equine acetabulum (Barone 2000).
lateral and cranial aspects of the hip joint can be visualised A periarticular injection of the same volume of contrast medium
(Tomlinson et al. 2001). Based on our experience, the acetabulum gave a diffuse poorly-defined area that did not follow the joint
and the femoral head are easily identified in any horse, but capsule contour and did not fill the joint space (Fig 1b). Finally, the
detection of the joint space, femoral head and neck junction, joint coxofemoral joint of an isolated pelvic specimen was penetrated
capsule and fibrocartilaginous labrum varies with the horse’s size under ultrasonographic guidance and a precontrast computed
and the ultrasound image quality. Ultrasonography to guide tomographic (CT) study performed with the needle left in place.
coxofemoral arthrocentesis has been reported in children (Hill Undiluted ionic iodinated contrast medium (30 ml Hypaque M
et al. 1990; Cavalier et al. 2003) as a technique that maximises the 60%) was then injected and CT repeated. The contrast medium was
chances for a successful aspiration, minimises risks to the child observed to remain contained within the coxofemoral joint, with a
and is easy to perform and teach (Cavalier et al. 2003). well-defined, smoothly marginated contour. This study (Fig 2)
We hypothesised that an ultrasound-guided coxofemoral confirmed that the needle was well introduced into the joint and that
arthrocentesis would be an easy, accurate, reliable and safe technique the capsule was punctured at its craniodorsolateral aspect using the
ultrasound-guided technique described in the following section.
in the standing mature horse. Our objectives were to develop the
technique on cadaver horses, to evaluate the feasibility of this new
Experimental study
technique in standing horses, to estimate its success rate and to
identify potential difficulties and complications.
Nine healthy mature mares (bwt range: 450–532 kg) from a
teaching herd were sedated with acepromazine2 (0.04 mg/kg bwt
Materials and methods
i.v.), and restrained in stocks with a nose twitch, standing squarely.
Both hips were injected and the first hip to be injected was
Pilot study
determined randomly (n = 18 joints). The pelvic area was first
The coxofemoral arthrocentesis technique described in this study
was first developed on 7 cadaver horses (n = 14 joints) using
injection of methylene blue. Injection accuracy was verified by
anatomical dissection of the specimen following injection. Two
additional cadavers were used to establish hip arthrogram reference
images following ultrasound-guided intra-articular or periarticular

Fig 1: Intra-articular and periarticular coxofemoral arthrograms. An

18 gauge 15 cm needle was introduced under ultrasonographic guidance
in the coxofemoral joint (a) or just on top of the joint capsule but not
entering the joint (b). Contrast medium and methylene blue mixture were
injected. The needle was left in place and a ventrodorsal radiograph Fig 2: Three-dimensional reformatted images of a computed tomographic
centred on the hemipelvis was taken. The injection site was confirmed by (CT) examination of the pelvis of an 18-month-old Standardbred
dissection. 1 = ilium, 2 = ischium, 3 = pelvic bone, 4 = femur, 5 = spinal specimen. An 18 gauge 15 cm needle was positioned in the left
needle. (a) = Intra-articular injection of contrast medium gave a well- coxofemoral joint under ultrasonographic guidance. The needle was left in
defined, regularly-marginated outline that followed the joint capsule place for the CT-scan. This study confirmed that the joint capsule was
contour. (b) = Periarticular injection of contrast medium gave a diffuse punctured at the craniodorsolateral aspect of the coxofemoral joint.
poorly-defined area that did not follow the joint capsule contour and did (a) = left craniolateral view; (b) = left caudodorsolateral view;
not fill the joint space. (c) = dorsal view; (d) = left dorsolateral view.
F. David et al. 81

