CHEMICAL SYNOVECTOMY VS RADIOACTIVE SYNOVECTOMY FOR THE TREATMENT OF CHRONIC HEMOPHILIC SYNOVITIS - A PROSPECTIVE SHORT-TERM STUDY

Between January 1992 and December 1994, a prospective study was perfor med in two centres comparing chemical synovectomy using repeated weekl y injections (range, 1-17) of Rifampicin (Group R) vs. radioactive syn ovectomy using 1-2 injections of Yttrium-90 (Group Y). The study was p erformed on 38 joints in a total of 35 haemophilic patients suffering from chronic haemophilic synovitis unresponsive to 3 months of conserv ative treatment (substitution therapy with the deficient coagulation f actor plus a rehabilitation protocol). Group R included 18 patients wi th an average age of 9 years, with an average follow-up time of 25 mon ths. In Group R, 19 joints were treated: nine knees, four elbows and s ix ankles. Group Y included 17 patients with an average age of 18 year s, with an average follow-up time of 23 months. In Group Y, 19 joints were treated: 14 knees, two elbows and three ankles. The joints were e valuated according to the frequency of bleeding episodes and the Pette rsson radiographic score. On the basis of the radiographic scale at th e time of the synoviortheses, the joints were categorized as stage I ( 0 points), stage II (1-2 points), stage III (3-7 points), stage IV (8- 10 points) and stage V (11-13 points). The overall results showed that in Group R, bleeding decreased in 12 joints, remained the same in six and worsened in one. In Group Y, bleeding decreased in 11 joints, rem ained the same in seven and worsened in one. In both Groups, bleeding was controlled best if joints were in stages I and II. In stages III, IV and V, synoviorthesis should not be carried out in haemophilia beca use it is not effective. Use of radioactive substances in persons unde r the age of 9 years has been discouraged in the past and therefore on ly Rifampicin was used in this age group. However, in patients over 9 years of age, this study showed similar decrease of bleeding in both t reatment groups. Taking into account the advantages and disadvantages of both agents, we suggest the use of Rifampicin in elbows and ankles but prefer Yttrium-90 for the knees.