Persistent cutaneous ulcers after Yttrium-90 synovectomy, an unusual complication: two case reports and a review of the literature

Abstract

Development of persistent deep cutaneous ulceration is a rare and serious complication of radiosynovectomy, an extended procedure used in the treatment of chronic synovitis. Cutaneous radiation necrosis is a rare complication of synovectomy, probably as a result of radiocolloid para-articular injection. This rare phenomenon should be suspected when an ulcer adjacent to an articulation appears several days or even months after a radiation synovectomy. It can turn into a challenging diagnosis for rheumatologists, orthopaedists and dermatologists, especially in those cases with a late development of the skin lesions. Recognition of this potential side effect is important in order to establish a proper therapeutic strategy and avoid unnecessary treatments. Surgical excision appears to be the treatment of choice. We report two patients with knee osteoarthritis treated with intra-articular injection of Yttrium-90 who developed persistent cutaneous ulcers secondary to radiation necrosis.

Keywords: Knee osteoarthritis; Rheumatoid arthritis; Synovitis; Treatment.

Figure 1

Clinical presentation. (A) Case 1: Two‐cm deep ulcer in the outer aspect of the left knee. (B) Case 2: Solitary, oval ulcer with minimal periulcerative inflammation in the left knee.

Figure 2

Histological images. (A) Dermal fibrosis with a hyalinised collagen and prominent dilated blood vessels (H‐E × 100). (B) Scattered enlarged pleomorphic stellate fibroblasts in the upper dermis (H‐E × 200).