On the safety of synoviorthesis in haemophilia

Abstract

One of the best procedures to prevent haem-arthrosis has been radioactive synovectomy (synoviorthesis). Since the first report of radioactive synovectomy in haemophilia of Ahlberg in 1971 [1], many centres adopted this procedure as the one of choice, through fibrosing the synovial membrane, prevent further haemarthrosis. Since 1976 we have performed 104 such radioactive synoviorthesis in 97 patients, age ranging from 6 to 40 years with a mean of 10 years. Sixty-five of these patients were under 12 years of age. The knees were injected in 61 cases, elbow in 26 cases, ankles in 14 cases and shoulders in three cases. The clinical results of this procedure show 80% of excellent results with no further bleeding. In case of failure, a new injection can be given in the same joint at a 6-month interval, or an injection for the same purpose in other joint. One of the criticisms against this method is the possible chromosomal damage induced by the radioactive material. In our centre, four studies have been carried out in order to see whether these changes, when they occur, are everlasting; all have demonstrated that chromosomal changes are reversible. The radioactive material used in the two first studies was Gold-189 (189Au). In 1978, 354 metaphases were studied with 61 ruptures, 17.23% (nonpremalign) and six structural changes, considered premalign (1.69%). Any number below 2% is considered not to be dangerous. A further study was done in 1982, in the same group of patients with a result of 21 ruptures (3.34%) and no structural changes. This demonstrated that the possible premalign changes disappeared with time. A third study was performed in a series of 13 patients that sustained radioactive synoviorthesis with Rhenium-186 (186Re) in November 1991. For comparison, we carried out a chromosomal study just before and 6 months after the radioactive material injection. The results confirmed that changes that could be linked to the radiation, appeared equally in nonirradiated patients, and those changes due to the radiation disappear with time, never reaching the dangerous zone of 2%. In the group treated with 186Re we studied an additional number of 130 metaphases with identical results and no structural changes. In a study on patients where 90Y was the radiocolloid, no premalign change was found before or after the synoviorthesis. It seems, in view of these results, that radioactive synovectomy is safe and gives great benefits to the haemophilic patients.

Elbow Arthroplasty in Patients with Bleeding Disorders. Preliminary Report of a Single-centre Experience

“…Za kwa li fi ko wa ny do lecze nia ope ra cyj ne go w związ ku ze znacz ną dys funkcją sta wu łok cio we go -ar tro pa tia he mo fi lo wa stopnia IV w kla sy fi ka cji Fer na dez -Pa laz zi i Ca vi glia (6). Oce na wg ME PI da ła wy nik 44 (zły) (7).…”

“…was 32 years old and had severe haemophilia A without an inhibitor. He was qualified for surgical treatment due to considerable elbow function impairment, classified as grade IV haemophilic arthropathy according to Fernandez-Palazzi and Caviglia [6]. His MEPI score was 44 points (poor) [7].…”

“…1. Ranges of motion, VAS scores for pain intensity and MEPI scores in the elbow joint and forearm in patient 1 before and at 3, 6 and 12 months after operation cze nia ope ra cyj ne go w związ ku ze znacz ną dys funkcją sta wu łok cio we go -ar tro pa tia he mo fi lo wa stopnia IV w kla sy fi ka cji Fer na dez -Pa laz zi i Ca vi glia [6], co ob ra zu je Ryc. 4 a i b.…”

“…function impairment: grade IV haemophilic arthropa thy according to Fernandez-Palazzi and Caviglia [6] as shown in Figs 4 a and b.…”

Grundlagen und Technik der Radiosynoviorthese

“…So berichteten Fernandez-Palazzi und Caviglia über eine RSO bei 97 Kindern mit einem Durchschnittsalter von 10 Jahren. Achtzig Prozent der Kinder profitierten von der Behandlung und zeigten im Langzeitverlauf über 25 Jahre keine weiteren Einblutungen in den behandelten Gelenken [28]. …”