Survival analysis of Y‐90 radiosynovectomy in the treatment of haemophilic synovitis of the knee: a 10‐year retrospective review

Abstract

Despite recent advances including new therapeutic options and availability of primary prophylaxis in haemophiliacs, haemophilic synovitis is still the major clinical problem in significant patient population worldwide. We retrospectively reviewed our 10-year experience with Y-90 radiosynovectomy to determine the outcome in the knee joints of patients with haemophilic synovitis. Between 2002 and 2012, 82 knee joints of 67 patients with haemophilic synovitis were treated with Y-90 radiosynovectomy. The mean age was 16.8 ± 7.8 years (range: 5-39 years). The mean follow-up period was 39.6 ± 25.6 months (range: 12-95 months). Failure of therapy represented re-bleeding after a radiosynovectomy was used as an end point in patient time to progression (TTP) analysis. The median TTP was calculated as 72.0 ± 3.6 months (95% CI 64.8-79.1 months) in Kaplan-Meier analysis. The 1, 3 and 5-year survival rates were 89%, 73% and 63% respectively. Longer TTP (hazard ratio for progression, 2.5; P = 0.00) was evident in patients who have greater reduction in bleeding frequency within 6 months after radiosynovectomy. We did not find a relationship between the TTP and the following variables: age, type and severity of haemophilia, the presence or absence of inhibitor, the radiological score, range of motion status of joints and the pretreatment bleeding frequency. We concluded that Y-90 radiosynovectomy in knee joint represents an important resource for the treatment of haemophilic synovitis, markedly reducing joint bleeding and long-term durability, irrespective of the radiographic stage and inhibitor status.

Radioisotope synoviorthesis in pediatric and adolescent patients with hemophilia

“…Turkmen et al 15 reviewed their experience of the application of 90 Y on 82 knees of 67 patients (mean age 16.8 ± 7.8 years, range 5-39 years) with synovitis secondary to hemophilia, observing rates of survival free of disease progression at 1, 3 and 5 years of 89%, 73% and 63%, respectively.…”

Effect of radiosynoviorthesis on the progression of arthropathy and haemarthrosis reduction in haemophilic patients

“…Despite recent advances including new therapeutic options and the availability of primary prophylaxis in haemophiliacs, haemophilic synovitis is still the major clinical problem in significant patient population worldwide …”

“…A first‐line treatment for chronic synovitis is radionuclide synoviorthesis, a widely disseminated method providing satisfactory results in adults, children and adolescents . Chemical synoviorthesis with Rifampicin or oxytetracycline chlorhydrate is a good alternative in developing countries where radionuclide is not available, when it is contraindicated or not tolerated by patients …”

“…RS reduces synovial inflammation (at between 2 and 6 months), pain and haemorrhagic frequency, increasing the quality of life of the patient …”

Recurrent Hemarthroses After TKA Treated With an Intraarticular Injection of Yttrium-90

“…Yttrium-90 is very energetic; mean and maximal tissue penetration are 3.6 mm and 11 mm respectively; maximal beta energy emission is 2.25 MeV [17]. In addition to treating persistent rheumatoid synovitis [20], yttrium-90 has been reported to be beneficial in hemarthrosis and synovitis associated with hemophilia [19], calcium pyrophosphate crystal arthropathy [20], pigmented villonodular synovitis [10], persistent synovitis after joint prosthesis surgery [8], and other forms of chronic synovitis [17].…”