Retrospective Study of Intraarticular Synovectomy in Chronic Synovitis in Person with Hemophilia

Aim To evaluate the safety and efficacy of Radiosynoviorthesis in Chronic Synovitis in Persons with Hemophilia. Materials and Methods : This retrospective observational study reviewed all radiosynoviorthesis conducted in persons with Hemophilia (PWH) from June 2016 to May 2024. Yttrium-90 (68%) was used for knee and shoulder joints. Lutetium-177(32%) was used for elbow, wrist and ankle joints. The inclusion criteria were patients of any sex, ³8 years or older, with stage 2 and 3 haemophilic arthropathy and target joint. Exclusion criteria included patients <8 years, pregnant females, those with acute bleeds, local infections, and stage 4 haemophilic arthropathy. Data were collected on resolution of target joints, functional (FISH and HJHS)and radiological score (Denver) before the procedure and at 1, 3, 6 months and 12 months post-procedure to assess the efficacy of the intervention. Results A total of 115 procedures were performed in 81 PWH. The median age of patients was 22 years (range: 8-62). Of all the cases, Haemophilia A were 85.3% (n=98), Haemophilia B were 10.4% (n=12), Hemophilia A with Inhibitor were 4.3% (n=5). Among all 94.4% were severe haemophiliacs and 5.6% were moderate haemophiliacs. Of 115 procedure, 57% (n=41) were knee, 25%(n=22) were elbow 13.8% (n=16) were Ankle, 3.4%(n=2) were shoulder joints. The majority 69% of patients had a good Caviglia score, while 31% had a poor score. Out of 81 PWH, 37 PWH with 56 (48.6%) procedures followed up regularly at the defined time-points and assessment was done accordingly. Out of 56 joints 50 had resolution of target joints. Median FISH, HJHS and VAS Scoring at pre procedure, 1 month, 3 months and 6 months are (27, 25, 25 and 24), (18,16,15 and 15) and (6, 5, 5 and 5) respectively with statistically significant improvement (P <0.001). The Denver score didn't show any statistical difference post procedure. The procedure was safe, with two episodes of skin burns reported. Conclusion : People who followed regularly has a decrease in the Annual Joint Bleed Rate. Radiosynovectomy is safe and effective intervention for patients with chronic haemophilic arthropathy irrespective of the type of radionuclide used