A retrospective review of yttrium-90 synovectomy in the treatment of knee arthritis

Abstract

We reviewed the case notes and X-rays of all patients with knee arthritis treated with yttrium-90 for the first time at a single institution from November 1981 to November 1995. Outcomes were assessed as 'improved' or 'not improved' by review of the case notes at 3, 6 and 12 months, and by the absence of further intra-articular (IA) steroid injections. Of the 121 knees treated, 87 had adequate follow-up information to allow an assessment of outcomes. Overall, 46% (95% CI 36-57) were improved at 12 months and 37% (95% CI 27-47) had no further IA injections (mean follow-up of 3.5 yr). Knees with osteoarthritis (OA) fared significantly worse with 10% (95% CI 0-29) vs 51% (95% CI 39-63) improved at 12 months (P < 0.05). Knees younger than 30 appeared to do better with 78% (95% CI 51-100) vs 28% (95% CI 17-45) having no further IA injections (P < 0.02). Knees with normal X-rays (Kellgren grade 0-1) did significantly better than those with more severe radiographic abnormalities (Kellgren grade 3-4), with 56% (95% CI 40-73) vs 24% (95% CI 8-40) improved (P < 0.01). Radiosynovectomy with yttrium-90 for knee arthritis appears to be of less value for patients with OA or with secondary OA changes on X-ray, and may be of more value for younger patients and those with spondyloarthropathies.

The Role of Synovial Macrophages in Rheumatoid Arthritis and Osteoarthritis: Its Implications for Radiosynovectomy

“…The use of radiosynovectomy in osteoarthritis is rather more controversial. A New Zealand study showed that while yttrium-90 radiosynovectomy was safe and moderately effective in infl ammatory arthritides of the knee, it was of little benefi t in established OA, or in patients with secondary OA changes on X-rays [ 83 ]. A German study showed good or excellent improvement in clinical symptoms in 40 % of 35 patients with therapy-resistant joint effusions caused by severe OA [ 89 ].…”

Nano‐sized Carrier Systems as New Materials for Nuclear Medicine

“…In some cases it is advantageous to keep radioactivity for therapeutical purposes in the site into which it was injected; such applications include above all radiosynovectomy (application of radioactivity into synovial space of the inflammated joint to suppress inflammation) [28][29][30] and brachytherapy (local radiotherapy of solid tumor by an implanted emitter) [31,32].…”

“…For radiosynovectomies [28][29][30], nanoparticles posses two significant advantages: they keep the radionuclide in the synovial space because of hindered diffusion due to their size and they are internalized by macrophages. Macrophages are the main cause of symptoms of inflammation, so when cytotoxic radioactivity is concentrated inside them, it has beneficial antiinflammatory effects.…”

“…Macrophages are the main cause of symptoms of inflammation, so when cytotoxic radioactivity is concentrated inside them, it has beneficial antiinflammatory effects. The choice of radionuclides is focused on ß-emitters with half-life of several days, mainly 90 Y (T 1/2 = 64.00 h) [28,29]. The ß" radiation has several milimeters effective range in the tissue with high linear energy transfer (LET) within the particle path, which corresponds to high biological activity in situ, but low radiation burden of distant tissues.…”

“…For radiotherapy, ß" emitters are radionuclides of choice, 90 Y [28,30,38,104], 131 I [54], «Cu [5][6][7]59,101] and 188 Re [98,99] being the most frequently considered in connection with nanomedicine. The high energy electron (β' radiation) has several mm range in tissue and high biological effectivity.…”