Radiocolloids in the management of hemophilic arthropathy in children and adolescents

Radiocolloids have been used in the treatment of hemophilic arthropathy. Fifty-eight joints of 35 patients were injected with 2-5 mCi of yttrium-90 silicate under local anesthesia. A preinjection arthrogram was performed to ensure correct placement of the needle. Plaster of paris cast immobilization of the joint was used for three days. After a mean follow-up period of seven years (range, two to 12 years), 47 joints were pain free, and 13 joints had not experienced another hemorrhagic episode. The mean hemorrhagic frequency had decreased from four per month to two per year. The radiation risk was far outweighed by the benefits of the procedure. Forty-seven of the 58 joints were rated as improved by the patients. The roentgenographic appearance of the joints had changed little. Only five complications occurred: three needle-track necroses because of extravasation of the radiocolloid, two severely painful joints immediately after injection, and one massive hemorrhagic episode. This form of treatment is suggested for hemophiliacs who have failed to respond to intensive physical and hematologic therapy, and for those patients who have inhibitors.