clipped and cleaned. It then underwent sterile preparation and cases of inaccurate positioning, the needle was drawn back and
ultrasound examination (Tomlinson et al. 2000) using a 3.5 MHz reoriented. This was defined as a repositioning attempt. Synovial
curvilinear probe3 and an Aloka 1400 ultrasound machine3. An fluid was aspirated with a 10 ml syringe and the volume was
operator wearing sterile gloves placed the probe in a sterile glove recorded. If no fluid was obtained, the needle was withdrawn a few
that had previously been filled with acoustic coupling gel4. Sterile mm and the aspiration was repeated. Under ultrasonographic control,
gel5 was applied on the skin and glove. Once the coxofemoral 4 ml lidocaine 2% and 250 mg (1 ml) of amikacine8 were injected
joint was located, the probe was orientated in a craniodorsal to with a 10 ml syringe, and resistance to injection was recorded as
caudoventral direction to visualise the craniolateral aspect of the minimal, moderate or high. Then, still under ultrasonographic
joint. Ultrasound image quality was classified as excellent, good, guidance, 30 ml undiluted ionic iodinated contrast medium
acceptable or poor based on predetermined criteria (Table 1). As (Hypaque M 60%) and 3 ml air were injected. When liquid was
illustrated in Figure 3, tremendous importance was given to injected, visualisation of fluid turbulences around the femoral head
identify clearly the greater femoral trochanter, femoral head and were noted. The needle was removed and the horse was hand walked
dorsal acetabular rim on the same image. 50 m to the radiology room. The total time required to locate the
Lidocaine 2%6 (1 ml) was injected subcutaneously at the caudal joint, obtain an accurate needle positioning and complete the
extremity of the ultrasound probe. An 18 gauge 15 cm spinal needle7 injection was recorded for each joint. Patient tolerance to the
was then introduced through the sterile gel at the caudal extremity of procedure and technical problems were also recorded.
the probe by the same operator performing the ultrasound, just To assess injection site accuracy, a standing ventrodorsal
proximally to the greater trochanter. The needle was represented radiographic view of each hemipelvis centred on the coxofemoral
sonographically by a distinct hyperechogenic line in the superficial joint was taken within 10 min following injection with a ceiling
muscular layers. The operator aimed for the joint space, close to the suspended radiographic tube (Gigantos-Optimatic 1250)9 on
dorsal acetabular rim, and the needle was advanced until resistance conventional fast-speed film10 with a grid as described by May et
was encountered. Accurate needle positioning was considered to be al. (1991). Additional sedation was administrated routinely
achieved when the tip of the needle was seen in contact with the (xylazine11 0.1–0.3 mg/kg i.v.; butorphanol8 0.01 mg/kg i.v.). The
femoral head. Additional confirmation was obtained by interpretation of arthrograms was performed by an evaluator
simultaneously feeling the tip of the needle hitting against bone. In blinded to the procedure. The radiographic image quality was
classified as good, acceptable or poor based on predetermined
criteria (Table 1), and the presence/amount of intra-articular
TABLE 1: Criteria used for coxofemoral ultrasound and radiographic
contrast medium and/or periarticular leakage were evaluated.
image quality evaluations
The mares underwent daily physical and lameness
Image quality Ultrasonography Radiography examination for 10 days following injection to detect signs of
complications. All procedures were approved by the Institutional
Excellent Bony landmarks (greater Not used Animal Care Committee of the Faculté de Médecine Vétérinaire
femoral trochanter, femoral de l’Université de Montréal.
head, dorsal acetabular rim)
clearly identified.

Other structures (femoral

head and neck junction,
joint space and joint capsule)
clearly identified.

Good Bony landmarks clearly Entire contour of

identified. coxofemoral contrast pool is
visible.
Other structures not Femoral neck, acetabulum
clearly identified. and pelvic bones are easily
seen.
Sufficient radiographic
contrast and exposure.

