Complications following radiosynoviorthesis in osteoarthritis and arthroplasty: osteonecrosis and intra-articular infection

Abstract

Objectives: In the literature, radiosynoviorthesis (RSO) has been associated only with a small number of complications. There is a trend towards increasing the use of RSO in diverse indications. After repeatedly observing several complications following RSO, a retrospective evaluation was undertaken to estimate the safety of this method.

Methods: Between 1995-2007, we evaluated the outcome of RSO in 93 patients (143 knees, seven hips, seven shoulders, three elbows, one ankle) who presented to our orthopaedic department after joint treatment with yttrium-90((90)Y) or Rhenium-186((186)Re) colloid in an external nuclear medicine institution.

Results: Seventy-nine of the 93 RSO treated patients had advanced primary or secondary osteoarthritis (OA), 12 had an arthroplasty. In seven cases, rheumatoid arthritis (RA) was responsible for secondary OA. The benefit in pain relief, as self-reported by the patients was low. Twenty-two of the 93 patients showed complications following RSO. We observed osteonecrosis (ON) in 19 and infection in five patients, including two with both complications. These findings were proven clinically, radiologically, intraoperatively, microbiologically and histologically. Statistical analysis revealed a strong correlation of arthroplasty to infection (rho=0.798, alpha=0.01), and a strong correlation of chronic obstructive pulmonary disease (COPD) and RA to ON following RSO (rho=0.674, alpha=0.01). Diabetes mellitus (DM) was also significantly correlated to ON after RSO treatment (rho=0.488,alpha=0.05).

Conclusions: Our data suggest that RSO may not be as safe as it has previously been reported, especially in advanced OA and arthroplasty.