Radioisotope Synoviorthesis Research Articles

Scope Assisted Ankle Arthrodesis in a Young Male with Hemophilic Arthritis: A Case Study

Category:Ankle Arthritis; ArthroscopyIntroduction/Purpose:Arthritis is a debilitating condition that negatively affects an individual's ability to carry out activities of daily living. While osteoarthritis is a term many have become familiar with, as it is the most common form of arthritis encountered, hemophilic arthritis is a condition not frequently seen or discussed. Hemophilia is a congenital bleeding disorder caused by the absence or decrease of clotting factor VIII (Hemophilia A) or XI (Hemophilia B). When severe, this X-linked disease commonly results in intra-articular bleeding which, can progress to joint destruction1-4. This subsequently leads to the progressive destruction of articular cartilage and bone6-7.Methods:Arthroscopic assisted ankle arthrodesis with calcaneal autograft was performed. Calcaneal autograft was acquired through a small linear incision along the lateral wall of the calcaneus, a power graft harvester was introduced into the medullary bone to procure the graft. The left lower extremity was then placed into a non-invasive Gould Ankle distraction system and the standard anteromedial and anterolateral ankle scope portals were established. A scope and shaver were utilized to extensively debride all visualized hemorrhagic synovium. The shaver was then exchanged for a burr following debridement to remove the articular cartilage to both the talus and tibia. Following adequate preparation of the joint margins for fusion, the ankle joint was filled with the calcaneal autograft and rhPDGF-BB.Results:Various treatments have been described for patients suffering from hemophilic arthritis. While the use of clotting factor concentrations (CFCs) may reduce the risk of hemarthrosis, the risk of bleeding cannot be completely avoided2. Arthroscopic or open synovectomies has been described to remove the pathogenic synovium. Chemical or radioisotopic synoviorthesis is an option for less severe cases, but the treatment of choice is joint fusion or arthrodesis for advanced stages of arthropathy3.Conclusion:In patients with hemophilia, regular replacement therapy with clotting factor concentrates (prophylaxis) is effective in preventing recurrent bleeding episodes into joints and muscles. However, despite this success, intra-articular and intramuscular bleeding is still a major clinical manifestation of the disease. The pathogenesis of hemophilic arthropathy is multifactorial, with changes occurring in the synovium, bone, cartilage, and blood vessels. Our case report presents a unique pathology and the successful outcome that can be accomplished through surgical intervention and a multidisciplinary treatment approach.

Radioisotope Synoviorthesis in the Control of Refractory Synovitis in Castilla-La Mancha. A 10-year Experience.

To describe the experience in the performance of radioisotopic synoviorthesis for arthritis refractory to other treatments in our hospital. Observational, descriptive and cross-sectional study protocolised through the review of the database of radioisotopic synoviorthesis performed between 2007 and 2017. Previous clinical data were collected (age, sex, pathology, previous treatments, previous infiltration and affected joint), and progress at 6 months after administering the isotope. An Excel database was created for a frequency analysis with SPSS 21. 30 radiosynovitis interventions were performed. The most frequent pathologies in this order were: pigmented villonodular synovitis (40%), rheumatoid arthritis (23.3%), spondyloarthritis (13.3%), osteoarthritis (10%) and nonspecific arthritis (6.7%), followed by systemic lupus erythematosus and gout. After 6 months, 56.7% of the patients improved compared to 36.7% who remained the same. Likewise, none of them presented complications related to the procedure. Six point six percent of the patients were lost to follow-up. In patients with episodes of recurrent arthritis with associated joint effusion in one or two joints, refractory to systemic treatments, to local infiltrations with corticosteroids and for patients for whom other treatments may be contraindicated, we must consider the possibility of performing an isotope radiosinoviortesis, as it is a simple, safe technique with a success rate of more than 50%.

Que reste-t-il de la synoviorthèse isotopique ?

Radioisotopic synoviorthesis or “radiosynoviorthesis” aims to achieve synovectomy by atrophy or necrosis of hypertrophic synovial villi during synovitis in chronic inflammatory arthritis. This local treatment also has its place in hemophilic arthropathies or villonodular synovitis in addition to surgical treatment, particularly in the knee. Its therapeutic indication in osteoarthritis of the finger and wrist joints is much more controversial. It is carried out in collaboration between a nuclear medicine department and a rheumatology department. It requires a rigorous technique, particularly for achieving the intra-articular position of the needle. Radiopharmaceuticals are prepared extemporaneously and the choice of radioisotope and the volume to be injected depends on the size of the joint. The only contraindications are pregnancy and breastfeeding. Complications are those of radioguided infiltration.

