Abstract
The history of synoviorthesis in haemophiliacs and recent studies has shown that it is a safe procedure and that the results are similar to those seen following open or arthroscopic synovectomy. Colloidal Yt 90 silicate is a beta emitter with a half life of 2.7 days and a mean depth of penetrating soft tissue of 4mm. We evaluate the outcome of Yt 90 injection in patients with chronic haemophilic synovitis of the knee.
A retrospective study was done from 1998–2006 of 35 patients with 44 joint injections. Indications were repeated bleeds (4 episodes); chronic synovitis. The age range was 4–27 years. A dose of 2–5 mCu was injected intra-articularly using a sterile technique and local anaesthetic, after an intravenous factor V111 infusion (5 patients had antibodies) and initial joint lavage. The knees were immobilized in above knee backslabs for 2/7. Patient follow up of up to 8 years was conducted. Patients were assessed for pain relief, range of movement, repeated bleeds, cost saving, quality of life and progression to haemophilic arthropathy.
Pain relief of 2 or more points on VAS was reported by 30 patients (85.7%). 18 Patients reported a decrease in bleeding frequency (51.4%). 11 Patients had no further bleeds (31.4%).
We conclude that there was a significant cost saving as a result of the decreased need for the use of cryo-precipitate. Two patients experienced localised areas of necrosis from radio colloid extravasation. These wounds healed after 3 weeks of local dressings. 60% of joints had and increased range of movement. 92% reported improved quality of life.
We have found yttrium synoviorthesis to be an inexpensive, relatively simple and painless technique for treating chronic haemophilic synovitis. The majority of patients were satisfied, experiencing pain relief, increased range of motion and significant monetary saving from reduced cryoprecipitate use.
Correspondence should be addressed to: Léana Fourie, CEO SAOA, PO Box 12918, Brandhof 9324 South Africa.