Acceptable Bony landmarks fairly Portions of contour of

visualised. coxofemoral contrast pool
are indistinguishable from
surrounding acetabulum or
femoral neck.
Pelvic bones and femur are
seen, but less clearly.
Other structures not Radiographic contrast and Fig 3: Landmarks for ultrasound-guided coxofemoral arthrocentesis in the
identified. exposure are suboptimal. standing horse. The ultrasound probe is applied on the hip joint area and
orientated in a craniodorsal to caudoventral direction. This allows for
Poor Bony landmarks poorly Most of coxofemoral contrast identification of the dorsal acetabular rim, the femoral head and the great
visualised. pool is hard to differentiate femoral trochanter on the same image. In this case, the ultrasound image
from the surrounding bones quality was qualified as ‘excellent’. An 18 gauge 15 cm needle is introduced
Other structures not and soft tissues. ventral to the probe, parallel to its long axis and introduced in the
identified. Pelvic bones and femur are coxofemoral articular space under ultrasonographic guidance as mimicked
difficult to see. on this image by the white arrow. 1 = skin, 2 = gluteal muscles, 3 = greater
Radiographic contrast and femoral trochanter, 4 = femoral head, 5 = dorsal acetabular rim, 6 =
exposure are insufficient. femoral head and neck junction, 7 = ilium, 8 = coxofemoral joint capsule.
82 Ultrasound-guided coxofemoral arthrocentesis in horses

Results the beginning of the procedure guarantees that the operator aims
cranially, avoiding the sciatic nerve area. The technique described
The ultrasound-guided arthrocentesis procedure was well here was developed using light breed mature horses (bwt range:
tolerated by most horses with minimal restraint (acepromazine 450–532 kg). Although high image quality is not essential, these
and nose twitch) but 2 mares required additional sedation basic landmarks could be hard to identify on mature draught horses
(xylazine 0.2 mg/kg bwt i.v.). with large hindquarters. Because of the potential complications
Arthrogram evaluation confirmed that intra-articular contrast mentioned previously (Stashak 2002; Bassage II and Ross 2003),
medium was present in all 18 injected joints. Radiographic image performing this ultrasound-guided arthrocentesis technique is not
quality was good in 7/18, acceptable in 9/18 and poor in recommended if these landmarks cannot be identified.
2/18 joints. Minimal periarticular contrast medium leakage was The needle was easily identified at the beginning of the
detected in 2/18 joints at the cranial aspect of the joint and could not procedure in the superficial muscular layers as a distinct
be totally excluded in the 2 joints with poor radiographic quality. hyperechogenic line. To keep the needle tip visible, strict alignment
The ultrasound image quality was excellent in 8/18 joints, of the needle with the long axis of the probe needed to be maintained.
good in 3/18 joints and acceptable in 7/18 joints. The mean ± s.d. For this purpose, a guide attached to the probe could help keep the
number of needle repositionings to obtain accurate needle alignment between the probe and the needle (Cavalier et al. 2003).
placement (Fig 3) was 1.55 ± 1.30 with a maximum of This was not necessary in our study. If the needle tip visualisation
4 repositionings per joint. Once the needle was positioned was lost, minimal realignment of the probe in a cranial or caudal
accurately, synovial fluid was collected from 7/18 joints. Volume direction allowed the operator to find it again. Once the needle was
aspirated varied 0.2–10 ml. The resistance to injection was identified, it was orientated and pushed toward the coxofemoral joint
minimal with the 10 ml syringe for 15/18 joints, moderate for under ultrasonographic guidance. Because of the joint depth, muscle
2/18 and not recorded for one joint. With the 30 ml syringe, contraction and the bending properties of the needle, reorientation of
resistance to injection was minimal for 15/18, with resistance the needle was necessary in many cases (1.55 ± 1.30 times per joint).
increasing substantially for one of the joints at the end of the It was noted that, when a needle was withdrawn, it left a
injection; moderate to high for 2/18, and not recorded for one hyperechogenic track that could lead to confusion if further attempts
joint. Fluid turbulences were detected around the femoral head for at needle positioning were necessary. It is therefore recommended
