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Clinical Orthopaedics and Related Research®

, Volume 467, Issue 11, pp 2852–2858 | Cite as

Outcomes after Excision of Pigmented Villonodular Synovitis of the Knee

  • Vivek Sharma
  • Edward Y. ChengEmail author
Symposium: Selected Papers Presented at the 2008 Meeting of the Musculoskeletal Tumor Society

Abstract

Pigmented villonodular synovitis (PVNS) has a high but variable recurrence rate. Prior studies do not compare recurrence-free survival (RFS) for various surgical approaches or salvage surgery for relapse. We therefore determined: (1) RFS after excision; (2) RFS after salvage surgery for relapse; (3) factors associated with relapse. We retrospectively reviewed the medical records of 49 patients with previously untreated PVNS of the knee (12 localized, 37 diffuse) who were treated with synovectomy from 1991 to 2008; there were 22 males and 27 females, with mean age of 35.2 years (range, 10–73). Minimum followup was 1 year (mean, 6.2 years; range, 1–13). Twenty-one patients had a relapse. The RFS for index surgery was 75% and 53%; and for salvage surgery was 71% and 52% at 2 and 5 years respectively. The RFS was 95% for open versus 62% for arthroscopic synovectomy at 2 years, 71% and 41% at 5 years. The RFS was 91% for localized and 70% for diffuse PVNS at 2 years, 73% and 48% at 5 years. Diffuse disease (RR = 4.49) and arthroscopic synovectomy (RR = 3.30) were associated with relapse. Recurrence was frequent after synovectomy. Reexcision can salvage relapses as successfully as excision for primary disease; however, morbidity was associated with additional surgeries.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Keywords

Reflex Sympathetic Dystrophy Diffuse Disease Pigment Villonodular Synovitis Arthroscopic Synovectomy Open Synovectomies 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Paul Lender from the Department of Orthopaedic Surgery, University of Minnesota for assistance with the statistical analysis.

