In July 2013, a miniature horse presented to the Cornell University Equine and Farm Animal Hospital Orthopedic Surgery Service with the complaint of acute, non-weight bearing lameness of the right hind limb. A coxofemoral luxation was diagnosed using a combination of physical exam, radiographic and computer tomography findings. The luxation was surgically reduced and secured with an extra-capsular suture technique using screws and fiber wire. Within 48 hours, the repair had failed and re-luxation occurred. The horse was again brought for surgical repair of the luxation using a similar technique using additional wire and screws. 72 hours later the horse luxated a third time, and a femoral head and neck ostectomy was elected. Following the third surgery an infection developed with multiple drug resistant bacteria cultured from the site. Stent bandages that had previously been covering the incision site were replaced with a sterile vacuum-assisted wound closure system to aid in removal of purulent drainage from the site, and antibiotics were chosen based on susceptibility results from the culture. Breakdown of the left hind limb suspensory mechanisms began to occur with the prolonged reduced weight bearing of the right hind limb. This was addressed through various techniques, including pain management, shoeing, and physical therapy to encourage use of the right hind limb. Over the next few weeks management for pain, infection, and breakdown of the opposite leg was performed with positive initial results. However, about one month after the initial presentation to the Cornell Equine and Farm Animal Hospital, the horse suffered an episode of a sudden increase in pain and discomfort, reverting to almost complete non-weight bearing lameness. Radiographs and CT evaluation were performed to rule out causes of the sudden increase in pain, with the only notable finding being contact between the femur and acetabulum. A femoral and sciatic nerve block were performed using EMG to attempt to isolate pain and rule out neuropathic causes, and an epidural catheter was placed for regular infusion of pain medication. Eventually the horse became refractory to all increases in pain management and therapy that was attempted, and the owner elected euthanasia and necropsy.