13/18 joints when liquid was injected. Four spinal needles were not to push the needle too far if its direction is not appropriate.
bent during the procedure, but none broke. Mean time required to The joint capsule originates from the acetabular rim and
localise the coxofemoral joint sonographically, perform an inserts at the femoral head and neck junction (Barone 2000).
accurate needle placement and inject was 4.36 ± 2.06 min. No Tensed over the femoral head, it delimitates a very narrow space
complications were observed in the 10 days following injection. that was represented sonographically by a small triangle when
good or excellent image quality was obtained (Fig 3). This space
Discussion contains the fibrocartilaginous labrum, an extension of the dorsal
acetabular rim. To enter the joint space, we tried to puncture the
The ultrasound-guided coxofemoral arthrocentesis technique joint capsule just ventral to the dorsal acetabular rim.
proved to be efficient and reliable, as 100% of coxofemoral joints In this study, synovial fluid aspiration was always attempted
filled with contrast medium. In addition, it proved to be safe for the once the needle was positioned adequately in the joint space. Fluid
manipulator, horse and ultrasound machine. Use of acepromazine, a was obtained in only 7/18 joints. In the traditional arthrocentesis
nose twitch and subcutaneous administration of lidocaine provided technique, whereas some authors mention frequent dry aspiration
sufficient restraint for most of the horses in stocks. This mild level (Mueller and Hay 1999), others report that synovial fluid is
of sedation should not preclude lameness examination, as the use of retrieved without any specific comment on frequency (Stashak
acepromazine in lameness examination has been reported as 2002; Bassage and Ross 2003). The fact that horses were free of
acceptable (Ross 2003). However, for safety purposes, 2 horses that hip pathology may explain part of the inconsistency in obtaining
were very anxious and moved before needle insertion received synovial fluid in this study. Since ultrasonographic landmarks
additional sedation that could have interfered with pain assessment. were relied upon to determine joint penetration with this new
As an initial step to the procedure, it was found essential to technique, obtaining synovial fluid was not a necessary decision
obtain a clear ultrasonographic visualisation of the dorsal criteria whether or not to inject the joint, in contrast to the
acetabular rim and the femoral head in continuity with the greater traditional technique (Stashak 2002; Bassage II and Ross 2003).
femoral trochanter on the same image. Keeping these landmarks To the authors’ knowledge, hip arthrograms have not been
visible on the same image, throughout the procedure, allowed described in horses. Prior to the study, reference arthrograms were
successful injection in all joints, even in the 7 where the joint space obtained to facilitate radiographic interpretation. In all ultrasound-
could not be visualised (acceptable image quality) and these guided injected coxofemoral joints, the large majority of the
structures were our only landmarks. Although such an image contrast medium was within the joint. However, 2 joints showed
quality would probably not allow diagnosis of subtle hip lesions, it minimal leakage at their cranial aspect, close to the site where the
at least allowed the operator accurately to guide the needle into the needle should have punctured the joint. To assess the injection
joint space in real-time. To obtain this image (Fig 3), the probe was site, we were limited by a ventrodorsal radiographic view of a
orientated in a craniodorsal to caudoventral direction, but this very thick area. It is therefore possible that other joints might also
could vary slightly with the horse’s posture. Aiming too caudally have had minimal periarticular contrast medium leakage that hard
with the ultrasound probe, the height of the caudal prominence of to detect. The poor retraction properties of the tensed joint
the greater trochanter prevented visualising the greater trochanter capsule, increased joint pressure at the end of injection and
in continuity with the femoral head and the dorsal acetabulum on potential fluid extravasation at needle withdrawal could explain
the same image. Therefore, keeping these 3 landmarks visible at the mild leakage in the craniodorsolateral area in 2 horses.
F. David et al. 83

