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.

Europeam Group of Neuro-orthopaedic (GLAENeO), Caracas, The prevention of a dislocated hip is one of the aims of early surgery in Cerebral Palsy children, specially those severely involved. We performed a retrospective study of those cerebral palsy patients operated of adductor tenotomy between 1975 and 1995 with a total of 1474 patients. We grouped them in those who had a unilateral tenotomy and those who had a bilateral tenotomy as primary surgery. Of these only 8% had an obturator neurectomy, without walking ability, and 92 % had it not. Age at surgery varied from 6 months to 8 years of age with a mean of 4 years and 3 months. Group I: 792 patients (53.7 %) with unilateral adductor contracture, sustained a unilateral adductor tenotomy. Of these patients a total of 619 (78, 2 %) required a contralateral adductor tenotomy at a mean of 3 years and 6 months. Group II: 682 patients (46, 3 %) with bilateral adductor contracture that had a bilateral adductor tenotomy in one stage. Of the 792 patients that sustained a two stage adductor tenotomy, 123 (20%) presented a unilateral dislocated hip and of these 115 (93 %) occurred in the hip operated secondly at a mean of 1 year post tenotomy. Of the 682 patients with bilateral adductor tenotomies only 7 (1 %) had a dislocated hip 2 years post tenotomy. Of the 72 dislocated hips, 12 (59 %) were quadriplegics, 28 (22 %) were diplegic, 21 (18 %) hemiplegics and 1 (1 %) tetraplegic.

Of the 619 patients tenotomized in two stages, in 143 the diaphyseal – cervical angle was 155 ° (23,1 %), at a mean of 6 and a half years of age and 3 years post the second tenotomy. In 102 of these patients (71 %) a varus derotation osteotomy was performed in the hip operated in the second act with further dislocation of the hip in 20 cases (20 %). Of the 685 patients with bilateral tenotomy in one stage, varus derotation osteotomy was required in 68 (68 %) at a mean of 6 years of age with only a 3 % of dislocations in this group.

In view of these results we recommend a bilateral adductor tenotomy be performd regardless of a difference in the degree of contracture of both sides, thus coordinating the forces and avoid further dislocation the hip.