One of the best procedures to prevent haemarthrosis in haemophilia has been radioactive synovectomy (synoviorthesis). Since the first report of radioactive synovectomy in haemophilia of Ahlberg in 1971, (7) many centers adopted this procedure as the one of choice to, through fibrosing the synovial membrane, prevent further haemarthrosis.

Since 1976 we have performed 119 such radioactive synoviorthesis in 110 patients with age from 3 to 40 years with a mean of 10 years of age, 71 of these patients were under 12 years of age. The knees were injected in 71 cases, elbow in 29 cases, ankles in 16 and shoulders in 3 cases. The clinical results of this procedure gives an 80% of excellent results with no further bleeding. In case of failure a new injection can be given in the same joint at a 6 month interval, or an injection for the same purpose in other joint. One of the criticisms against this method is the possible chromosomal damage induced by the radioactive material.

In our center, 4 studies have been made in order to see whether these changes, in case of appearance, are everlasting and all have demonstrated that chromosomal changes are reversible. The radioactive material used in the 2 first studies was 189 Au. In 1978, 354 metaphases were studied with 61 ruptures, 17.23%, (non premalign) and 6 structural changes -considered premalign-, 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 premalign changes disappeared with time. A third study was performed in a series of 13 patients that sustained 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 and the results confirmed that changes that could be blamed 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. In the study on patients that had 90Y as radiocolloid performed before and after the synoviorthesis no premalign change was found in neither. It seems, in view of these results, than radioactive synovectomy is safe and gives great benefits to the haemophilic patients.

This is a non controlled experimental prospective4 clinical study that obtained satisfactory results in the chemical Synovectomy with Oxitetracycline Clorhydrate (Emicine), in dfferent joints, demonstrating that it is an Effective method in the treatment of recurrent haemarthrosis in haemophilia.

Materials: 84 patients of whom 77 concluded the complete treatment. 82 joints were injected. The dosage injected was 5 cc of the drug (25 mgms.) in 5 cc of anaesthesia for the knee. 2 cc with 1 cc anaesthesia for the elbow. 1 cc plus 1 cc anaesthesia for the ankle. These injections were performed once weekly with a reinforcement in one month. In case of failure the same can be done repeatedly.

Evaluation and results: Subjective parameters. Pain, range of movement and use of the joint involved. Pain decreased from a mean of 6.5 to 0.9 (Likert scale). Range of movement increased from 5.9 to 9 and joint use increased from 5.9 to 9.2. Objective parameters. Joint diameter and range of movement. Range of movement for flexion and extensiòn improved from 72.2 and 149.2 to 73.7 and 167 respectively for the knees. From 57.3 and 160 to 66.6 and 170 respectively for the shoulder. And from 22.7 and 10.8 to 34 and 18.6 respectively for the ankle.

Conclusion: This procedure has multiple advantages such as immediate therapeutic effect, short period of treatment, easy technique, much les AHF coverage (•0% above coagulation level, less cost than radiocolloid treatment which makes it an perfect alternative of treatment for developing countries and not so underdeveloped.

Besides the experimental demonstration of its action in rabbits is exposed.