[Radiotherapy for painful degenerative joint disorders. Indications, technique and clinical results]

Abstract

Background: Radiotherapy of degenerative joint disorders is almost replaced by other treatments, although its efficacy is well known. Compared to orthopedic studies radiotherapy data are lacking long-term analysis and objective reproducible evaluation criteria.

Patients and methods: From 1984 to 1994, 85 patients with painful osteoarthritis were treated. The mean follow-up was 4 (1 to 10) years. Seventy-three patients (103 joints) were available for long-term analysis: 17 patients (27 joints) with omarthrosis, 19 (20 joints) with rhizarthrosis, 31 (49 joints) with osteoarthritis of the knee and 6 patients (7 joints) with osteoarthritis of the hip. All patients were intensively pretreated over long time. Mean symptom duration prior to radiotherapy was 4 (1 to 10) years. Orthovoltage or linac photons were applied using some technical modifications depending upon the joint. Two radiotherapy series (6 x 1 Gy, total dose: 12 Gy, 3 weekly fractions) were prescribed. The interval between the 2 series was 6 weeks. The subjective pain profile was assessed prior to and 6 months after radiotherapy and at last follow-up. The classification and assessment of pain symptoms were performed using the Pannewitz score and 5 pain categories and 3 pain grades. Joint edema and effusion were objective response parameters together with special orthopedic scores for each joint.

Results: Forty-six (63%) patients (64 joints) achieved a reduction of pain symptoms; 16 of those had a "major pain relief" and 14 "complete pain relief". Large joints--knee and hip--responded better (64% each) than the rhizarthrosis (53%). All pain categories and grades and their combined pain score were significantly reduced. The pain reduction was mostly pronounced for the symptom "pain at rest". The orthopedic score correlated well with the subjective response of the patients. The thumb score improved in 11 (57%) joints, the shoulder score of Constant and Murley [5] in 16 (59%), the Japonese knee score of Sasaki et al. [37] in 33 (67%), the hip score of Harris [12] in 5 (71%) joints. Only 9 of 19 patients which were treated to avoid surgery, had to be operated, and 3 of those received a total arthroplasty of the hip or knee. In multivariate analysis for the endpoint "complete" or "major pain relief" only the criterion "symptom duration > or = 2 years prior to radiotherapy" was an independent negative prognostic parameter (p < 0.05).

Conclusions: Radiotherapy for refractory osteoarthritis is a very effective treatment option for pain reduction compared to other conventional methods. Due to the very low risk of side effects and the low costs, radiotherapy provides an excellent alternative to conventional conservative treatment methods and in case of inoperability.