Long‐term evaluation of radioisotope synovectomy with Yttrium 90 for chronic synovitis in Turkish haemophiliacs: Izmir experience

Abstract

Since 2001 we have performed 105 radioisotope synovectomy (RS) in 65 children and young adults, age ranging from 3 to 25 years with a average of 15 years in Ege University Hospital, Izmir, Turkey. One fourth of cases were below 10 years of age. All patients had severe haemophilia A and B. Ten patients (17 joints) had high responder inhibitor. We prefer to use Yttrium 90 for all joints (5 mCi for knees; 2 mCi for others). The knees were injected in 56 cases, elbows in 24 cases, ankles in 23 cases and shoulders in two cases. Steroid injections were not preferred as the principle drug of choice. Mean follow-up period after procedure was 2 years (range: 6 months to 3.5 years). All inhibitor patients had satisfactory results. The best results were obtained in elbows than knees and ankles. Excellent rates (no bleeding) were observed in grade-II synovitis 84% for knees, 93% for elbows and 50% for ankles. Because of the excellent and good response (bleeding reduction to 75%), rates were 100% for knees and elbows and 92% for ankles. In six cases, repeated injections were given at 6-month interval and all of them had good results. The grading of synovitis seems to be an important parameter than the age of the patient. Even in patients below 10 years of age, outcomes are not satisfactory in all joints with grade-III vs. grade-II synovitis (12% vs. 73%). No serious complications were observed during and after procedure except two cases. A mild and transient inflammatory reaction was observed in the ankle. There was a minimal radioisotope leakage to superficial skin in the elbow. RS seems to be a safe and effective treatment for chronic synovitis causing recurrent joint bleedings.

Hemophilia Patients Treated with Radioactive Synovectomy

“…Bu aşamadan sonra sinovit tedavi edilemediği takdirde çok genç yaşta bile kalıcı eklem sakatlığı kaçınılmaz olacaktır. Benzer kronik sinovit tablosuyla kalıcı sakatlık oluşturan Romatoid Artrit hastalarında 50 yıldır uygulanan radyoaktif sinovektomi tedavisinden elde edilen deneyimlerin hemofili sahasındaki uygulamaları ile elde edilen sonuçlarla 2000 yılından itibaren çok güncel bir tedavi şekli olarak tanıtılmaya başlamıştır (8). Cerrahi sinovektomi ile karşılaştırıldığında radyosinovektominin birçok avantajı vardır.…”

Diagnostic evaluation of our patients with hemophilia A: 17-year experience

“…Zül-fikar et al (17) performed RAS in 60 joints (27 knees, 16 ankles, 15 elbows and two shoulders) of 39 patients 37 of whom had hemophilia A, one of whom had hemophilia B and one of whom had acquired hemophilia with a median age of 16 years and reported that they obtained successful results with a rate of 80%. Kavaklı et al (16) performed RAS in a total of 190 joints in 107 patients with severe hemophilia A and 20 patients with severe hemophilia B within 6 years and found a decrease in the mumber of bleedings and in factor consumption in a three-year follow-up period after RAS. They reported that no bleeding attack was found in 50% of the patients in the first year in the follow-up.…”

Radiation synovectomy therapy combined with surgical synovectomy in chronic nonspecific synovitis of the knee joint

“…[7][8][9] Radyasyon sinovektomi işlemi sırasında çok az olguda komplikasyon bildirilmiştir. En önemli yan etkileri radyonekrozlar ve teorik malignensi gelişi-midir.…”

“…Radyasyon sinovektomi en sık romatoid artrit (RA) tedavisinde kullanılmasına rağmen; [3] kronik efüzyonlarda, spondiloartropatilerde, [4] osteoartritte, [5] villonodüler sinovitte [4][5][6] ve hemofilik artropatilerde de kullanılmaktadır. [7][8][9] Radyasyon sinovektomi sinovit tedavisinde tek başına kullanıldığı gibi, açık ya da artroskopik sinvektomi ile kombine olarak da uygulanabilmektedir. [3,5,10] Sunulan çalışmanın amacı diz ekleminin tıbbi ya da cerrahi tedaviye yanıt vermeyen non-spesifik sinovitlerinin RS işlemi ile birlikte artroskopik ya da açık sinovektomi tedavisi sonuçlarını değerlendir-mektir.…”