A retrospective study on chemical and radioactive synovectomy in severe haemophilia patients with recurrent haemarthrosis

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia Vol. 5; no. 2; pp. 115 - 123
• Main Authors: MOLHO, P., VERRIER, P., STIELTJES, N., SCHACHER, J.-M., OUNNOUGHÈNE, N., VASSILIEFF, D., MENKES, C.-J., SULTAN, Y.
• Format: Journal Article
• Language: English
• Published: Oxford UK Blackwell Science Ltd 01-03-1999
• Subjects: Adolescent; Adult; chemical synovectomy; Child; Child, Preschool; haemarthrosis; haemophilia; haemophilic arthropathy; Hemarthrosis - etiology; Hemarthrosis - surgery; Hemophilia A - complications; Hemophilia A - surgery; Humans; Injections, Intra-Articular; Middle Aged; Osmium Tetroxide - adverse effects; Osmium Tetroxide - therapeutic use; radioactive synovectomy; Radioisotopes - adverse effects; Radioisotopes - therapeutic use; Radiopharmaceuticals - adverse effects; Radiopharmaceuticals - therapeutic use; Recurrence; Retrospective Studies; Synovectomy; Yttrium Radioisotopes - therapeutic use
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1046/j.1365-2516.1999.00287.x

Between 1970 and 1994, 116 chemical and 90 radioactive synovectomies were performed in 107 patients with severe haemophilia and two with type 3 von Willebrand's disease. The products used were osmic acid (OA) in 100 cases, 90‐Yttrium in 35 cases, 186‐Rhenium in 48, 169‐Erbium in two, hexacetonide triamcinolone in 16 and radioactive gold in five cases. The use of radioactive colloids is not allowed in France in patients under 15 years of age. Twenty‐nine patients had more than one synovectomy per joint. All patients were evaluated for 6 months post‐synovectomy, using both a clinical and a radiological score. Six months after synovectomy, a good or excellent result was obtained for 81% of the joints treated with isotopes, compared with 44% of those treated with OA, P < 0.001. This superiority of isotopes over osmic acid was still observed after 6 months for the 89 joints that were re‐evaluated, with follow‐up ranging from 1 to 9 years. It was possible to calculate a radiological score in 84 cases. With OA the best results were from the joints with the lowest scores pre‐synovectomy (<7). No correlation could be established between the clinical and the radiological scores, due to the small size of the sample. In summary: (1) chemical and radioactive synovectomy are simple and safe procedures for haemophilic arthropathy, (2) in our series, after 6 months the efficacy of isotopic synovectomy was greater than that of chemical synovectomy, and this benefit seems to persist after 6 months, and up to 9 years in the group of patients with longer‐term follow‐up.