LONG-TERM EVALUATION OF RADIOISOTOPE SYNOVECTOMY WITH YTTRIUM-90 AND RHENIUM-186 FOR CHRONIC SYNOVITIS IN PEDIATRIC HEMOPHILIA: AKDENIZ UNIVERSITY EXPERIENCE

Abstract

OBJECTIVE: This study aimed to evaluate the effect of radioisotope synovectomy with Yttrium-90 and Rhenium-186 on the joints of patients with chronic hemophilic synovitis.MATERIAL AND METHODS: Retrospective analysis of radioisotope synovectomy using Yttrium-90 and Rhenium-186 in pediatric hemophilia patients treated in the Akdeniz University School of Medicine between June 2005 and September 2014 was carried out.RESULTS: Eighteen patients with severe hemophilia (mean age 12.55±4.93 years) underwent a total of 32 radioisotope synovectomy procedures: 13 elbow (40.6%), nine knee (28.2%), nine tibiotalar (28.2%), and 1 metatarsal (3.1%) joint. Ten patients (55.5%) had radioisotope synovectomy to a single joint; five patients (27.8%) had simultaneous radioisotope synovectomy to two joints. Three patients with inhibitors underwent a total of five radioisotope synovectomy procedures (15.6%). In 15 patients (83.3%), hemarthrosis was reduced after radioisotope synovectomy and no further treatment was required. The other three patients (four joints) underwent repeat radioisotope synovectomy after a mean of 20.75±14.77 months. The mean follow-up period of our patients was 8.81 ± 4.87 years [9.42 years (min-max; 1-22.58)]. Uncontrolled bleeding, need for additional dose factor treatment, radioisotope leakage, and local inflammatory reaction were not observed during and after radioisotope synovectomy.CONCLUSIONS: Radioisotope synovectomy is an effective treatment method that can be used to prevent permanent joint damage in hemarthrosis and to reduce the frequency of bleeding and the use of coagulation factors. Treatment of radioisotope synovectomy should be considered before progressive joint damage has developed.