Radioisotope synoviorthesis in pediatric and adolescent patients with hemophilia

ObjectiveTo assess the outcome and adverse-effects of the radioisotope synoviorthesis in pediatric and adolescent patients with hemophilia. Material and methodsProspective study of historical cohort was conducted. A total of 20 consecutive hemophiliacs with a mean age of 13.1 years (range 4–17) were included with a mean follow-up of 64.9 months (range 18–109). The diagnosis of synovitis was established on the basis of clinical follow-up including radiological images (radiography and/or MRI). For evaluation, the classification proposed by Fernandez-Palazzi was used. Inclusion criteria: Patients aged less than 18 years old with hemophilia and more than one haemarthrosis in less than 3 months remaining a chronic synovitis despite prophylactic therapy intensification. Exclusion criteria: Any contraindication for radionuclide synoviorthesis. Twenty-seven radioisotope synoviorthesis with 90Y-citrate-colloid and/or 186Re-sulphide-colloid were done. The effectiveness of the procedure was assessed through pre and posttreatment clinical comparison at 6 months after radioisotope synoviorthesis. ResultsNineteen of the 27 synoviorthesis (70.3%) had a good or excellent response and 8 joints (29.7%) had partial response. It was necessary to repeat the procedure in 3 joints in 3 different patients, obtaining in all cases a good or excellent response. We appreciated inflammatory reaction after procedure in 4 cases (14.8%), which improved with analgesics and nonsteroidal anti-inflamatory drugs. None of the patients presented malignant or premalignant lesions during the follow-up. ConclusionThe radionuclide synoviorthesis is a very effective procedure in pediatric and adolescent patients with hemophilia, being a minimally invasive procedure, easy to perform, safe and with minimal side effects.

Efectos clínicos y funcionales de la radiosinoviortesis en pacientes con sinovitis crónica hemofílica. Un estudio prospectivo. Nivel de Evidencia: IV

BackgroundThe joint haemarthrosis is the most common manifestation in patients with haemophilia, whereas radioisotope synoviorthesis (radiosynoviorthesis) is a widely used procedure for the treatment of chronic synovitis in order to prevent progression to a chronic arthropathy. There are no available reports of the clinical or functional outcomes of patients undergoing radiosynoviorthesis. The aim of this study was to describe the sociodemographic characteristics and clinical and functional response of patients with chronic haemophilic synovitis in which radiosynoviorthesis was performed. MethodsBetween January 2010 and December 2012 in a high complexity centre, all patients with chronic haemophilic synovitis that received radiosynoviorthesis as a treatment were included in a prospective cohort. The joint function Gilbert scale for haemophilia patients was applied to each patient, identifying sociodemographic, clinical and functional features prior to the procedure. A minimum follow-up of one year after the intervention was achieved for each patient, when the Gilbert scale was applied once again to determine the functional outcome of the involved joint. ResultsThe mean functional Gilbert scale score was 7.95 before the procedure, and 5.53 after the procedure representing statistical significance (P=.002). The improvement mainly depends on three characteristics: the frequency and haemarthrosis characteristics, the presence of joint effusion, and pain. Other variables measured by the scale of Gilbert Scale remained almost constant after the procedure. DiscussionWe found an improvement in the scale of Gilbert after the procedure, with significant difference mainly pain control (P=.005) and episodes of hemarthrosis. An improvement in the number and characteristics of haemarthrosis was observed in 84% (P=.001) of patients. These results are encouraging for the use of radiosynoviorthesis as a very good alternative for the treatment of haemophilic patients with chronic synovitis.Evidence Level: IV.

Radioisotope synoviorthesis with Holmium‐166‐chitosan complex in haemophilic arthropathy

Radiosynoviorthesis is a safe and easy method for synovectomy in haemophilic arthropathy. Various agents have been used in radiosynoviorthesis, especially newly developed agent Holmium-166-chitosan complex has good clinical outcome. This study analysed clinical results and radiologic evaluation of radioisotope synoviorthesis using Holmium-166-chitosan complex in haemophilic arthropathy. From March 2001 to December 2003, 58 radiosynoviorthesis were performed in 53 haemophiliacs. The average age at procedure was 13.8 years. The Arnold and Hilgartner stage of the patients was from I to IV. Holmium-166-chitosan complex was injected in 31 ankle joints, 19 elbow joints and 8 knee joints. Average follow-up was 33 months since primary procedure. The range of motion of each joint, frequency of intra-articular bleeding and factor dose used were analysed for clinical assessment. There was no significant improvement of range of motion in affected joints. After procedure, the average frequency of bleeding of the elbow joint has decreased from 3.76 to 0.47 times per month, the knee joint from 5.87 to 1.12 times per month, and the ankle joint from 3.62 to 0.73 times per month respectively (P < 0.05). After treatment, the average coagulation factor dose injected was significantly decreased to 779.3 units per month from 2814.8 units per month before treatment (P < 0.001). Radioisotope synoviorthesis with Holmium-166-chitosan complex in haemophilic arthropathy is a very safe and simple procedure with the expectation of a satisfactory outcome without serious complication. It has excellent bleeding control effect on target joint and the need for substitution of coagulation factor concentrate can be reduced.

