tourniquet control through an elongated medial parapatellar incision. The synovium and menisci were removed, and the cruciate and collateral ligaments and.
EFFECT
OF
SYNOVECTOMY
XENON
(133Xe)
ON FROM
WITH W. CARSON
P. FREEMAN,
rate
of clearance
of
radioactive
OF
JOINT
OF
RADIOACTIVE
PATIENTS
ARTHRITIS G. NUKI,
GLASGOW,
The
CLEARANCE
KNEE
RHEUMATOID
A. SHENKIN,
DICK,
THE
THE
K.
and
WI-IALEY
W. W. BUCHANAN,
SCOTLAND
xenon
(‘33Xe)
Boyle l968a ; Dick, Whaley, St Onge, Downie, been shown to reflect the degree of inflammatory
from
Boyle, Nuki, involvement
and
a joint
(St
Onge,
Dick,
Bell
Gillespie and Buchanan l970b) has of the joint at the time of study,
and has been used to measure synovial blood flow in the human knee (St Onge, Dick, Boyle, Jasani, Whaley, Pack and Buchanan l968b; Dick, St Onge, Gillespie, Downie, Nuki, Gordon, Whaley, Boyle and Buchanan l970a). We have investigated the effect of synovectomy on the synovial
blood
flow
measured
by the
rate
of clearance
CLINICAL
Two
groups
“classical” studies
and
of patients
rheumatoid performed
at one
arthritis
before
year
were
after
studied. (Ropes,
synovectomy
operation.
The
of 133Xe from
the
human
knee.
MATERIAL
The
first
group,
comprising
eight
patients
with
Bennett, Cobb, Jacox and Jessar 1956) had 133Xe of the knee, at one to three months after synovectomy, mean age of these patients was 524 years (range thirty-
three
to sixty-one years) and five were male. The second group, comprising twenty-one rheumatoid arthritis (Ropes and colleagues 1956), and sheep
three years (mean cell agglutination
erosions. one
years).
29 years) after synovectomy tests (Ziff 1957) and in all,
Sixteen were women and the mean age All the women were post menopausal.
TECHNIQUE
Synovectomy medial parapatellar collateral
ligaments
was carried incision. and
the
from the back of the joint in all cases. The joint was The
knee
was
The
degree
patients had 1Xe
popliteus
tendon
was removed closed in two
manipulated
at two
CLINICAL
of inflammatory
OF
out with pneumatic The synovium and
weeks
of the knee. radiographs was
546
under
or
“classical” between two
All these patients had positive of the knees showed articular
years
(range
twenty-six
to seventy-
OPERATION
tourniquet menisci were
were
cleared
control removed,
general
OF
through an elongated and the cruciate and
of granulation
with the knee fully flexed. layers with a suction drain
ASSESSMENT
involvement
with “definite” studies performed
The and
tissue.
Synovium
patella was left intact a plaster was applied.
anaesthesia.
THE
of the joint
KNEE
JOINT
at the time
of the study
was
estimated
before the 133Xe studies. A history of pain and of stiffness was elicited and graded. The knee was then subjected to firm pressure over the joint margin and the response graded. Finally, the degree of swelling was estimated subjectively and graded. Grading in all cases was on a 0 to 3 basis, where 0=”absent”, 1 ==“slight”, 2=”moderate” and 3= “severe”. All clinical examinations were performed by one observer (C. D.). Each patient was asked whether the result of the operation was “excellent”, “satisfactory”, “poor” or “bad”. 70
THE
JOURNAL
OF
BONE
AND
JOINT
SURGERY
\v.
C. l)ICK.
A. SHENKIN,
P. FREEMAN,
G. NUKI,
‘33Xe
With were
full
aseptic
injected
to avoid
into
the
precautions the
knee
presence
of air
10 pCi
by a lateral
bubbles
of
in the
from five to thirty-five minutes order of 5 per cent of the count
the
graph
semi-logarithmic
by a single between
paper
exponential
syringe
18 and
concentration
following rate, was
as a function
function.
of time.
and
The
and
The measured
?=the
partition
coefficient
clearance
constant.
and
synovectomy
gave
the
semilog
from
the
plots
of 133Xe homogenised
a mean
fl
where
(K)=9$3
100 millilitres per blood flow
coefficient excised
is the
of the
value
results
taken
soluble
attempt
was
in air,
made
and
to aspirate
the knee extended and immobilised with crystal (375 x25 centimetres) connected inches from the medial aspect of the joint point. Counts per minute were recorded and the background, The results were then
In all cases studies
the
the
results
room
which plotted
could
was on
be described
temperature
remained to reduce
the
FLOW
100 millilitres of133Xe
for
per
synovial
tissue
of the
tissue
with
colleagues
to
and the
The
values
could
to blood
blood has been tissue obtained at
clearance
of 133Xe from T4
Lindbjerg employs
respect
synovial l970a).
disappearance
monoexponential,
with
respect
of rheumatoid and
by Lassen, The method
minute
for synovial
samples
time were
is highly
to apply to 133Xe flow in this way.
of 1 (Dick
halving
an
saline
were
an extraction fan was in operation gas exhaled by the patient.
modified blood
K=the
partition in several
cavity
of sterile
Precautions
in terms ofblood flow (millilitre per 100 millilitres per Dick and colleagues 1970a) is based on the work of
Kety (1949) which was subsequently Munck (1964) who measured muscle relationship: S.B.F.=K.X. S.B.F.=synovial
133Xe
BLOOD
method ofexpressing the results (St Onge and colleagues l968b,
where
since
these
SYNOVIAL
minute)
approach.
the injection subtracted.
Throughout
21 degrees Centigrade in the air of the radioactive
71
W. W. BUCHANAN
of 133Xe in 1 millilitre
infrapatellar
before the introduction of the isotope into the joint the jOiIlt completely. After the injection the patient lay supine with sandbags. A collimated sodium iodide scintillation to an ECHO scaler (type H530G) was positioned six using the upper border of the patella as a reference manually
AND
STUDIES
approximately
joint
K. WHALEY
constant
the joint.
be readily
Since obtained
graph. RESULTS
Group
1-Figure
synovial arthritis before, one to three the values one to three months
rheumatoid
be seen mm.) S.E.M.
that are
1 shows
significantly
0’25
ml./lOO 034
the
lower
(p
