SURGERY

ORTHOPAEDIC SURGERY

Arthroscopy

Newmarket Equine Hospital leads the way in the UK and Europe with arthroscopic surgery. Over 250 arthroscopic surgical procedures were performed at NEH in 2010 alone. The hospital clinicians and surgeons at NEH have published widely on the subject in both peer reviewed scientific journals and in the standard text book on the subject. One of the surgeons at NEH is a co-editor of the current edition of this book.

Athroscopic surgery provides a minimally invasive means of operating on joints in the horse. A rigid endoscope is used to visualise the interior of joints, and to guide surgery as it is being performed. The technique was first applied to removal of intra-articular chip fractures, but since then the applications have grown enormously. Arthroscopy is now used routinely as a diagnostic procedure, as-well as for the therapeutic options offered. In addition to treatment of osteochondral injuries, soft tissue pathology, such as meniscal tears in the stifle, are now routinely diagnosed and treated arthroscopically. As more has been learnt with arthroscopic surgery of joints, the technique has been extended to great effect for use in tendon sheaths and bursae.

Examples:

  1. Arthroscopic view of an OCD fragment from the distal intermediate ridge of the tibia in the tarsocrural (hock) joint. View Image Here.
  2. Tenoscopic image of a torn manica flexoria within the digital flexor tendon sheath. View Image Here.
  3. Arthroscopic view of a large OCD lesion of the lateral trochlear ridge of the femur, within the femoropatellar (stifle) joint. View Image Here.
  4. General view of arthroscopic surgery being performed at Newmarket Equine Hospital. View Image Here.

Fracture Repair

Newmarket Equine Hospital is the premier center in the UK and Europe for equine fracture repair. More internal fixation procedures are performed at NEH than any other veterinary center - in 2010 88 fracture repair surgeries were performed. In addition, surgeons at NEH have significantly contributed to this subject area in the veterinary literature, publishing in peer reviewed scientific journals and with contribution of 3 chapters to the 2nd edition of standard text book of equine fracture repair to be published in 2011.

The basic principles for equine fracture repair are i) anatomical reduction ii) stable internal fixation iii) preservation of blood supply iv) early active pain-free mobilization. These are long standing principles which have withstood the test of time. However, since the early days, there has been substantial advances in our knowledge of fracture repair, and capabilities. Where-as in the past, many fractures were considered untreatable, now these represent the minority. This has been made possible by development of new equipment and techniques, the latter of which NEH surgeons are proud to have contributed.

Fractures occur in horses from all disciplines, many being traumatic in origin. Other types of fractures however results from cumulative strain and fatigue of the bone - these are usually seen in highly trained athletes.

Examples:

  1. Radiograph of a medial spiral condylar fracture which has been repaired with 8 screws. View Image Here.
  2. Radiograph of a chip fracture of the radial carpal bone which has been repaired with a small (2.7mm) screw. View Image Here.

SOFT TISSUE SURGERY

Colic Surgery

Over the past 20 years vast improvements in survival rates of horses with colic have been seen. This is aided by earlier recognition and referral for treatment of conditions requiring surgery. At the Newmarket Equine Hospital we have a theatre dedicated for abdominal surgery. For each horse treated for colic, a team of surgeons, interns and nursing staff provide round the clock care in our specialised intensive care unit.

Laparoscopic Surgery

Laparoscopic (key-hole abdominal) surgery is a rapidly evolving technique which can be performed in both standing and anaesthetised patients. Procedures which previously would have been performed under general anaesthetic through a large open incision can now be done using this minimally invasive technique, which reduces patient morbidity and speeds up the convalescent period. Examples of the use of this technique include:

  • removal of ovaries from mares with severe temperament changes whilst in season, or ovarian tumours
  • cryptorchid (rig) castration
  • investigation of chronic colic

Over the last few years, Newmarket Equine Hospital helped develop a pioneering technique for treatment of infertile mares, by instillation of prostaglandin onto obstructed oviducts using laparoscopy.

Respiratory Surgery

Abnormal function or anatomy of the respiratory tract can cause atypical noise at exercise and reduced performance in horses.

Surgeries such as tie-backs or tie-forwards are routinely performed to treat affected horses with conditions such as:

  • Laryngeal hemiplegia (roarer)
  • Dorsal displacement of the soft palate
  • Epiglottic entrapment

The hospital also performs laser surgery, which allows many procedures to be performed in the standing patient using videoendoscopy. This avoids the need for general anaesthesia and open surgical incisions, reducing patient discomfort and convalescence.

Urogenital Surgery

The hospital is equipped to perform a full range of urogenital procedures.

With the high population of breeding mares in and around Newmarket, foaling injuries are common, such as perineal lacerations and rectovaginal fistula. We routinely perform delicate surgery in the standing patient to reconstruct the normal anatomy of the urogenital tract.

In the male horse, the more frequently performed procedures are those used to treat a common neoplasm (tumour) of the penis (squamous cell carcinoma). Untreated, spread of tumours is life-threatening. Procedures performed to remove neoplastic tissue include:

  • Reefing
  • Partial phallectomy
  • En-bloc phallectomy
  • Penile retroversion

SURGICAL FACILITIES

The surgery unit in the hospital has two state of the art theatres (one dedicated for orthopaedic surgery), located in a closed suite with filtered, conditioned air delivered under positive pressure. There are four padded anaesthetic induction and recovery stalls, with one adapted to include a specialised assisted recovery system for high risk orthopaedic patients. The induction stalls lead into an intervening prep area where horses are prepared for surgery, before being taken into theatre.

In theatre there are fully networked stations for viewing radiographs and images from other diagnostic modalities. For arthroscopic and laparoscopic procedures a networked digital capture system is used to take and store images and videos during surgery.

SURGICAL STAFF

The theatres are run by a highly trained team of surgical nurses, including three qualified equine veterinary nurses and headed up by an advanced veterinary nursing Diploma holder. General anaesthesia is performed exclusively by a designated team of specially trained veterinary surgeons, under the supervision of two Diploma holders in veterinary anaesthesia (one Royal College of Veterinary Surgeons Diplomat and One American College of Veterinary Anaesthesiologists Diplomat).

Surgery at the hospital is performed by highly qualified veterinary surgeons, including three European Specialists in Equine surgery. Two are also recognised by the Royal College of Veterinary Surgeons as Specialists in Equine Surgery. Between them, the Hospital And Referrals team holds four European Diplomas in Equine Surgery, two RCVS Diplomas in Equine Orthopaedics and four RCVS Certificates in Equine Surgery.