Synovectomy For Pigmented Villonodular Synovitis Research Articles

The Use of Radiosynovectomy Using Yttrium-90 as an Adjunct to Mechanical Synovectomy for Pigmented Villonodular Synovitis: How Effective Is This?

Introduction Pigmented villonodular synovitis (PVNS) or giant cell tumour of the tendon sheath (GCTT) is a rare disorder involving the proliferation of the synovium in any joint; however, the knee, hip, and ankle joints are most commonly targeted. The aim of this study is to follow the short-term outcomes of the treatment of patients with PVNS of the knee managed by intra-articular injection of yttrium-90 or radiosynovectomy (RS) aloneand a combination of RS and arthroscopic/open debulking synovectomy. Methods A cohort of eight knees from six patients was included in this study, including three knees treated with combined arthroscopic synovectomy and RS, and five knees treated with RS alone. Patients were asked to complete the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire before attending their three-month follow-up appointment. Their answers were collated and scores were calculated using the designated specific equation. Results Our results demonstrate that although patients in the combined arthroscopic synovectomy and RSarm possess on average higher pain scores and symptoms than those who underwent RSalone, the combined therapy had higher scores in activities of daily living (ADLs), sports and recreation (Sport-Rec), quality of life (QoL), and overall KOOS scores. Conclusion Neoadjuvant arthroscopic mechanical debridement is a safe and quick procedure with minimal side effects, with improved overall KOOS scores.

Is posterior knee arthroscopy using posterior portals necessary for orthopedic surgeons? The latest evidence on applications and techniques.

Various uses of posterior knee arthroscopy have been shown, including all-inside repair of posterior meniscal lesions, posterior cruciate ligament (PCL) reconstruction or PCL avulsion fixation, extensile posterior knee synovectomy for pigmented villonodular synovitis or synovial chondromatosis, posterior capsular release in the setting of knee flexion contractures, and loose bodies removal. Posterior arthroscopy provides direct access to the posterior meniscal borders for adequate abrasion and fibrous tissue removal. This direct view of the knee posterior structures enables the surgeon to create a stronger biomechanical repair using vertical mattress sutures. During PCL reconstruction, posterior arthroscopy gives the surgeon proper double access to the tibial insertion site, which can result in less acute curve angles and the creation of a more anatomic tibial tunnel. Moreover, it gives the best opportunity to preserve the PCL remnant. Arthroscopic PCL avulsion fixation is more time-consuming with a larger cost burden compared to open approaches, but in the case of other concomitant intra-articular injuries, it may lead to a better chance of a return to pre-injury activities. The high learning curve and overcaution of neuromuscular injury have discouraged surgeons from practicing posterior knee arthroscopy using posterior portals. Evidence for using posterior portals by experienced surgeons suggests fewer complications. The evidence suggests toward learning posterior knee arthroscopy, and this technique must be part of the education about arthroscopy. In today's professional sports world, where the quick and complete return of athletes to their professional activities is irreplaceable, the use of posterior knee arthroscopy is necessary.

The Use of Radiosynovectomy Using Yttrium-90 as an Adjunct to Mechanical Synovectomy for Pigmented Villonodular Synovitis

The Use of Radiosynovectomy Using Yttrium-90 as an Adjunct to Mechanical Synovectomy for Pigmented Villonodular Synovitis

Mid-Term Results of Arthroscopic Synovectomy for Pigmented Villonodular Synovitis of the Hip