Some resistance to injection was experienced in 5 joints, even Bergfeld, W.A., 3rd (1978) Coxitis in a horse. J. Am. vet. med. Ass. 172, 273-274.
if the needle was correctly inserted into the joint according to the Blaik, M.A. and Hudson, J.A. (1999) What is your diagnosis? Bilateral separation of
ultrasonographic image observed and confirmation obtained by the proximal femoral epiphysis from the metaphysis (type-I Salter-Harris
fracture). J. Am. vet. med. Ass. 215, 933-934.
simultaneously feeling the tip of the needle hit against bone.
Cavalier, R., Herman, M.J., Pizzutillo, P.D. and Geller, E. (2003) Ultrasound-guided
Therefore, it is possible that the needle tip was engaged in the aspiration of the hip in children: a new technique. Clin. Orthop. Relat. Res.
articular cartilage or in the fibrocartilaginous labrum explaining 415, 244-247.
resistance to injection. In that case, slight withdrawal of the needle Clegg, P.D. (1995) Idiopathic infective arthritis of the coxofemoral joint in a mature
would resolve the problem. Another reason for increased horse. Vet. Rec. 137, 460-464.
resistance to injection would be periarticular injection. In the Clegg, P.D. and Butson, R.J. (1996) Treatment of a coxofemoral luxation secondary
study, there was evidence of periarticular contrast leakage on to upward fixation of the patella in a Shetland pony. Vet. Rec. 138, 134-137.
radiographs in only one of 5 joints where increased resistance was Dyson, S.J. (2003) Pelvic injuries in the non-racehorse. In: Diagnosis and
Management of Lameness in the Horse, Eds: M.W. Ross and S.J. Dyson, W.B.
noted. In 4 others, no contrast leakage was detected. Considering
Saunders Co, Philadelphia. pp 491-500.
the small number of cases where resistance to injection occurred,
Haakenstad, L.H. (1953) Undersokelser over den pathologiske hofteleddluksasjon
and the fact that all the joints were thoroughly filled with contrast hos hest med hensyn til lidelsens vesen og etiologiske forhold. Nord. vet.
medium, modification of the ultrasound-guided injection Med. 5, 884-896.
technique described here is not recommended. Hance, S.R. (1998) Hematogenous infections of the musculoskeletal system in foals.
The major advantage of the ultrasound-guided arthrocentesis Proc. Am. Ass. equine Practnrs. 44, 159-166.
technique reported here was that needle positioning could be Hendrickson, D.A. (2002) The coxofemoral joint. In: Adams' Lameness in Horses,
ascertained within the joint space before injection. In addition, the 5th edn., Ed: T.S. Stashak. Lippincott Williams & Wilkins, Philadelphia.
pp 1037-1043.
injection could be visualised in real-time in 13/18 joints due to fluid
Hill, S.A., MacLarnon, J.C. and Nag, D. (1990) Ultrasound-guided aspiration for
turbulence around the femoral head under the joint capsule. The transient synovitis of the hip. J. Bone. Joint. Surg. Br. 72, 852-853.
liquid injected contained diluted 2% lidocaine (4 ml in
Hunt, D.A., Snyder, J.R., Morgan, J.P. and Pascoe, J.R. (1990) Femoral capital
35 ml total volume) however no hindlimb paresis was experienced physeal fractures in 25 foals. Vet. Surg. 19, 41-49.
as reported with the traditional approach (Bassage II and Ross Jogi, P. and Norbery, I. (1962) Malformation of the hip-joint in a Standardbred horse.
2003). Injection of 10–30 ml lidocaine or mepivacaine as Vet. Rec. 74, 421-422.
recommended for intrasynovial analgesia (Mueller and Hay 1999; Lamb, C.R. and Morris, E.A. (1987) Coxofemoral arthrosis in an aged mare. Equine
Stashak 2002; Bassage II and Ross 2003) was not an option in this vet. J. 19, 350-352.
study because a large volume of contrast medium was needed Lewis, R.D. (1996) Techniques for arthrocentesis of equine shoulder, elbow, stifle
to perform the arthrogram. Therefore, it was not possible to evaluate and hip joints. Proc. Am. Ass. equine Practnrs. 42, 55-63.
the potential effects of such a large volume of local anaesthetic Little, C. and Hilbert, B. (1987) Pelvic fractures in horses: 19 cases (1974-1984).
