title: Radiosynovectomy in haemophilia: long-term results of 500 procedures performed in a 38-year period.
abstract: BACKGROUND
  Radiosynovectomy (RS) can reduce the number of haemarthroses in chronic haemophilic synovitis. The purpose of this study was to assess the effectiveness of RS in terms of the objective improvement of five parameters (number haemarthroses, articular pain, degree of clinical synovitis, clinical score of the World Federation of Haemophilia (WFH), and radiological score of the WFH.
  
  
  METHODS
  In a 38-year period (1976-2013), five hundred radiosynovectomies were performed in 443 joints of 345 patients with haemophilia diagnosed with chronic synovitis. The mean patient age was 23.7 years (range, 6-53). The mean follow-up was 18.5 years (range: 6 months-38 years). The RS was carried out with either yttrium-90 or rhenium-186. We performed 1 to 3 injections (RS-1, RS-2, RS-3), with a 6-month interval between them.
  
  
  RESULTS
  RS resulted in significant improvement in all the parameters studied, except in the WFH radiologic score that showed no improvement. On average, the number of haemarthroses decreased by 64.1% and articular pain decreased by 69.4%. The degree of synovitis showed a reduction of 31.3%. The WFH clinical score revealed an improvement of 19%. The WFH radiological score showed no improvement. There were four complications (0.9%) of RS. Twenty-eight (6.3%) joints eventually had to be subjected to arthroscopic synovectomy or total knee replacement (TKR). No cancer was observed in this group of patients during the 38-year period.
  
  
  CONCLUSIONS
  Radiosynovectomy (RS) is an effective, safe, minimally invasive, well tolerated procedure in the long-term for the treatment of chronic haemophilic synovitis. Moreover, it is very easy to perform. The knee required more injections than the elbow or the ankle and more severe synoviums required a higher number of RS procedures.
authors.affiliation: Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain. Electronic address: ecrmerchan@gmx.es.
authors.forename: E C
authors.initials: EC
authors.lastname: Rodriguez-Merchan
authors.affiliation: Department of Rehabilitation and Physical Therapy, La Paz University Hospital, Madrid, Spain.
authors.forename: H
authors.initials: H
authors.lastname: De la Corte-Rodriguez
authors.affiliation: Department of Haematology, La Paz University Hospital, Madrid, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Jimenez-Yuste
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease; D005500:Follow-Up Studies; D006395:Hemarthrosis / Q000150:complications* / Q000628:therapy; D006467:Hemophilia A / Q000150:complications* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D011868:Radioisotopes / Q000627:therapeutic use*; D012211:Rhenium / Q000627:therapeutic use*; D013585:Synovitis / Q000150:complications* / Q000628:therapy; D055815:Young Adult; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D011868:Radioisotopes; D015021:Yttrium Radioisotopes; D012211:Rhenium
keywords: Articular variables; Efficacy; Haemophilia; Radiosynovectomy; Results; Synovitis