Nuclear medicine joint treatment (Radiation synovectomy)

Diagnostic procedure

One of our doctors will take plenty of time to fully discuss your symptoms and any previously performed tests and treatments. In order to be sure that radiation synovectomy will be successful for you, we will need an image that shows the inflammation. This may be either a bone scintigraphy (see “bone scintigraphy” information for patients) or an MRT.

If the criteria for a radiation synovectomy fit your situation, the procedure will be discussed at length in a consultation. 

Below are some important details:

  • The treatment is only for inflammation (joint synovitis), not for wear and tear damage to bone or cartilage.
  • Symptoms begin to improve in 4 to 8 weeks, though they might worsen for several days directly after the procedure. Only 3 to 4 months after treatment is it possible to conclusively determine the procedure’s success. 
  • If the synovial membrane is massively enlarged, a second treatment session may be necessary after 3 or 4 months.
  • The joint must remain still for about 2 days. May weight be placed on the joint? Yes, carefully. May the joint be moved for any reason? No. 
  • If you had treatment on a leg joint, please use crutches for trips to the toilet.
  • Risks: Infection (very rare because of injection of a radioactive substance) and tissue destruction because of the injection close to the joint (extremely rare); pathological bonding of the joint cavity to adjacent tendon sheaths (very rare), thrombosis (primarily in varicose veins, in cases of a history of thrombosis, familial clotting disorders, or lack of movement)
  • Side effect (rare): a warm sensation and a throbbing sensation in the joint

A trace of a radioactive substance will be injected into the affected joint, with the help of an ultrasound scan or an X-ray for guidance. The substance accumulates in the synovial membrane, and accurately targets the inflamed tissue with its high-energy radiation (radiation range is only a few millimeters). As a result, effusion and pain in the joint decrease. This substance is easily tolerated. There has never been any report of an allergic reaction. In addition, cortisone is injected into the joint in most cases. This may cause a harmless, temporary redness in the face. For diabetic patients, it may also cause a general rise in blood sugar.

After the injection, the joint is immobilized with a tight bandage, with a splint as well if necessary. You should not bend the joint for the following 2 days in order to prevent the medicine from scattering. Peak stress on the treated joint(s) should be avoided for the week after the radiation synovectomy.

After that, images of the treated joint will be taken to document where the substance is active. This exam will be conducted on the treated joint in a lying or sitting position. The scan is made with a large camera (the “gamma camera”). This machine is not a closed tunnel. It is open to each side, and makes no noise. Therefore, patients suffering from claustrophobia tolerate the process well. Throughout the examination, one of our medical technicians will assist you and remain within hearing distance.

In a final consultation, your doctor will discuss the next steps with you.

This includes:

  • Protection of the joint for 2 days.
  • You may carefully place some weight on the affected limb, but without moving the treated joint. This will help prevent the injected substance from flowing out of the joint cavity.
  • A follow-up visit after 3 or 4 months on referral may include a check-up scan, including a skeletal scintigraphy.

Important

  • Plan one to two hours to have the procedure done, on a Thursday or a Friday.
  • Please wear loose clothing on the day of the procedure, due to the bandages.
  • You may eat as normal. Take any medicines as normal.
  • For patients taking Warfarin / Marcumar: the INR should be 50% on the day of the treatment.
  • This procedure is covered by social health insurance, the cost of the substance used is very high. If you are unable to make your appointment for any reason, we urge you to let us know as soon as possible, as the substance has a very short shelf life and is therefore ordered on time specifically for you.