Research Article
Volume 11 Issue 2 - 2020
Treatment of Chronic Knee Synovitis with Radiosynoviorthesis After Failure of Surgical Interventions
Szentesi M1*, Papp I1, Farbaky ZS2, Nagy Z3, Berkes I4 and Nagy GY1
1Department of Rheumatology, Polyclinic of the Hospitaller Brothers of St. John in God Budapest, Hungary
2Department of Radiology, Polyclinic of the Hospitaller Brothers of St. John in God Budapest, Hungary
3Department of Nuclear Medicine, Polyclinic of the Hospitaller Brothers of St. John in God Budapest, Hungary
4Semmelweis University, Traumatology Institute, Sport-Surgery and Sports-Medicine Department, Hungary
*Corresponding Author: Szentesi M, Department of Rheumatology, Polyclinic of the Hospitaller Brothers of St. John in God Budapest, Hungary.
Received: December 16, 2019; Published: January 11, 2020




Abstract

Objective: Authors make a long-term evaluation of patients treated with radiosynoviorthesis (RSO), including patients having formerly unsuccessful surgical interventions of the knee. Aim was also, to evaluate the effectiveness of RSO after these ineffective surgical interventions.

Methods: From the patient pool of N = 205 patients: 115 had rheumatoid arthritis (RA), 17 had spondylarthritis ankylopoetica (SPA), 13 other seronegative spondylarthritis (SNSA, as arthritis psoriatica, M. Crohn, Colitis ulcerosa), 47 inflammed osteoarthritis (OA), 1 hydrops articulorum intermittens (HAI), and 1 pigmented villonodular synovitis (PVNS); respective 11 patients were with chronic synovitis following trauma. From the total of 205 patients treated there were 6 patients in radiological stage I, 107 patients in stage II, and 92 patients in stage III.

From the n = 39 patients who had surgical interventions: 14 had RA, 5 had SPA, 4 SNSA, 1 PVNS, 6 had previous trauma, and 9 had OA. Regarding the radiological grading: 15 patients had grade II and 24 patients had grade III, based on the Steinbrocker respective Kellgren and Lawrence classification. Before the radiosynoviorthesis was performed in the n = 39 patients: 22 patients had surgical synovectomy, 4 patients had chemical synovectomy, 9 patients’ meniscectomy, 3 patients had operation for popliteal (Baker’s) cyst, and 1 had anterior cruciate ligament (ACL)-reconstruction. 

Results: From the total 205 patients treated with 90-Yttrium RSO, in the first 4-years there was a 70% “excellent/good” success rate. The excellent/good classified patients rate decreased to 65% in the 5th year. The decrease was not significant. Those 39 patients who underwent formerly surgical interventions, the success rate in the 5th year was between 68-70%. There was no significant difference between the two groups: so, even that several patients were treated earlier with surgical interventions, the later (> 6 weeks) administered RSO was successful on long term (2-5 year).

Conclusion: For both groups (surgical intervention and not operated) the administration of the RSO was considered 65-70% effective within the first 5 years. The surgical intervention group reacted as well, there was no difference, so RSO is indicated to be applied in this group also. We analysed the long-term determinants of the effectiveness of the RSO, and we had the conclusion that the primary diagnosis (i.e. rheumatoid or other arthritides), respective the preliminary radiological staging was influencing the final results. There were no major correlations regarding the age, gender, duration of the background disease and the persistence of the synovitis, respective the intra-articular number of punctions and surgical interventions in the joints.

Keywords: Radiosynoviorthesis; Yttrium-90; Chronic Synovitis; Surgical Synovectomy

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Citation: Szentesi M., et al. “Treatment of Chronic Knee Synovitis with Radiosynoviorthesis After Failure of Surgical Interventions”. EC Orthopaedics 11.2 (2020): 01-14.

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