Key hole surgery

Bajan born vet Dr Jonathan White explains the process of doing arthroscopic surgery on horses

BY RUDDY ALLEN
Observer staff reporter

Tuesday, April 24, 2018

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Barbadian-born veterinary surgeon Dr Jonathan White, who is a lecturer in equine surgery at The University of the West Indies' veterinary school in Trinidad and Tobago, has been in Jamaica over the last two weeks performing arthroscopic surgery on horses at Caymanas Park, using the stable compound of trainer Anthony Nunes as his base.

Dr White works in conjunction with a team of local vets including Dr Graham Brown, who helped to coordinate the visit, and Dr Andrew Garvey, who assists with the surgeries.

Arthroscopic or keyhole surgery is now commonplace in humans and has replaced open surgery.

During an average knee arthroscopy in humans, a small fibre-optic camera (the arthroscope) is inserted into the joint through a small incision. The advantage of arthroscopic surgery over traditional open surgery is that the joint does not have to be opened up fully. For knee arthroscopy only two small incisions are made, one for the arthroscope and one for the surgical instrument to be used in the knee cavity.

Dr White explained the procedure involved in performing arthroscopic surgery on a horse to the Supreme Racing Guide.

“Arthroscopic surgery is the way to perform knee surgery or joint surgery in a horse. Significantly, the advantage over open surgery is that basically you are able to see more of the joints, and if you see more of the joints you can see more of the problems. For example, if they have fragments or fractures then you can treat them, and the horses have a shorter down time because the incisions are very small, in what has become known [as] keyhole surgery,” he explained. “It is two incisions — less than one centimetre each in length. You look into the joints and take out any fragments, and hopefully halt any arthritic or slow down any arthritic changes in the joint.”

Arthroscopic surgery has been done in Jamaica before, according to Dr White, but not with the same intensity nor as many times as he is doing now along with Dr Brown and other members of the arthroscopic team.

“This is kind of new as it is not often performed here. Actually it has been performed here before, possibly by some external vets, but we haven't really set up any facility where we can do it on a regular basis. What is new is that it is a Caribbean-based person doing it, as I was born in Barbados,” he said.

“There a number of machines that we use. I think that what is new here is that we have a gas and an anaesthesia machine, where the horse is induced to sleep with no fear of risking falling out of anaesthesia simply by inhaling amnestic gas — and that is a new piece of equipment that has come in.

“Then, I have brought in my arthroscopy equipment, which isn't normally here — the arthroscopy camera, which goes inside the joint, and some of the other bits of equipment such as the smaller shavers which go inside the joints to tidy up the bones and take out the softer tissues. So basically, it is working inside the joints with two chopstick-sized instruments,” White said.

White, with 15 years of experience in the field, said that arthroscopic surgery is the best method to treat knee injury in a racehorse.

“It is the most effective way of taking out fragments, performing fracture repair and it depends a little bit on what you find in the joint as well. But it is certainly the gold standard treatment for fragment removal and a visualisation of joint and cartilage in the joint,” he said.

White, who studied at the University of Glasgow in Scotland where he did his first degree, said that there are no real side effects from performing arthroscopic surgery, but rather some small complications to it.

“There are always possible complications to any form of surgery and there is always a risk to any surgery, and that is why we are very careful with how that surgery is performed. But there is always a risk to anaesthesia in knocking a horse down; keeping asleep a 500 kg animal has to come with a risk.

“That is why you have to carefully monitor a horse during surgery to ensure that the horse is not moving when the surgery is being done. So yes, there are complications of anaesthesia and complications to the surgery would be things like infections. That is why we have to keep the operating area as clean as possible,” said White, who also studied at the University of Pennsylvania in the United States.

Dr Brown, who is a director of the promoting company Supreme Ventures Racing and Entertainment Limited (SVREL), stated that the new operators of the racetrack recognise the need for a proper equine facility at Caymanas Park.

“It is my hope that in the near future there will be no need to operate on horses in tents.

“Almost all the major racetracks in the world have modern facilities where equine medicine can be practised and SVREL will be working hard to develop such a facility here in Jamaica,” Dr Brown said.

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