Radionuclide synovectomy and chronic haemophilic synovitis in Asians: a retrospective study

Abstract

Radionuclide synovectomy has been identified as the procedure of choice in treating chronic haemophilic synovitis among Caucasian populations. Its effectiveness among East Asians has not been studied. A retrospective study was carried out on 12 Asian haemophiliacs who underwent 12 radionuclide synovectomies. The average follow-up was 30.7 months (range 6-55) for primary procedures. 32P chromic phosphate and 188Re-tin colloid were injected into target joints according to protocol. There was a significant 80% decrease in the median frequency of haemarthrosis from 1.4 per month (range 0.2-7.0) to 0.25 per month (range 0.0-1.8) (P<0.05). Half of the patients had excellent results by 1 year of synovectomy. The median factor usage for target joint haemarthrosis postsynovectomy was 792 units per month (range 0-3209) reduced significantly from a presynovectomy level of 1452 units per month (range 306-7125) (P<0.05). Patients also reported a reduction in joint pain scores, and an improvement in joint mobility and quality of life. The majority of patients were satisfied with the overall outcome of radionuclide synovectomy. Radionuclide synovectomy appears to be effective in reducing the incidence of target joint haemarthrosis and quantity of factor usage for such bleeds among Asians with haemophilic synovitis.

Radiosynovectomy in Hemophilic Synovitis: Correlation of Therapeutic Response and Blood-Pool Changes

“…This outcome is comparable to the previous reports which had a success rate ranged from 75% to 90% after radiosynovectomy with Y-90, Re-186, and other radionuclides in patients with hemophilia. [4][5][6][7][8][9][10][11][12]20 In this study, radiosynovectomy fails to control hemarthrosis in 13% of the joints (joints had less than 30% reduction in bleeding episodes or no chance). On the other hand, 3% of treated joints had moderate improvement, and 9% of treated joints had mild improvement.…”

“…3 The results of radiosynovectomy, using different radionuclides from several centers, have shown effective clinical results, averaging a 75%-90% reduction in hemarthrosis in patients with hemophilia. [4][5][6][7][8][9][10][11][12] The evaluation of the therapeutic effectiveness of radiosynovectomy in patients with hemophilia is largely based upon improvements in measurable patient variables, such as bleeding frequency and range of motion (ROM) values. In the past, blood-pool imaging has proven to be a reliable method to estimate increased blood-pool supply of an inflamed joint for evaluating the grade of inflammation and effectiveness of radiosynovectomy in patients with arthritis.…”

Musculoskeletal Complications of Hemophilia

“…In our center, we use it before arthroscopic synovectomy. The aim of both radiosynovectomy and arthroscopic synovectomy is to remove the inflamed and hypervascular synovium as soon as possible in order to prevent the onset of hemophilic arthropathy [7][8][9][10][11][12][13][14][15]. Ideally, however, these methods should be performed before the articular cartilage has eroded.…”

Musculo-Skeletal Complications of Hemophilia

“…In our center, we use it before arthroscopic synovectomy. The aim of both radiosynovectomy and arthroscopic synovectomy is to remove the inflamed and hypervascular synovium as soon as possible in order to prevent the onset of hemophilic arthropathy [7][8][9][10][11][12][13][14][15]. Ideally, however, these methods should be performed before the articular cartilage has eroded.…”