09/04/2026
If you have followed Surprise for a while, you know that her right stifle is something we will be managing for the rest of her life.
Today, Dr. Tuso injected that stifle again. This was Surprise’s third steroid injection, and because we get a lot of questions about joint injections, we thought this was a good opportunity to explain what we are treating, why we have used both Arthramid and steroids, and what actually happens before and after an injection like this.
Surprise’s retirement story actually started before she ever became a Mareworthy mare.
Horse Husband Stables purchased Surprise in November 2024 while she was carrying her 13th foal. They bought her with the intention of allowing her to have that final baby and then permanently retiring her from breeding. Before purchasing her, they had already spoken with us about whether Mareworthy could provide her a retirement home once that foal was weaned.
At the time, Surprise was already dealing with significant degeneration in her right stifle.
A healthy joint has smooth articular cartilage covering the ends of the bones, along with synovial fluid and other structures that allow those surfaces to move against one another with very little friction. In a severely arthritic joint like Surprise’s, much of that normal protection has been lost. There are areas of her stifle where there is essentially no meaningful cushioning left between the joint surfaces.
In much simpler terms: she has areas that are effectively bone on bone.
And that is painful.
Horse Husband Stables began treating the stifle while Surprise was still in their care, including having her injected with Arthramid. They continued managing her through her pregnancy, foaling and weaning, and Surprise officially joined Mareworthy in December 2025.
Their responsibility for her did not end when she arrived here, either. Horse Husband Stables continues to donate every month specifically to help cover Surprise’s ongoing care.
So what was the Arthramid for, and why are we now periodically using steroids?
They are doing two different jobs.
Arthramid is a polyacrylamide hydrogel that is injected into the joint. It does not recreate missing cartilage or magically put a damaged joint back together. Instead, it interacts with the lining of the joint and is intended to provide longer-lasting support in an osteoarthritic joint. For a horse like Surprise, whose underlying structural damage is permanent, the goal was to improve the joint environment and help her remain as comfortable as possible over the longer term.
But even with that support, a severely damaged joint can still become inflamed.
And inflammation hurts.
When Surprise’s stifle becomes more inflamed, she begins showing us in relatively subtle ways. She works harder to use that hind leg. Her movement becomes more guarded. She starts compensating more with the rest of her body.
That is what we had started seeing again.
Surprise is already on Equioxx daily to help control the chronic inflammation and discomfort associated with her arthritis, but approximately every six to eight months we have reached a point where that baseline management is no longer enough.
That is where the steroid injection comes in.
A corticosteroid placed directly into the joint is a very potent anti-inflammatory. It cannot replace the cartilage Surprise has lost, create a new joint surface or undo the damage that is already there. What it can do is significantly reduce the inflammatory response occurring inside that damaged joint.
And that matters even when the underlying problem is “bone on bone.”
Every time those abnormal joint surfaces move and the damaged tissues are stressed, they can stimulate inflammation within and around the joint. That inflammation then creates additional pain, which makes the horse protect the limb more, which changes how she moves and can create problems elsewhere.
By knocking down that inflammatory response, we can hopefully make the joint considerably less painful and allow Surprise to use that leg more comfortably again.
The actual injection is also only one very small part of the process.
Before Dr. Tuso ever puts a needle into Surprise’s stifle, there is a LOT of scrubbing.
A joint is supposed to be a protected environment, and introducing bacteria into it can result in a very serious infection. So joint injections are performed using strict sterile technique. The injection site is carefully prepared and repeatedly scrubbed and disinfected, Dr. Tuso scrubs in, and everything is kept sterile before the needle is placed into the joint.
The medication itself may take only seconds to administer. Preparing safely for those seconds takes much longer.
And we are not finished when the needle comes out.
Surprise will stay inside for the next couple of days so we can monitor that stifle very closely. Some inflammatory response following a joint injection can occur, so we will be watching for heat, swelling, increased pain or any change that looks greater than what we would expect after the procedure.
She is also receiving stronger anti-inflammatory support for the next several days while the joint settles back down.
Assuming everything looks the way we want it to, she will then return to turnout.
And then the most important part is simply watching Surprise.
Hopefully, as the inflammation decreases, we will see that right hind become easier for her to use again, just as we have following her previous treatments.
This is Surprise’s third steroid injection, and at this point we generally find ourselves needing to repeat them about every six to eight months. That does not mean there is a calendar hanging in the barn telling us when to inject her again. We monitor the horse in front of us and make that decision with our veterinarian when she starts telling us that her current level of management is no longer keeping her comfortable enough.
There is no treatment that is going to give Surprise a normal right stifle again.
Arthramid cannot replace the cartilage she has lost. Steroids cannot reverse the damage. Daily Equioxx cannot cure her arthritis.
But those treatments can each play a different role in controlling the consequences of that damage.
For Surprise, good retirement care means accepting that this is a permanent problem while also refusing to simply accept chronic pain as inevitable. We watch her, we adjust, we treat the inflammation when it begins breaking through, and we keep asking one question:
Is Surprise comfortable being Surprise?
As long as the answer is yes, our job is to keep listening. 💜