References

  1. 1.
    Beguin J, Locker B, Vielpeau C, Souquieres G. Pigmented villonodular synovitis of the knee: Results from 13 cases. Arthroscopy. 1989;5:62–64.PubMedGoogle Scholar
  2. 2.
    Bertoni F, Unni KK, Beabout JW, Sim FH. Malignant giant cell tumor of the tendon sheaths and joints (malignant pigmented villonodular synovitis). Am J Surg Pathol. 1997;21:153–163.PubMedCrossRefGoogle Scholar
  3. 3.
    Blanco CE, Leon HO, Guthrie TB. Combined partial arthroscopic synovectomy and radiation therapy for diffuse pigmented villonodular synovitis of the knee. Arthroscopy. 2001;17:527–531.PubMedGoogle Scholar
  4. 4.
    Byers PD, Cotton RE, Deacon OW, Lowy M, Newman PH, Sissons HA, Thomson AD. The diagnosis and treatment of pigmented villonodular synovitis. J Bone Joint Surg Br. 1968;50:290–305.PubMedGoogle Scholar
  5. 5.
    Chiari C, Pirich C, Brannath W, Kotz R, Trieb K. What affects the recurrence and clinical outcome of pigmented villonodular synovitis? Clin Orthop Relat Res. 2006;450:172–178.PubMedCrossRefGoogle Scholar
  6. 6.
    Chin KR, Barr SJ, Winalski C, Zurakowski D, Brick GW. Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Joint Surg Am. 2002;84:2192–2202.PubMedGoogle Scholar
  7. 7.
    Chin KR, Brick GW. Extraarticular pigmented villonodular synovitis: A cause for failed knee arthroscopy. Clin Orthop Relat Res. 2002;404:330–338.PubMedCrossRefGoogle Scholar
  8. 8.
    Cox D. The analysis of exponentially distributed life-times with two types of failures. J R Stat Soc. 1959;Series B21:411–421.Google Scholar
  9. 9.
    De Ponti A, Sansone V, Malchere M. Result of arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy. 2003;19:602–607.PubMedGoogle Scholar
  10. 10.
    Flandry FC, Hughston JC. Pigmented villonodular synovitis. J Bone Joint Surg Am. 1987;69:942–949.PubMedGoogle Scholar
  11. 11.
    Flandry FC, Hughston JC, Jacobson KE, Barrack RL, McCann SB, Kurtz DM. Surgical treatment of diffuse pigmented villonodular synovitis of the knee. Clin Orthop Relat Res. 1994;300:183–192.PubMedGoogle Scholar
  12. 12.
    Granowitz SP, D’Antonio J, Mankin HL. The pathogenesis and long-term end results of pigmented villonodular synovitis. Clin Orthop Relat Res. 1976;114:335–351.PubMedGoogle Scholar
  13. 13.
    Jaffe HL, Lichtenstein L, Sutro CJ. Pigmented villonodular synovitis, bursitis and tenosynovitis: A discussion of the synovial and bursal equivalents of the tenosynovial lesion commonly denoted as xanthoma, xanthogranuloma, giant cell tumor or myeloplaxoma of tendon sheath with some consideration of this tendon sheath lesion itself. Arch Pathol. 1941;31:731–765.Google Scholar
  14. 14.
    Kaplan EL, and Meier P. Nonparametric estimation for incomplete observations. J Am Stat Assoc. 1958;53:457–481.CrossRefGoogle Scholar
  15. 15.
    Kim SJ, Shin SJ, Choi NH, Choo ET. Arthroscopic treatment for localized pigmented villonodular synovitis of the knee. Clin Orthop Relat Res. 2000;379:224–230.PubMedCrossRefGoogle Scholar
  16. 16.
    Moskovich R, Parisien JS. Localized pigmented villonodular synovitis of the knee: Arthroscopic treatment. Clin Orthop Relat Res. 1991;271:218–224.PubMedGoogle Scholar
  17. 17.
    Ogilvie-Harris DJ, McLean J, Zarnett ME. Pigmented villonodular synovitis of the knee. The results of total arthroscopic synovectomy, partial arthroscopic synovectomy, and arthroscopic local excision. J Bone Joint Surg Am. 1992;74:119–123.PubMedGoogle Scholar
  18. 18.
    O’Sullivan B, Cummings B, Catton C, Bell R, Davis A, Fornasier V, Goldberg R. Outcome following radiation treatment for high-risk pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys. 1995;32:777–786.PubMedGoogle Scholar
  19. 19.
    Schwartz HS, Unni KK, Pritchard DJ. Pigmented villonodular synovitis. A retrospective review of affected large joints. Clin Orthop Relat Res. 1989;247:243–255.PubMedGoogle Scholar
  20. 20.
    Shabat S, Kollender Y, Merimsky O, Isakov J, Flusser G, Nyska M, Meller I. The use of surgery and yttrium-90 in the management of extensive and diffuse pigmented villonodular synovitis of large joints. Rheumatology (Oxford) 2002;41:1113–1118.CrossRefGoogle Scholar
  21. 21.
    Tyler WK, Vidal AF, Williams RJ, Healey JH (2006) Pigmented villonodular synovitis. J Am Acad Orthop Surg 14:376–385.PubMedGoogle Scholar
  22. 22.
    Ward WG Sr, Boles CA, Ball J, Cline MT. Diffuse pigmented villonodular synovitis: preliminary results with intralesional resection an p32 synoviorthesis. Clin Orthop Relat Res. 2007;454:186–191.PubMedCrossRefGoogle Scholar
  23. 23.
    Wiss DA. Recurrent villonodular synovitis of the knee: Successful treatment with Yttrium-90. Clin Orthop Relat Res. 1982;169:139–144.PubMedGoogle Scholar
  24. 24.
    Wu CC, Pritsch T, Bickels J, Wiemberg T, Malawar MM. Two incision synovectomy an radiation treatment for diffuse pigmented villonodular synovitis of the knee with extra-articular component. Knee. 2007;14:99–106.PubMedCrossRefGoogle Scholar
  25. 25.
    Zvijac JE, Lau AC, Hechtman KS, Uribe JW, Tjin-A-Tsoi EW. Arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy. 1999;15:613–617.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryUniversity of MinnesotaMinneapolisUSA

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