Management Plan


The treatment of septic arthritis of traumatic origin is multifaceted. The most important 
part of the treatment involves administration of an appropriate systemic antibiotic, as 
determined by the culture and sensitivity. In this specific case, the Klebsiella bacteria 
isolated from the infected joint are susceptible to a number of antibiotics, including 
amikacin, gentamicin, and cephalosporin. Our treatment will involve a combination of 
amikacin and potassium penicillin, because it is better tolerated in foals as opposed to 
gentamicin. Intra-articular antibiotics will also be included to combat the infection; in this 
case aminoglycosides are most commonly used, so gentamicin is indicated. The intra-
articular use of gentamicin is safer than systemic use, as it does not reach the toxic 
concentrations necessary to incite kidney damage. This treatment is most commonly 
performed post joint lavage.

Joint lavage is performed to remove the products of inflammation that lead to cartilage 
destruction (enzymes, protein debris, fibrin, inflammatory cells). Removal of purulent 
material also improves antibiotic efficiency. Sedation and perhaps general anesthesia may 
be needed to perform lavage on a painful foal. An adequate volume of lavage solution is 
more important than the specific type of fluid used. Normasol-R is ideal as a lavage 
solution because it is very close to the pH of normal synovial fluid, however Lactated 
Ringers solution and physiologic saline may also be effectively used. Intra-articular 
injection of gentamicin will follow the lavage.

An anti-inflammatory drug is administered to prevent inflammatory prostaglandins from 
exerting negative effects on the joint tissue. NSAIDs are also valuable for their pain-
relieving affects. Phenylbutazone will be administered for these reasons in addition to the 
systemic amikacin-potassium penicillin.

The use of sodium hyaluronate injections may be beneficial to the foal in the future once 
the initial inflammation is controlled, however they are not indicated at this time. 
Hyaluronic acid content of synovial fluid is reduced in infectious arthritis, and sodium 
hyaluronate injections help in the long term management of the joint. The use of this drug 
will be decided upon re-evaluation of the foal in 2 weeks.

The use of a Robert Jones bandage is indicated to cover the wound, provide relative 
immobility, allow for some swelling, and provide comfort to the animal. Stall rest 
supplemented by hand walking and physical therapy (passive flexion of the joint) will aid 
in the healing of the joint. Prolonged rest (90 days) is advised before strenuous exercise.