Isotopic synovectomy with P-32 in paediatric patients with haemophilia

Isotopic synovectomy is being proposed as an option in the treatment of pat ients with haemophilic arthropathy. We present our experience with 11 paedi atric patients who underwent 17, P-32 isotopic synovectomies for chronic ha emophilic arthropathy. P-32 was injected into the joint per protocol, appro ved by the institutional review board. All our patients were male. Nine wer e factor VIII and two were factor IX deficient. The following joints were t reated: ankle (n = 10 procedures), elbow (n = 5) and knee (n = 2). The firs t procedure was performed on December 1993. None were human immunodeficienc y virus positive. Mean age at the first procedure was 10.8 years (range, 5. 2-15.2 years). Mean pretreatment joint clinical scores using the World Fede ration of Hemophilia guidelines for the ankle was 5.5 (SD +/- 2.3), the elb ow 4.2 (+/- 2.5), and knee 5.5 (+/- 3.5); the corresponding post-treatment scores were 2.6 (+/- 2.0), 1.4 (+/- 0.5) and 2.5 (+/- 3.5) respectively. Pr esynovectomy mean radiological scores using the Pettersson method were: ank le 1.8, elbow 1.8, and knee 1.5. A scoring system used in our centre for ev aluating joints using magnetic resonance imaging (MRI) gave the following m ean pretreatment scores: ankle 9.5, elbow 8.4, and knee 5.0. A marked decre ase (an 80-100% decrease) in bleeding was seen in 13 of 17 procedures, and a moderate decrease (51-79% decrease) in two procedures, accounting for 85% reduction in bleeding into the target joints. The procedure was well toler ated and no untoward side-effects were noted as of May 1999, with a median follow-up of 40 months (range 19-65 months). None had any clinical evidence of cancer. Three patients had their joints retreated [elbow (one), ankle ( two)]. These procedures were also well tolerated. In conclusion, in our stu dy, isotopic synovectomy using P-32 appears to be feasible, safe and effica cious in the treatment of haemophilic arthropathy in paediatric patients wh o have been followed for a median of 40 months. As previously shown, MRI ap pears to give more detailed information about joint arthropathy than plain radiographs.