Abstract
Since 1976 we have performed 60 radioactive synoviorthesis in 53 haemophilic patients with age from 6 to 40 years with a mean of 10 years of age, 45 of these patients were under 12 years of age. The knees were injected in 38 cases, elbow in 16 cases, ankles in 5 and shoulders in 1 case. The procedure was performed in 6 sittings of 10 patients each. The synoviorthesis is done by an intrarticular injection of the radioactive material preceded by a local anesthetic. The clinical results of this procedure gives an 80 % of excellent results with no further bleeding. One of the criticisms against this method is the possible chromosomal damage induced by the radioactive material. In our center, two previous studied have been done in order to see whether these possible changes are everlasting and both have demonstrated that chromosomal changes are reversible. The radioactive material used in these synoviorthesis was 189 Au In 1978, 354 metaphases were studied with 61 ruptures, 17.23 %, (non premalign) and 6 structural changes -considered premalignant, 1.69 %. Any number below 2 % is considered non dangerous. A further study was done in 1982, in the same group of patients with a result of 21 ruptures, 3.34% and no structural changes. This demonstrated that the possible premalignant changes disappeared with time. A third study was performed in a series of 13 patients that unstained radioactive synoviorthesis with Re 186 in November 1991. We performed for comparison a chromosomal study just before and 6 months after the radioactive material injection. The results confirmed that changes that could be attributed to the radiation, appears equally in non irradiated patients and those due to the radiation disappear with time, never reaching the dangerous zone of 2 %. In these group treated with 186 Re we studied an additional number of 130 metaphases with identical results and NO structural changes.
Conclusions: In view of these results, it seems that radioactive synovectomy is safe procedure and gives great benefits to the haemophilic patients, and no long standing structural chromosomal damage
Local Host: British Society for Children’s Orthopaedic Surgery. Conference Theme: Congenital Deficiencies of the Lower Limb. These abstracts were prepared by A.Catterall.
