Radiosynovectomy in patients with chronic haemophilic synovitis: when is more than one injection necessary?

One hundred and fifty-six radiosynovectomies (RSs) were performed in 104 joints of 78 haemophilic patients diagnosed with chronic haemophilic synovitis. Mean patient age was 18 yr. Previous studies on the same group of patients indicated that RS is an effective procedure for treating chronic haemophilic synovitis, which may require the performance of 1-3 injections (RS-1, RS-2, RS-3), with a 6-month interval between them. Those studies also revealed that the parameters showing the greatest improvement after RS were pain and haemarthrosis, followed by the World Federation of Haemophilia (WFH) clinical score and muscle strength and range of motion. Such studies also demonstrated that the improvement achieved further to RS is independent of the patient's age, the type and severity of haemophilia, the previous haematologic treatment regime administered (on demand or prophylactic), the presence or absence of a circulating inhibitor, the patients' previous level or activity (or inactivity), the presence or absence of previous arthropathy (joint degeneration), of the isotope used (yttrium-90 or rhenium-186) and of the appearance or otherwise of RS-derived complications. In this study, we looked into the potential relationship between the type of joint treated and the degree of synovitis present with the need of one or more further RSs, and we found that the knee requires more injections than the elbow or the ankle and that the more severe synovites require a higher number of RS procedures.