Radiosynoviorthesis in children with haemophilia

Recurrent bleeding into joints represents the clinical hallmark of haemophilia and, if not adequately treated, it may cause chronic synovitis and degenerative arthropathy. The first treatment option of recurrent haemarthroses and/or chronic synovitis is represented by synoviorthesis, both chemical and radioisotopic, with a success rate of approximately 80% for both. However, radioisotopic synoviorthesis should be preferred because it makes it possible to obtain complete synovial fibrosis usually in one session, without the need for repeated injections, thus reducing the risk of bleeding complications and concentrate consumption. For all these reasons this procedure should be implemented and supported, particularly in developing countries.

Synoviorthesis in haemophilia patients with inhibitors

Recurrent bleeding into joints represents the clinical hallmark of haemophilia and, if not adequately treated, it may cause chronic synovitis and degenerative arthropathy. In haemophilia patients with inhibitors, a more severe degree of synovitis is often observed owing to the fact that treatment is more problematic in this setting. The first treatment option of recurrent haemarthroses and/or chronic synovitis is represented by synoviorthesis, both chemical and radioisotopic, with a success rate of approximately 80% for both. However, radioisotopic synoviorthesis should be preferred in inhibitor patients because it makes it possible to obtain complete synovial fibrosis usually in one session, without the need for repeated injections, thus reducing the risk of bleeding complications and concentrate consumption. For all these reasons this procedure should be implemented and supported, particularly in developing countries.

Cuantificación de la gammagrafía ósea en dos fases como método objetivo en el seguimiento de la sinoviortesis radioisotópica

This work tries to provide the clinicians an objective tool that can contribute to the assessment of the results of radioisotopic synoviorthesis (RS). This study aims to assess the value of the quantification of bone scintigraphy in blood pool and late phase of the affected joints treated with 90Y silicate, in order to observe the clinical improvement experienced by most of these patients. A total of 69 bone scintigraphies (BS) in blood pool and late phase have been quantified. They belonged to 23 patients who were treated with RS with 90Y. The first scintigraphy study was performed before the treatment, the second and the third ones were performed 2 and 6 months after treatment. In each BS we quantified the index: counts per pixel of healthy / affected joint. We also have calculated the fraction in the late phase: counts per pixel of healthy bone / counts per pixel of affected and healthy joint. For the comparative statistical analysis of the results we used the Student's t test. We considered statistical significance when p < 0.05. All the patients presented clinical improvement. If we compare the index obtained in BS 2 months after treatment and pre-treatment we find statistical significance (p < 0.05) in the increase of index in the anterior view and late phase. If we compare the index obtained in BS 6 month after treatment and pre-treatment, we find a statistically significant increase in the anterior (p < 0.01) and posterior (p < 0.05) view of the blood pool phase and the anterior view of late phase (p < 0.01). The fraction counts per pixel of healthy bone / counts per pixel of affected and healthy joint did not present a significant increase in any BS control (2 and 6 months). We recommend quantification using the index (counts per pixel healthy / affected joint ) proposed in this work, because it is easy to perform, cheap and reliable in the follow-up of patients treated with RS.

La sinoviortesis radioisotópica en la artritis reumatoide. Estudio de 108 casos

There are several therapeutic alternatives in the local treatment of rheumatoid arthritis (RA): intraarticular corticosteroids, chemical synoviorthesis, surgical synovectomy and synoviorthesis with radioisotopes. We present the results of an observational study on radioisotopic synoviorthesis carried out in the Valencian health care area from January 1989 to May 1997 which included 108 synoviortheses performed in 51 patients. This study aimed to assess the efficacy and safety of radiosynoviorthesis in the treatment of RA which had not responded to conventional treatment. Good and moderate results were obtained in 76.2% of the cases, there being significant differences in the efficacy of synoviorthesis in patients with and without advanced radiographic alterations. There were few side effects (3.7%). We conclude that radiosynoviortesis is a useful and safe therapeutic tool in RA that does not respond to conventional treatment, that it is more effective in large joints with little cartilaginous deterioration and that its repeated use does not decrease the expected therapeutic effect.

Non-surgical synovectomy

Rheumatoid patients with intractable knee effusions may benefit from medical or radio-isotopic synoviorthesis. These offer more convenient, less costly alternatives to surgery with similar long-term outcome. Temporary symptomatic relief may be obtained, but disease progression is unaffected. Potential adverse effects include development of osteoarthrosis with osmic acid and teratogenicity and mutagenicity with alkylating agents and radioisotopes.

Case Report: The Treatment of Chronic Synovitis by Chemical Synovectomy

Repeated hemarthrosis in hemophiliacs results in early joint destruction. When conservative treatment including factor replacement, immobilization, and physiotherapy fails to halt the bleeding, chronic synovitis develops and a more drastic definitive procedure is required to establish local hemostasis. Various techniques including surgical synovectomy, chemical or radioisotopic synoviorthesis have been used. We describe the successful rehabilitation and return to sport participation of a young boy, once bedridden by ankle synovitis, by the use of intraarticular osmic acid. J Orthop Sports Phys Ther 1986;8(2):85-87.