Yttrium-90 radiation synovectomy in knee osteoarthritis: a prospective assessment at 6 and 12 months

Abstract

To assess the outcome of yttrium-90 radiation synovectomy at 6 and 12 months in patients with knee osteoarthritis unresponsive to systematic or local medical treatment. Consecutive patients with osteoarthritic knee pain resistant to conventional therapy and submitted to intraarticular yttrium-90 treatment because of synovial inflammation, as demonstrated by early-phase bone scintigraphy, were prospectively evaluated at 6 and/or 12 months. The assessment of the outcome of treatment was based on self-reporting of relief of knee pain limiting daily activities, measured as percentage reduction of the pretherapeutic joint discomfort with a Visual Analogue Scale. Resting and nocturnal pain also were considered, together with knee flexibility and ultrasonographic changes. Among a total of 97 patients, a > or =50% Visual Analogue Scale pain palliation was experienced by 64 of 90 (71.1%) patients at 6 months and 50 of 69 (72.5%) at 12 months (P = 0.992). Moreover, nocturnal and resting pain alleviation, gain in knee flexibility and regression of large joint effusions and Baker's cysts were observed in considerable proportions. In the evaluation of the outcome of treatment in 62 patients with serial assessments using a composite criterion, 42 (67.7%) versus 40 (64.5%) had a satisfactory response at 6 and 12 months, respectively (P = 0.850). The probability of a favourable therapeutic result was inversely related to the severity of radiographic joint changes. Yttrium-90 synovectomy exerts a beneficial therapeutic effect in a substantial proportion of patients with osteoarthritic knee pain and synovial inflammation, inadequately controlled by pharmacotherapy. Clinical improvement is inversely related to radiographic knee damage.