The Relationship Between Y-90 and Bleeding Frequency in Haemophilic Synovitis of the Knee: A Systematic Review

Haemophilic synovitis secondary to joint bleeding predisposes to recurrent episodes of haemarthrosis and the development of haemophilic arthropathy (HA). The knee is the most common large joint involved. Knee HA is one of the major causes of morbidity in haemophilia patients. Primary prophylaxis of haemarthrosis with clotting factor concentrates or novel agents can prevent haemarthrosis but is often infeasible in resource constrained settings globally. Once haemarthrosis is established, treatment options are limited and may require joint replacement. Injection of radioactive isotopes into joints (radiosynovectomy; RSV) has been used to try to prevent progression of HA. In this systematic review, we assess the association between Yttrium-90 RSV and bleeding frequency in haemophilic knee synovitis.

A systematic literature review was performed to identify randomised control trials (RCTs) and cohort studies assessing the change in bleeding frequency or resolution of target joint status in persons with haemophilia treated with intra-articular Yttrium-90 injection. Risk of bias was assessed with the Newcastle-Ottawa Score and the MINORS criteria.

No RCTs were identified. Six observational studies were included, none of which were high quality. Two studies reported statistically significant bleeding reduction in the short term.

The conclusions of this systematic review are constrained by the absence of randomised studies and the risk of bias of the included observational studies. From an evidence-based medicine perspective, there is insufficient evidence to support Y-90 RSV reducing bleeding in haemophilic knees. This review identifies a need for at least high-quality observational studies to justify this intervention.