To analyze mid-term outcomes after arthroscopic synovectomy of both diffuse and nodular hip pigmented villonodular synovitis (PVNS). This is a retrospective case series of patients that underwent hip arthroscopy for hip PVNS with a single senior surgeon between 2007 and 2016. Inclusion criteria were magnetic resonance imaging evidence, arthroscopic visualization, and/or histologic confirmation of PVNS; and a minimum of 3 years of follow-up. Concomitant pathology such as femoroacetabular impingement also was treated at the time of surgery. Primary outcome measures were recurrence of hip PVNS and the rate of revision hip surgery. Secondary outcomes were complications, visual analog scale pain score, pain relief, and patient satisfaction, and 6 patient-reported outcome measures were collected at latest follow-up. In a case series of 14 patients consisting of 6 (42.9%) male and 8 (57.1%) female patients, the mean operative age was 32.69 ± 12.73 years with a mean follow-up was 6.66 ± 1.87 years. PVNS type was determined intraoperatively: 5 (35.7%) patients had diffuse hip PVNS and 9 (64.3%) had nodular type. There was only 1 case (7.14%) of recurrence that was treated arthroscopically and no cases (0%) progressed to revision open synovectomy or arthroplasty. Mean patient-reported outcome measure scores were notable for a modified Harris Hip Score of 74.08 ± 16.84. The mean visual analog scale pain score decreased by 4.9 ± 1.7, which was significant with a P<.001, with a larger decrease in patients with localized type. This study presents a large case series of hip PVNS managed arthroscopically with mid-term follow-up of slightly over 6.5 years. The survival rate was 93%, with only 1 (7%) recurrence and 0 (0%) progression to revision open synovectomy or arthroplasty with 0 (0%) complications. We conclude that arthroscopic synovectomy is a reliable and effective treatment of hip PVNS. Case Series, Level IV.

Arthroscopic synovectomy for pigmented villonodular synovitis of the knee: recurrence rate and functional outcomes after a 4-year follow-up

Arthroscopic synovectomy for pigmented villonodular synovitis of the knee: recurrence rate and functional outcomes after a 4-year follow-up

Primary arthroscopic synovectomy for pigmented villo-nodular synovitis of the knee: Recurrence rate and functional outcomes after a mean follow-up of seven years

Pigmented villo-nodular synovitis (PVNS) is an uncommon proliferative condition of the synovial membrane that chiefly affects the knee. Arthroscopic synovectomy may carry lower morbidity rates but higher recurrence rates than open synovectomy. Here, our objective was to evaluate recurrence rates and functional outcomes after primary arthroscopic synovectomy for PVNS of the knee. Primary arthroscopic synovectomy preserves knee function while producing low recurrence and complication rates. We retrospectively included consecutive patients with histologically documented PVNS managed with primary arthroscopic synovectomy at two centres between 1998 and 2011. Twenty-three patients, 13 men and 10 women with a mean age of 41 ± 12 years, were reviewed including 16 patients with nodular and 7 with diffuse form of this disease. Patients with localized disease underwent partial synovectomy and those with diffuse disease complete synovectomy followed by chemical synovectomy of any residual lesions. The primary outcome measure was recurrence. Secondary outcome measures were the Tegner-Lysholm and Ogilvie-Harris scores. Follow-up data were obtained after a mean of 7 ± 4 years in 21 patients (14 with nodular and 7 with diffuse disease), of whom 2 had recurrences, after 2 and 5 years, respectively. At last follow-up, neither patient had any evidence of recurrence. The mean Tegner-Lysholm score was significantly improved (from 68 ± 10 to 90 ± 8, P=0.0004) and the mean Ogilvie-Harris score indicated excellent function (11 ± 1). Primary arthroscopic synovectomy ensures satisfactory control of PVNS while preserving knee function. A full recovery remains possible even in patients with diffuse disease. In the event of a recurrence, open synovectomy can be performed.

