Comparison of Chemical, Radiation and Surgical Synovectomy for Knee Joint Synovitis

Abstract

In 66 patients with rheumatoid knee joint synovitis and hydrops and with only slight radiological destruction, local treatment of the knee was randomly performed either with osmic acid, radioactive yttrium or surgical synovectomy. After a one-year follow-up the clinical and radiological results were slightly better in patients who underwent surgical synovectomy than in other treatment groups. However, radiological osteoarthrosis had progressed more in synovectomized patients than in others. In 2 patients with radioactive yttrium a relapse requiring surgical synovectomy was seen. Because osmic acid is almost as effective as surgical synovectomy, is very cheap and easy to perform, it can be recommended as the first choice for local therapy in patients with corticosteroid-restant knee joint synovitis, in the early stage of the disease.

Osmium Tetroxide in Antigen-Induced Arthritis: Failure to Inhibit Joint Destruction

“…The tentative conclusion from this study then is that Os04 in doses corresponding to those used in humans probably does not cause significant joint damage. This is in agreement with current clinical evidence (Nissila et al 1978) showing the results of OsO, treatment to be comparable to surgical synovectomy and 'yttrium. A biopsy study (Nissill et al 1977a) in 18 patients 1-18 months after osmium injections showed only minor light microscopic differences compared with controls, although electron microscopy revealed increased amounts of cell debris.…”

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

“…Studies comparing Y90 synovectomy to surgical synovectomy or chemical synovectomy with osmic acid show no dierences between these forms of treatment [4,6].…”

Double blind glucocorticoid controlled trial of samarium-153 particulate hydroxyapatite radiation synovectomy for chronic knee synovitis

“…A multicentre trial attempted to resolve this question by comparing Y-90 with triamcinolone hexacetonide but the target patient number was not reached because of problems with recruitment 16. Furthermore, published data show no difference in efficacy between radiation and surgical synovectomy,17 radiation and chemical synovectomy18 and chemical and surgical synovectomy 19…”