Dr. Larry Bramlage (DVM, MS, Diplomate ACVS) is an internationally recognized equine orthopedic surgeon and partner at Rood & Riddle Equine Hospital in Lexington, Ky. A former president of the American Association of Equine Practitioners, Bramlage has been received numerous honors during his veterinary career, including the Special Award of Merit from the British Equine Veterinary Association and the Jockey Club Gold Medal from The Jockey Club. He serves as a liaison to the media in the event of equine injuries at major racing events, including the Triple Crown and Breeders' Cup.
Bramlage spoke with the Paulick Report about corrective surgeries of Thoroughbred foals and yearlings, and the impact the procedures may have on racing or the breed itself. Excerpts of the interview appeared in print editions of the Paulick Report Special distributed earlier this week at the Keeneland September yearling sale.
Does surgery for angular limb deformities help or hurt a horse in performance?
I think properly applied it definitely helps them. We shouldn't be doing the surgery for situations where it doesn't improve the horse's conformation and function. Obviously there are extremes of deformity where nobody has any question as to whether it is beneficial. When you get close to the acceptable limit, we do get asked to do some surgeries that, were it my decision, I'd probably say the horse is acceptable. It's hard to say to someone who is going to take it to the sale that you shouldn't do this surgery because making it just slightly better might make a significant difference in their sale price.
What do the statistics say about horses that have this corrective surgery done?
Research numbers show they are no different than their siblings. The ideal would be to take a group of foals and leave some of them totally crooked and correct some of them. That's not realistic because no one does that, so the best you can do is compare the ones that have had surgery to the ones that have not. When you do those numbers they come out within the statistic range of identical. There is no data to support the contention that some people make that we are actually doing harm by correcting the conformation in the horses. There is actually quite a lot of data that shows both the improved conformation is as good as the sibling that doesn't need surgery and also that conformational flaws do create certain types of injuries. So the scientific data would indicate that you should correct them.
What year did these procedures begin or become relatively commonplace?
It started 20 to 25 years ago in the mid-1980s. I think there was a big change in the entire horse business at around that time. It got precipitated by tax law changes, and the tenor changed at the sales. There used to be 300 consignors with three to 30 horses apiece. Now there are 30 consignors and each of them may sell 300. Part of the difference is when tax laws changed it made it much more difficult for small producers to effectively stay in the market.
At the same time, horse agents started having a much more prominent role. The horse agent now has more pressure on him because he is interposed between the owner and the trainer. If he purchases a horse with any flaw he is open to criticism. Whereas when the owner and trainer go there (without an agent), the owner is spending his own money or the trainer is spending it, and they in general have a wider range of acceptability. If they make a mistake, they say, 'I bought a bad horse.' But if an agent buys a bad horse, it's a whole lot more pressure for him.
When is the best time to have these surgeries performed?
Distal metacarpal physis, or what's commonly called the fetlock corrections, have to be done by about three months of age because the foal stops growing at four months. The knees, or the distal radial physis, are normally done at 10 to 12 months of age. You can do them up to about 15 months of age with no problem. They stop growing at about 18 months. Practically that works out that the fetlocks are done when the foals are still on the mare, the yearlings are done at the early part of the yearling year.
Is it recommended only for foals intended for the commercial market, or for “breed to race” foals?
We do many that are breed to race, or homebreds, for the same reason the buyers want straight-legged horses in the commercial market: the data would indicate they are sounder horses.
Do you have any numbers that estimate the percentage of foals that undergo surgery of this type?
Informally I did it quite a few years ago, and at farms where I looked at the foals, it turned out we would do something to about 15% of them. There are some farms that do a higher number than that; some that will do less. Some depend more on (corrective) shoeing and do less surgery. Some lean to more surgery and less shoeing. In many instances, it's actually cheaper and faster to do it surgically. It's a one-time event and it disturbs the horse's routine less than having specialized shoes on for months at a time.
What is the cost of surgery?
For us it's one price. It's about $500 to do a foal and $1,000 to do a yearling, and that includes any number of corrections. There will be places that are somewhat cheaper, and I'm sure there are some places that are higher.
Can a visual inspection of a yearling determine whether it had surgery as a foal?
No, not visually, but radiographically you normally can. Previously, before digital radiographs you couldn't get any indication, but certainly in the knees, if you look closely, you can tell which horses have had surgery and which horses haven't. The digital radiographs have traces of the previous surgery because of the higher detail. Once digital radiographs became common, the argument of disclosure kind of went out the window. You don't hear about that much any more because people who really do want to know can just look at the radiographs in the repository if they want and, with rare exceptions, you can tell.