J. Am. vet. med. Ass. 190, 1203-1206.
using the ultrasound-guided arthrocentesis technique on hindlimb
paresis. Although correct position of the needle is confirmed before Malark, J.A., Nixon, A.J., Haughland, M.A. and Brown, M.P. (1992) Equine
coxofemoral luxations: 17 cases (1975-1990). Cornell Vet. 82, 79-90.
injection and, should leakage occur, it would be craniodorsolateral
May, S.A., Patterson, L.J., Peacock, P.J. and Edwards, G.B. (1991) Radiographic
(far from the sciatic nerve) making paresis unlikely. However technique for the pelvis in the standing horse. Equine vet. J. 23, 312-314.
additional work is required to substantiate this observation. Miller, C.L. and Todhunter, R. (1987) Acetabular osteochondrosis dissecans in a foal.
In conclusion, ultrasound-guided coxofemoral arthrocentesis Cornell Vet. 77, 75-83.
is an efficient, safe and relatively quick technique that can be Mueller, P.O.E. and Hay, W.P. (1999) Examination of the musculoskeletal system -
performed on the standing horse with minimal sedation. Although regional anesthesia. In: Equine Medicine and Surgery. 5th edn., Eds: P.T. Colahan,
this technique remains to be tested on clinical cases, it is a I.G. Mayhew, A.M. Merritt and J.N. Moore, Mosby, St Louis. pp 1292-1306.
promising tool to facilitate diagnosis of coxofemoral pain, septic Nixon, A.J. (1994) Diagnostic and operative arthroscopy of the coxofemoral joint in
horses. Vet. Surg. 23, 377-385.
arthritis or administration of intra-articular medication.
Nixon, A.J., Adams, R.M. and Teigland, M.B. (1988) Subchondral cystic lesions
(osteochondrosis) of the femoral heads in a horse. J. Am. vet. med. Ass. 192, 360-362.
Manufacturers’ addresses
Rejno, S. and Stromberg, B. (1978) Osteochondrosis in the horse. II. Pathology. Acta.
1Amersham Radiol. Suppl. 358, 153-178.
Health, Oakville, Ontario, Canada.
2Ayerst Veterinary Laboratories, Guelph, Ontario, Canada. Rose, J.A., Rose, M.E. and Smylie, D.R. (1981) Case history: Acetabular
3Aloka, Tokyo, Japan. osteochondrosis in a yearling thoroughbred. J. equine vet. Sci. 1, 173-175.
4Eco-Med Pharmaceutical Inc., Mississauga, Ontario, Canada.
5AMG Medical Inc, Montreal, Quebec, Canada. Ross, M.W. (2003) Movement. In: Diagnosis and Management of Lameness in the
6Vetoquinol N.-A. Inc., Lavaltrie, Quebec, Canada. Horse, Eds: M.W. Ross and S.J. Dyson, W.B. Saunders Co, Philadelphia. pp 61-73.
7Becton Dickinson and Company, Franklin Lakes, New Jersey, USA. Speirs, V.C. and Wrigley, R. (1979) A case of bilateral hip dysplasia in a foal. Equine
8Wyeth Animal Health, Guelph, Ontario, Canada.
vet. J. 11, 202-204.
9Siemens, Mississauga, Ontario, Canada.
10Medical Tronic, Laval, Quebec, Canada. Stashak, T.S. (2002) Examination for lameness. In: Adams' Lameness in Horses,
11Novopharm Limited, Toronto, Ontario, Canada. 5th edn., Ed: T.S. Stashak, Lippincott Williams & Wilkins, Philadelphia.
pp 113-183.
Tomlinson, J.E., Sage, A.M. and Turner, T.A. (2000) Ultrasonographic examination of
References the normal and diseased equine pelvis. Proc. Am. Ass. equine Practnrs. 46, 375-377.
Tomlinson, J.E., Sage, A.M., Turner, T.A. and Feeney, D.A. (2001) Detailed
Barone, R. (2000) Articulations de la ceinture et du membre pelviens. In: Anatomie
ultrasonographic mapping of the pelvis in clinically normal horses and ponies.
Comparée des Mammifères Domestiques - Arthrologie et Myologie. 4th edn., Ed:
Am. J. vet. Res. 62, 1768-1775.
E. Vigot, Paris. p 984.
Trent, A.M. and Krook, L. (1985) Bilateral degenerative coxofemoral joint disease in
Bassage II, L.H. and Ross, M.W. (2003) Diagnostic analgesia. In: Diagnosis and
a foal. J. Am. vet. med. Ass. 186, 284-287.
Management of Lameness in the Horse, Eds: M.W. Ross and S.J. Dyson, W.B.
Saunders Co., Philadelphia. pp 93-124.
Bennett, D., Campbell, J.R. and Rawlinson, J.R. (1977) Coxofemoral luxation Author contributions All authors contributed to all aspects of this
complicated by upward fixation of the patella in the pony. Equine vet. J. 9, 192-194. study.