Hemophilic synovitis of the knee: radiosynovectomy or arthroscopic synovectomy?

Abstract

Radiosynovectomy (RS) is the best choice for patients with persistent synovitis of the knee unresponsive to a 3-month trial of prophylactic factor replacement. If three consecutive RSs with 6-month intervals have been ineffective, an arthroscopic synovectomy should be indicated in patients older than 12 years of age (adolescents). In children younger than 12 years of age, adequate prophylaxis should be maintained, with arthroscopic synovectomy always being the last resort. In the knee, we recommend Yttrium-90 at a dose of 90 mBq in children and 185 mBq in adults. Although the dose of radiation of RS is minimal and neither articular nor systemic neoplastic changes related to RS have been reported so far, all patients must be given the opportunity to consider the risk/benefit ratios. Our current recommendation is to use knee RS in hemophilia patients older than 12 years of age (adolescents).

Keywords::

• arthroscopic synovectomy
• hemophilia
• knee
• radiosynovectomy
• synovitis

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Prophylactic replacement therapy and physiotherapy are paramount to slow the development of knee synovitis and arthropathy.

• When synovitis develops, radiosynovectomy (RS) should be performed very early instead of an arthroscopic synovectomy.

• RS can be repeated up to three-times with 6-month intervals.

• For knee hemophilic synovitis, we currently use Yttrium-90 at a dose of 90 mBq in children older than 12 years of age and 185 mBq in adults.

• Although the dose of radiation of RS is minimal and neither articular nor systemic neoplastic changes related to RS have been reported so far, all patients must be counseled about malignancy concerns and given the opportunity to consider the risk/benefit ratios.