Aren't there a number of buyers once you get past the first few days of the sale that don't use the repository?
Mostly they don't care. The only place the argument holds is if you are buying a horse for a stallion. Once you get past the first couple days of the sale, people are buying horses functionally to race. Really all that they care about is what the horse looks like – the actual horse. They would be less likely to pay someone to look at the radiographs or look at the radiographs themselves, but they also care less, because those people are in the market for horses that can run.
What happens to horses with angular limb deformities that forego surgery?
They are predisposed to injury. They don't last as long. They end up with chip fractures in the knees and or ankles. Usually the ankles are no big deal; they can be solved surgically. But a significantly crooked horse is more prone to injuring suspensory ligaments, breaking sesamoids, the kind of things that are going to terminate his career. Chip fractures in the lower joint of the knee – that's usually where they get them if they are crooked. Those horses are rarely as good after that injury as they were before. The upper joint of the knee is quite different; it's very forgiving. But that's not predisposed to injury by the horse being crooked.
Is there any long-term negative effect to the surgery?
Not for the individual that you do it on. You might argue the breed has been altered. You can no longer look at a mare and know exactly what she looked like as a foal or what her dip out of the gene pool might look like. But we know the stallions who produce stallions that are prone to conformational problems, and truthfully we don't care. We'll breed to anything that produces a fast horse.
If we really cared about the individual stallions very much, we would actually move away from those stallions. But if they produce runners, people don't move away from them at all – in fact, they move toward them. Any horseman that's been in the business for a long period of time can give you a list of what horses are prone to producing what kind of conformations.
What about the mare a breeder may be buying at a bloodstock sale. Is there any way of knowing by reading X-rays if her conformation was surgically improved?
No, you can't with a mare that's been retired. You can't look at that horse and know for sure if there has been any alteration. But if you're a knowledgeable bloodstock agent, you usually know what the breeding's conformation tends to be. Some people do make matings, for instance, you may have a bow-legged mare, you would tend to go to a stallion that produces knock-kneed horses, and the opposite is true. A knock-kneed mare, you would tend to go to a stallion that is a bit more offset in the knees.
I'm one of those people who believe we really have changed the conformation of the breed – but not by the surgical conformation. It's that we have moved the entire breed to a different conformation: the offset knee. It's happened because those have been the most productive horses. It's the stallion that traces back to certain individuals that are prone to do that, and I don't know if I dare name them for publication.
In a perfect world, wouldn't it make sense to have disclosure all the way through on a horse's record, with a veterinary passport from cradle to grave?
Theoretically, you could make it available, but it would have to be done through microchipping or something like that. It would require a huge recordkeeping system, would produce tons of lawsuits – mostly frivolous, which we get occasionally now where someone will buy a mare, and the conditions say major surgery needs to be disclosed, and the buyer goes back and finds arthroscopic surgery years before which has nothing to do with this current mare. With buyer's remorse it opens the door and people are able to sue.
If you ask me personally, first of all it's reams of information to go through and almost nobody would go through it. Are you going to pay someone to pore through these records to see if a mare had a surgery in the past that might have nothing to do with her? You're going to look at her conformation and breeding and buy her on that scenario. It's too cumbersome to ferret out that information. Now if it were entirely electronic to where you could search it … well, we can't even do that with people.
You touched on your belief that the conformation of horses is changing. Is this an irreversible trend?
You could select and go the other way, but racing changed. We depend on speed now; we don't depend on stayers. Certain conformations are associated with certain heritable traits. Speed is highly associated with the offset knee, the toe-in. Interestingly, that's the same in people. There's never been a 100-yard dash winner in the Olympics that wasn't pigeon-toed. Horses that have a lot of speed tend toward the toed-in conformation as well.
Now, the old-time Thoroughbreds, the ones I knew when I was in college 40 years ago, they were a different type. They were taller, more angular and tended to be a little knock-kneed. But those horses raced more like they race in Europe, where no horse went out as fast as you could go. Everybody stayed in somewhat of a pack, and then they sprinted home the last quarter. That's the way racing was conducted until there was an alteration and change – the racing Quarter horse influence came in when certain trainers really emphasized speed early in a race, and almost everyone has adopted some version of that.
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