The long-term effects of radioactive phosphorous synoviorthesis on hemophilic arthropathy Amir Sobhani Eraghi a , Mohammad Hasan Kaseb b , Ramin Espandar b , Shirin Mardookhpour c, ⁎ a Department of Orthopedics, Rasoul Akram Hospital, Iran University of Medical sciences, Tehran, Iran b Department of Orthopedics, Imam Khomeini Hospital, Tehran University of Medical sciences, Tehran, Iran c Radiologist, Imam Khomeini Hospital, Tehran University of Medical sciences, Tehran, Iran abstract article info Article history: Submitted 20 January 2015 Accepted 29 March 2015 Available online 30 March 2015 Communicated by Narla Mohandas Keywords: Hemophilia Synovectomy Radioactive synoviorthesis Background: Radioactive synoviorthesis was carried out by an injection of radioactive materials into the joint that has been known as a successful alternative treatment to invasive surgical synovectomy. This study was designed to evaluate short-term and long-term results and complications of radioactive synovectomy of hemophilic ar- thropathy using radioactive phosphorus. Materials and methods: This study was conducted on 40 patients with hemophilic arthropathy. After obtaining clotting factors, the intra-articular injections of radioactive phosphorus were done. Thirteen patients were eval- uated during 36 months (short-term follow-up) and 27 patients were followed up for more than 36 months (long-term follow-up). Patients were evaluated for hemarthrosis, factor consumption per month, joint range of motion (ROM) and clinical and radiological involvement grade. Results: The patients mean age was 22.9 ± 6.6 and there were 38 men and 2 women. Consumption of clotting factors was significantly reduced in the short-term follow-up of patients (p b 0.05), but there was no significant difference in the long-term follow-up (p N 0.05). ROM decreased significantly in the long-term follow-up (p b 0.05). Radiologic evaluation showed significantly increased involvement in their joints (p b 0.05). Conclusion: Using radioactive synoviorthesis led in decreased consumption of clotting factors and the hemarthrosis incidence in short term but it did not have significant impact on clinical situation (ROM) and radio- logical findings of hemophilic patients in long-term follow-up. © 2015 Elsevier Inc. All rights reserved. 1. Introduction Intra-articular hemorrhage is the most common complication in he- mophilic patients (82%) and synovium is the primary source of bleeding [1,2]. If chronic hemophilic synovitis is left untreated, the vicious cycle of hemorrhage–synovitis–hemorrhage causes destruction of articular cartilage and bones and thus leads to hemophilic arthropathy [3–7]. Given that the main cause of morbidity in patients with hemophilia is arthropathy, the main goal of treatment in these patients is prevention of hemarthrosis. There are two synovectomy methods (medical or surgical) that are cheaper and more effective than factor replacement therapy [2,4,5]. Medical synovectomy (synoviorthesis) includes intra- articular injection of a substance to stabilizing (orthesis) synovium. Ra- dioactive synoviorthesis has been done using gold, yttrium 90, rhenium 186, phosphorous 32 (P32) and erbium 169. Radioactive synoviorthesis has been shown in recent studies to reduce hemarthrosis and improve joint function and quality of life. P32 is reported by numerous studies as a safe material with no carcinogenic effect for using in different age and it has been approved by FDA [2,8–12]. Regarding the benefits of synoviorthesis than surgical synovectomy (more effective, cheaper and lower risk), this procedure could be an appropriate alternative to prevent hemarthrosis in hemophilic patients. This study was designed to evaluate short-term and long-term results and complications of radioactive synoviorthesis of hemophilic arthropathy using radioactive phosphorus. 2. Materials and methods This study was performed on 40 hemophilic patients referred to Imam Khomeini Hospital, a referral hospital, Tehran, Iran from 2005 to 2012. There were 40 patients with the mean age of 22.9 ± 6.6 years (10 to 37 years). The subjects consisted of 38 men (95%) and 2 women (5%). Patients had undergone X ray and magnetic resonance imaging (MRI) of the joints. Patients with synovial hypertrophy who met the in- clusion criteria were enrolled to the study. All patients or their parents (for children) gave informed written consent. In addition to baseline characteristics (age and sex) patients were asked about their inherent bleeding disorder, presence or absence of inhibitors, hemarthrosis fre- quency and consumption of clotting factor. Patients were also evaluated for ROM, synovial hypertrophy, joint involvement based on clinical assessment (Fernandez-Palazzi classification) and radiographic findings (Arnold-Hilgartner classification). The inclusion criteria were having Blood Cells, Molecules and Diseases 55 (2015) 68–70 ⁎ Corresponding author. Phone: 00982161192328, 00989125274695. E-mail address: shirinmardookhpour@yahoo.com (S. Mardookhpour). http://dx.doi.org/10.1016/j.bcmd.2015.03.011 1079-9796/© 2015 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Blood Cells, Molecules and Diseases journal homepage: www.elsevier.com/locate/bcmd