The use of 185 MBq and 740 MBq of 153-samarium hydroxyapatite for knee synovectomy in haemophilia

The penetration of beta energy of 153-samarium (153Sm) (0.8 MeV) is not only appropriate for synovectomy of median articulations but is possible to improve the radiobiological effect using increased activities. The aim of this study was to assess the effectiveness of 185 MBq and 740 MBq of 153-samarium hydroxyapatite (153Sm-HA) in knees of haemophilic patients. Thirty-one patients – 36 knees, 30 males, were divided into two groups without coinjection of corticosteroid: A – 14 patients (17 knees) treated with intra-articular dose of 185 MBq of 153Sm-HA, average age 23 years; B – 17 patients (19 knees) with 740 MBq of 153Sm-HA, average age 21.3 years. The evaluation before and after 1 year of synovectomy used the following criteria: reduction in the number of haemarthroses and use of the coagulation factor and improvement in articular motility. Adverse-effects occurrence was considered too. Early and late scintigraphic studies were performed after synoviorthesis and no joint immobilization was recommended. The reduction in haemarthrosis and use of coagulation factor were: group 1 – 31.3% and 25%; group 2 – 81.5% and 79% with P < 0.001 respectively; no significant improvement in knees motility was noted for both groups. Four cases of mild reactional synovitis were observed in each group. The scintigraphic control showed homogenous distribution of the radiopharmaceuticals with no articular escape; the material was considered safe by its permanence in the articulation. We have significant improvement in the synovectomy of haemophilic knees with 740 MBq of 153Sm-HA; the less penetration of its beta radiation was compensated by the increased biological effect with the higher used activity.