Synovitis: Hemophilia and Pigmented Villonodular Synovitis

Abstract

In this chapter, the treatment of chronic hemophilic synovitis and pigmented villonodular synovitis (PVNS) is analyzed. Radiosynovectomy (RS) is the advised first option for the management of chronic hemophilic synovitis; the procedure is highly cost effective in comparison to arthroscopic synovectomy (AS). The second-line recommended therapy is AS. Regarding pigmented villonodular synovitis (PVNS), there are two forms of the disease: diffuse PVNS (DPVNS) and localized PVNS (LPVNS). For both, the surgical options are AS and open synovectomy (OS). In general, the rate of recurrence of DPVNS ranges from 8 to 70 %, and the rate of recurrence of LPVNS ranges between 0 and 8 %. For LPVNS, the two most-reported options are OS and AS. Between these two techniques, no difference has been found in terms of local recurrence (8.7 % for OS and 6.9 % for AS) and postoperative complications (<1 % for OS and 0 % for AS). For DPVNS, the two most-reported options are OS and AS. Between these two courses of treatment, no difference has been encountered in terms of local recurrence (22.6 % for OS and 16.1 % for AS). A lower rate of reported complications between OS (19.3 %) and AS (0 %) has also been found. Internal irradiation or external beam radiation as an adjuvant treatment to surgical synovectomy seems to diminish the rate of local recurrence in DPVNS.