yttrium-silicate and Hemarthrosis

Radiocolloids have been used in the treatment of hemophilic arthropathy. Fifty-eight joints of 35 patients were injected with 2-5 mCi of yttrium-90 silicate under local anesthesia. A preinjection arthrogram was performed to ensure correct placement of the needle. Plaster of paris cast immobilization of the joint was used for three days. After a mean follow-up period of seven years (range, two to 12 years), 47 joints were pain free, and 13 joints had not experienced another hemorrhagic episode. The mean hemorrhagic frequency had decreased from four per month to two per year. The radiation risk was far outweighed by the benefits of the procedure. Forty-seven of the 58 joints were rated as improved by the patients. The roentgenographic appearance of the joints had changed little. Only five complications occurred: three needle-track necroses because of extravasation of the radiocolloid, two severely painful joints immediately after injection, and one massive hemorrhagic episode. This form of treatment is suggested for hemophiliacs who have failed to respond to intensive physical and hematologic therapy, and for those patients who have inhibitors.

Topics: Adolescent; Adult; Child; Child, Preschool; Colloids; Follow-Up Studies; Hemarthrosis; Hemophilia A; Humans; Range of Motion, Articular; Silicates; Silicic Acid; Synovitis; Yttrium; Yttrium Radioisotopes

The aim of this study was to evaluate the long term effect of radiation synovectomy with yttrium-90 silicate in haemophiliac patients with recurrent haemarthrosis.. The bleeding frequency and the mobility of the joint were recorded in 16 joints of 14 patients 1 year before radiosynovectomy and during follow up, which ranged from 3 to 6 years. Patients evaluated the effect of their own treatment by completing a questionnaire. Radiographs of the joints were scored by an independent radiologist before treatment.. A satisfactory reduction of the frequency of haemorrhage was achieved in 94% of joints during the first year after treatment and was maintained in 63% until the end of the follow up period. In general there was no decrease in mobility attributable to radiosynovectomy, and the patients' own evaluations agreed with the evaluations based on the frequencies of haemarthrosis in 75%. Patients who had only minor, or no, radiological abnormalities of the joints before treatment showed the best results. One patient developed synovitis as a complication of the radiosynovectomy.. Radiosynovectomy is an effective and safe treatment for recurrent haemarthrosis in haemophiliac patients, especially in those who have joints with no or minor radiological damage.

Topics: Adolescent; Adult; Arthrography; Child; Follow-Up Studies; Hemarthrosis; Humans; Joints; Middle Aged; Silicates; Silicic Acid; Synovial Membrane; Yttrium; Yttrium Radioisotopes