Paper 16: Arthroscopic Management of Pigmented Villonodular Synovitis in the Hip

This is the first clinical case series to report on the role of primary synovectomy for a synovial-based disorder in the hip. Arthroscopy has diagnostic and therapeutic utility, producing acceptable results with minimal morbidity. Synovial disease is a well-recognized indication for arthroscopy, and arthroscopic surgery of the hip is a well-accepted technique, yet there are few publications on arthroscopic management of synovial disease in the hip. The purpose of this study is to report the results of prospectively collected data on arthroscopic synovectomy for pigmented villonodular synovitis (PVNS) in the hip. All patients undergoing hip arthroscopy are prospectively assessed with a modified Harris hip score preop and postop at 3, 12, 24, 60 and 120 months. Fourteen patients were identified with histologically confirmed PVNS and minimum one-year follow-up. This cohort represents the substance of this report. There was 100% follow-up at an average of 32 months (range 12-60 months.) All patients improved with an average of 28 points (preop 60; postop 88) which was statistically significant (p<0.001). There were no complications. The average age was 27 years (range 14-46 years) with nine females and four males. The disease pattern was nodular in seven cases, diffuse in five and combined in two. Ten cases had other associated intraarticular pathology including labral tears (7), chondral damage (7), loose fragments (3), impingement (3) and disrupted ligamentum teres (1). Although synovial disease is mentioned as an indication for hip arthroscopy, the only published series are for loose body removal associated with synovial chondromatosis. This is the first clinical case series to report on the role of primary synovectomy for a synovial-based disorder in the hip. Arthroscopy has diagnostic and therapeutic utility, producing acceptable results with minimal morbidity.

Pigmented Villonodular Synovitis of the Elbow Treated With the Tsuge Wide Joint Exposure Technique

Pigmented villonodular synovitis (PVNS) is a benign, locally aggressive disease of the synovium; its cause remains unclear. The most frequently involved joint is the knee, followed by the hip, ankle, wrist, and shoulder. Pigmented villonodular synovitis of the elbow joint is rare. Synovectomy is currently believed to be the best treatment for PVNS. Open or arthroscopic synovectomy is usually selected. During synovectomy for PVNS, the possibility of local recurrence after surgery must be considered. The recurrence rate after synovectomy of any joint for PVNS is approximately 40%. Therefore, surgical treatment for PVNS of the elbow requires sufficient removal of the lesion. For good functional results, prevention of postoperative joint stiffness is also necessary. This article describes a case of a 29-year-old woman with PVNS of the right elbow who was treated by total synovectomy using the Tsuge technique. Tsuge reported a new surgical technique for debridement arthroplasty using a posterolateral approach to the elbow in 1987. He has also reported using this procedure during arthroplasty for posttraumatic stiff elbow and for synovectomy in rheumatoid arthritis. This approach permits easy dislocation of the elbow and provides a good view of the whole joint. Although the recurrence rate of PVNS of the elbow is high, our patient has retained good elbow function with no evidence of local recurrence at 30 months postoperatively.

Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Knee

Purpose : To evaluate the efficacy of arthroscopic synovectomy through the direct posteriorposterior approach in pigmented villonodular synovitis (PVNS) of the knee. Materials and Methods : Between January 1997 and May 2004, twenty-one patients underwent an arthroscopic synovectomy for PVNS of knee. The mean follow-up period was 35 months. The arthroscopic and MRI findings revealed the localized form of PVNS in six patients and the diffuse form in fifteen patients. All patients underwent an arthroscopic examination and synovectomy through the direct posterior-posterior approach. The clinical results were evaluated by the range of motion, Lysholm knee score, and the knee pain score using the visual analogue scale (minimum 0-maximum 10). Results : Among the fifteen cases with the diffuse form, three cases (14%) recurred and had secondary arthroscopic total synovectomy. One cases recurred again. Therefore, radiation therapy was performed. The Lysholm knee score improved from 62.5 to 87.3, and the VAS score improved from 5.9 to 1.8. Three patients had a mild limitation in knee motion. However, the others had full range of motion of the knee at the last follow-up. Conclusion : Arthroscopic synovectomy through the direct posterior-posterior approach could be a useful method for the treatment of PVNS of the knee, and can be used as an effective therapeutic tool particularly in posteromedial or posterolateral lesions.

Total Arthroscopic Synovectomy for Pigmented Villonodular Synovitis of the Knee

Total Arthroscopic Synovectomy for Pigmented Villonodular Synovitis of the Knee