Between 1970 and 1994, 116 chemical and 90 radioactive
synovectomies were performed in 107 patients with severe
haemophilia and two with
type 3 von Willebrand's disease. The products used were
osmic acid (OA) in 100 cases, 90-Yttrium in 35 cases, 186-Rhenium in 48, 169-Erbium in two, hexacetonide
triamcinolone in 16 and radioactive
gold in five cases. The use of radioactive
colloids is not allowed in France in patients under 15 years of age. Twenty-nine patients had more than one
synovectomy per joint. All patients were evaluated for 6 months post-
synovectomy, using both a clinical and a radiological score. Six months after
synovectomy, a good or excellent result was obtained for 81% of the joints treated with
isotopes, compared with 44% of those treated with OA, P<0.001. This superiority of
isotopes over
osmic acid was still observed after 6 months for the 89 joints that were re-evaluated, with follow-up ranging from 1 to 9 years. It was possible to calculate a radiological score in 84 cases. With OA the best results were from the joints with the lowest scores pre-
synovectomy (<7). No correlation could be established between the clinical and the radiological scores, due to the small size of the sample. In summary: (1) chemical and radioactive
synovectomy are simple and safe procedures for haemophilic
arthropathy, (2) in our series, after 6 months the efficacy of isotopic
synovectomy was greater than that of chemical
synovectomy, and this benefit seems to persist after 6 months, and up to 9 years in the group of patients with longer-term follow-up.