Synoviorthesis or Radiosynovectomy is the medical removal of the swollen lining of the joint. A radiosynovectomy is the injection of a small amount of radioactive substance into the joint. This procedure is similar to joint aspiration, but a substance is injected rather than fluid being drawn out.
The chemical substance destroys the swollen synovial tissue, which reduces pain and swelling, and decreases the frequency of acute bleeds. The radionuclides are injected in colloidal form so that they remain in the synovium and are not transported by lymphatic vessels causing radiation exposure to other organs. Complete reduction of knee joint swelling has been seen in above 40% and pain relief in 88% of patients. Wrist, elbow, shoulder, ankle and hip joints showed significant improvement in 50-60% and restoration of normal function and long term pain relief has been achieved in about 70% of small finger joints. In hemophilic arthropathies complete cessation of bleeding in about 60% and improved mobility in 75% of patients has been reported.
A medical synovectomy is usually done as an outpatient procedure. It is much less invasive than a surgical synovectomy, and results in less loss of range of motion. There is less need for rehabilitation and after about 24 hours of moderate rest you may be able to gradually return to regular physical activity. It generally does not require hospitalization and requires less clotting factor therapy, therefore, it is less costly.
RADIONUCLIDES USED IN RADIOSYNOVECTOMY:
The lesser range (weaker) beta rays are used in smaller joints like Erbium-169 for finger joints. Similarly the medium range beta rays of Rhenium-186, Phosphorus-32, etc. are used for larger joints (wrist, elbow, shoulder, ankle and hip joints) while the high-energy beta rays of Yttrium-90 with tissue penetration of 3 to 11 mm are used for knee joints. In recent years several other radionuclides like Holmium-166, Rhenium-188, Samarium-153, etc. have successfully been introduced [10-18].
It is difficult to exactly determine the required dosage. The absorbed dose is not only dependent on the type of the radionuclides and the amount of activity (MBq
/ mCi) used but also on various other factors like the size of joint cavity, synovial thickness, distribution of the colloids in the joint fluid (water, gelatinous or
Hemorrhagic) and the inflammatory activity of the joints. A typical dose of 185 MBq (5mCi) of Yttrium (Yt-90) is used for knee joints. Approximately 100 Gy per 100 gm synovial tissue should be absorbed, to have optimal effect.
If done properly, no side effects have been observed. Infection of the joint is very rare (one in 35,000) in comparison to intra-articular corticosteroid injections. This is because of the intense beta radiation emitted by the high concentration of radioactive material in the joint killing all the bacteria. Temporary radiation or crystal synovitis, thrombosis due to immobilisation and lymphoedema may occur.
Here’s what Dr. Manoranjan Chouhan has to say about this treatment in his own words.
“I do Radiation synovectomy the treatment to relieve the joint pain in patients of Arthritis and this is most effective therapy for cases of joint pain. I am trained in Germany for same.”
MBBS,DRM,DNB (Nuclear Medicine)
Fellow Molecular imaging TUM, Germany
Consultant and Head, Nuclear Medicine Dept.
Ruby Hall Clinic, Pune Maharhashtra India
Some of his success stories:
Dr Manorajan Chowhan has sent you a message.
Subject: Dear Abdulrehmanji
I convey my sincere thanks for your blog.I think this is nice as it gives detail information in nutshell about this treatment.You will be happy to know that today a patient flew from USA for the treatment of his arthritis.I treated the same today.
This patient also had undergone surgical synovectomy by a orthopedic surgeon but there was persistent swelling and pain so patient came to me for this treatment.
I am thankful to colleague like you who does everything to popularize this treatment.
We can surely reach maximum patients through your sincere help.
I thank you and God bless you.
with warm regard from Dr Chowhan