A retrospective study on chemical and radioactive synovectomy in severe haemophilia patients with recurrent haemarthrosis

Between 1970 and 1994, 116 chemical and 90 radioactive synovectomies were p erformed in 107 patients with severe haemophilia and two with type 3 von Wi llebrand's disease. The products used were osmic acid (OA) in 100 cases, 90 -Yttrium in 35 cases, 186-Rhenium in 48, 169-Erbium in two, hexacetonide tr iamcinolone in 16 and radioactive gold in five cases. The use of radioactiv e colloids is not allowed in France in patients under 15 years of age. Twen ty-nine patients had more than one synovectomy per joint. All patients were evaluated for 6 months post-synovectomy, using both a clinical and a radio logical score. Six months after synovectomy, a good or excellent result was obtained for 81% of the joints treated with isotopes, compared with 44% of those treated with OA, P < 0.001. This superiority of isotopes over osmic acid was still observed after 6 months for the 89 joints that were re-evalu ated, with follow-up ranging from 1 to 9 years. It was possible to calculat e a radiological score in 84 cases. With OA the best results were from the joints with the lowest scores pre-synovectomy (<7). No correlation could be established between the clinical and the radiological scores, due to the s mall size of the sample. In summary: (1) chemical and radioactive synovecto my are simple and safe procedures for haemophilic arthropathy, (2) in our s eries, after 6 months the efficacy of isotopic synovectomy was greater than that of chemical synovectomy, and this benefit seems to persist after 6 mo nths, and up to 9 years in the group of patients with longer-term follow-up .