Abstract
We report a case of a 27-year-old man with pigmented villonodular synovitis of the hip joint with coincident osteonecrosis of the femoral head. According to our review of the English-language literature, no detailed report of osteonecrosis of the femoral head complicated with pigmented villonodular synovitis has been published. Preoperative X-ray images showed joint narrowing and severe multiple bone erosions at the acetabulum and femoral neck. Magnetic resonance imaging revealed a low-intensity band attributable to osteonecrosis of the femoral head and massive diffuse pigmented villonodular synovitis lesions. Comparison of a three-dimensional computed tomographic image of this patient with an angiographic image of a normal individual demonstrated proximity of the pigmented villonodular synovitis-induced bone erosions to the medial and lateral femoral circumflex arteries and retinacular arteries, suggesting likely the compromise of the latter by the former. We propose that the massive pigmented villonodular synovitis may have contributed to the pathogenesis of osteonecrosis of the femoral head in this patient. We performed open synovectomy and total hip arthroplasty. No operative complications occurred, and no recurrence of the pigmented villonodular synovitis was detected for 3 years after the operation.
Highlights
Pigmented villonodular synovitis (PVNS) was named and described by Jaffe et al in 1941 [1]
We propose that the massive PVNS may have contributed to the occurrence of ONFH in this patient, creating multiple bone erosions around the femoral neck
Cotton et al reported that both hips were affected in only 2 of 58 patients [7]
Summary
Pigmented villonodular synovitis (PVNS) was named and described by Jaffe et al in 1941 [1]. Myers and Masi estimated that the overall prevalence of PVNS is 1.8 per million people [2]. They reported that the knee is the most commonly affected joint, accounting for up to 80% of cases, and that the hip is the second most commonly affected joint, accounting for 15%. We report a case of ONFH complicated with PVNS, which, to our knowledge, is the first detailed report of this presentation in the English-language literature. We propose that the massive PVNS may have contributed to the occurrence of ONFH in this patient, creating multiple bone erosions around the femoral neck
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