Hemophilic synovitis of the knee: radiosynovectomy or arthroscopic synovectomy?

Radiosynovectomy (RS) is the best choice for patients with persistent synovitis of the knee unresponsive to a 3-month trial of prophylactic factor replacement. If three consecutive RSs with 6-month intervals have been ineffective, an arthroscopic synovectomy should be indicated in patients older than 12 years of age (adolescents). In children younger than 12 years of age, adequate prophylaxis should be maintained, with arthroscopic synovectomy always being the last resort. In the knee, we recommend Yttrium-90 at a dose of 90 mBq in children and 185 mBq in adults. Although the dose of radiation of RS is minimal and neither articular nor systemic neoplastic changes related to RS have been reported so far, all patients must be given the opportunity to consider the risk/benefit ratios. Our current recommendation is to use knee RS in hemophilia patients older than 12 years of age (adolescents).