A 7-year-old Standardbred stallion presented to Cornell’s Large Animal Orthopedic Surgery service for a 3-week history of progressive left hindlimb lameness and swelling of the left tarsus. Clinical presentation and synovial joint fluid analysis were consistent with the diagnosis of septic arthritis. The patient was given a guarded to poor prognosis however, an arthroscopy of his left hock was performed. Post-operatively, the patient received daily standing joint lavages, intra-articular injections of antibiotics and sterile bandaging. At the time of discharge the patient was lame but able to bear weight on his hind limb. He returned 4 weeks later after becoming non-weightbearing lame again. Joint fluid analysis revealed persistent joint sepsis and arthroscopy was performed a second time. Slow release antibiotic beads were placed within the joint pouches and 3 days of intravenous regional limb perfusions and bandage changes were performed. The patient was discharged with a poor prognosis for complete resolution.