Radioactive synovectomy in haemophilic haemarthrosis. Follow-up of fifty cases.

Radioactive synovectomy using gold (Au 198) and rheniun (Re 186) was performed in 50 joints of 43 haemophilic patients for recurrent haemathroses. The joints treated were 31 knees, 30 elbows, 5 ankles and 1 shoulder on five separate occasions. Three patients required injections into two separate joints and in four patients the same joint was injected twice. In 30 joints (60 percent) no further haemarthrosis occurred over the whole follow-up period. Bleeding was diminished in 14 joints (28 percent) but increased in 6. Overall 88 percent of joints improved with this treatment. Prior to the synovectomy the joint was scanned with technetium (Tc 99m) to compare the inflammation before and after radioactive injection. This was repeated at six months following injection. A leucocyte culture for chromosomal studies was performed in twelve patients after radioactive injection and in four without treatment. All lesions found (non-specific structural changes) were of no significance and all premalignant changes noted in the first culture disappeared in further control cultures.