Unacceptable complications following intra-articular injection of yttrium 90 in the ankle joint for diffuse pigmented villonodular synovitis.
BACKGROUND
Simple resection of diffuse pigmented villonodular synovitis of the ankle joint is associated with local recurrence rates as high as 50%. Thus, adjuvant treatment modalities, such as radiation or intra-articular isotope injection, are sometimes used after tumor resection. Our initial and highly satisfactory experience with the injection of radioactive yttrium 90 to treat pigmented villonodular synovitis of the ankle joint eroded with time so much so that we discontinued its use in the ankle and believe that it is important to alert our colleagues to the complications that we observed.


METHODS
Between 1989 and 2006, we treated seven patients who had diffuse pigmented villonodular synovitis of the ankle joint with subtotal synovectomy followed by intra-articular injection of 15 mCi of yttrium 90.


RESULTS
Two of the study patients had full-thickness skin necrosis develop around the injection site, necessitating free muscle flap transfer within three months of treatment, and a third patient had development of a draining sinus that was associated with chronic severe pain. The other four patients reported pain after the injection that was reasonably controlled by the use of nonsteroidal anti-inflammatory drugs. At the most recent follow-up evaluation, no study patient had recurrent disease.


CONCLUSIONS
Because of the unacceptably high rate of serious complications associated with the injection of yttrium 90 into the ankle joint following subtotal synovectomy, we discontinued its use as a local adjuvant in the management of diffuse pigmented villonodular synovitis of the ankle.
Bickels
Jacob
J
National Unit of Orthopedic Oncology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel. jbickels@012.net.il
Isaakov
Josephine
J
Kollender
Yehuda
Y
Meller
Isaac
I
D000328:Adult; D000843:Ankle Joint; D018771:Arthralgia / Q000209:etiology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications; D011832:Radiation Injuries / Q000209:etiology / Q000473:pathology; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000009:adverse effects*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012867:Skin / Q000473:pathology; D000074402:Synovectomy; D013586:Synovitis, Pigmented Villonodular / Q000532:radiotherapy* / Q000601:surgery; D015021:Yttrium Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects*
D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes