Yttrium synovectomy: a meta-analysis of the literature.
BACKGROUND
Yttrium synovectomy for chronic synovitis of the knee enjoys widespread usage in Australia with approximately 400 patients receiving yttrium-90 in 1991. Despite abundant anecdotal evidence of its efficacy there is a paucity of controlled trials and those that have been done have produced conflicting results and have been of insufficient sample size.


OBJECTIVE
To critically and quantitatively evaluate the published English literature on comparative trials of yttrium-90 therapy for chronic synovitis of the knee.


METHODS
The technique of meta-analysis was utilised. The literature search was carried out using the MeSH terms of synovectomy and knee; and yttrium. This was augmented by referring to reviews, current textbooks and back-references. Outcome measures varied between trials but could be grouped as treatment success. The Peto modification of Mantel and Haenszl was used for statistical pooling of data yielding a pooled odds ratio (OR).


RESULTS
The literature search revealed ten controlled trials of which two were excluded from further analysis. Yttrium was superior to placebo (OR 2.42, 95% CI 1.02-5.73) but this result should be interpreted with caution due to possible publication bias. Yttrium was not superior to triamcinolone (OR 1.89, 95% CI 0.81-10.55) or other active modalities (OR 1.04, 95% CI 0.72-1.52). Further research comparing yttrium with other modalities is necessary to properly determine its place in rheumatological practice.
Jones
G
G
Department of Rheumatology, Royal Newcastle Hospital, NSW, Australia.
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D006801:Humans; D007719:Knee Joint; D000074402:Synovectomy; D013583:Synovial Membrane / Q000528:radiation effects; D013585:Synovitis / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000031:analogs & derivatives / Q000627:therapeutic use; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
D000893:Anti-Inflammatory Agents; D015021:Yttrium Radioisotopes; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide