Skip to main content
SpringerLink
Log in

Pigmented villo-nodular synovitis and giant-cell tumor of tendon sheaths: a binational retrospective study

Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Cite this article

Abstract

Aim

Pigmented villonodular synovitis is rare. Thus, we initiated a retrospective multi-center study regarding symptoms, location, type of disease, type of surgery, number of recurrences, use of adjuvant therapies and functional outcome.

Results

Ten centers contributed. Data from 173 patients were sampled. The disease was seen predominantly in joints, less frequently in tendon sheaths and bursae. Patients with articular lesions suffered mainly from the diffuse type. In tendon sheaths, the relation “diffuse versus nodular” was nearly 50 % each, in bursae most often the nodular type was found. Anatomically, mostly the knee was affected. Institutions with more than 20 patients had a lower rate of recurrence than those with less than 20 cases. Regarding the knee, there were less recurrences in joints treated with open synovectomy than in those treated arthroscopically.

Conclusions

Since the rate of recurrence has been rather high, the use of adjuvant treatments (radiosynoviorthesis or radiotherapy) is recommended. In our study, the rate of their application was quite low. Patients who received an adjuvant therapy after primary surgery did not show any recurrence. In 14 % of patients in whom an adjuvant therapy had been used, after at least one recurrence, further recurrences were observed. Functional results were excellent in 84 % of patients.

Level of evidence

Prognostic multi-center study, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Goldmann AB, Di Carlo EF (1988) Pigmented villonodular synovitis: diagnosis and differential diagnosis. Radiol Clin North Am 26(6):1327–1347

    Google Scholar 

  2. Klompmaker J, Veth RPH, Robinson PH, Molenaar WM (1990) Pigmented villonodular synovitis. Arch Orthop Trauma Surg 109:205–210

    Article  PubMed  CAS  Google Scholar 

  3. Bruns J, Schubert T, Eggers-Stroeder G (1993) Pigmented villonodular synovitis in children. A case report. Arch Orthop Trauma Surg 112:148–151

    Article  PubMed  CAS  Google Scholar 

  4. Myers BW, Masi AT (1980) Pigmented villonodular synovitis and tenosynovitis. Medicine 59:223–238

    Article  PubMed  CAS  Google Scholar 

  5. Flandry FC, Hughston JC, McCann SB, Kurtz DM (1994) Diagnostic features of diffuse pigmented villonodular synovitis of the knee. Clin Orthop Relat Res 300:212–220

    Google Scholar 

  6. Kim SJ, Shin SJ, Choi NH, Choo ET (2000) Arthroscopic treatment for localized pigmented villonodular synovitis of the knee. Clin Orthop Relat Res 379:224–230

    Article  PubMed  Google Scholar 

  7. Hamlin BR, Duffy GP, Trousdale RT, Morrey BF (1998) Total knee arthoplasty in patients who have pigmented villonodular synovitis. J Bone Joint Surg Am 80:76–82

    PubMed  CAS  Google Scholar 

  8. Blanco CE, Leon HO, Guthrie TB (2001) Combined partial arthroscopic synovectomy and radiation therapy for diffuse pigmented villonodular synovitis of the knee. Arthroscopy 17:527–531

    Article  PubMed  CAS  Google Scholar 

  9. Byers PD, Cotton RE, Deacon OW, Lowry M, Newman PH, Sisson HA, Thompson AD (1968) The diagnosis and treatment of pigmented villonodular synovitis. J Bone Joint Surg Br 50:290–305

    PubMed  CAS  Google Scholar 

  10. Chiari C, Pirich C, Brannath W, Kotz R, Trieb K (2006) What effects the recurrence and clinical outcome of pigmented villonodular synovitis? Clin Orthop Relat Res 450:172–178

    Article  PubMed  Google Scholar 

  11. de Visser E, Pruszcynski M, Wobbes T, Van de Putte LB (1999) Diffuse and localized pigmented villonodular synovitis evaluation of treatment of 38 patients. Arch Orthop Trauma Surg 119:401–404

    Article  PubMed  Google Scholar 

  12. Dines JS, DeBerardino TM, Wells JL, Dodson CC, Shindle M, DiCarlo EF, Warren RF (2007) Long-term follow-up of surgically treated localized pigmented villonodular synovitis of the knee. Arthroscopy 23:930–937

    Article  PubMed  Google Scholar 

  13. Flandry FC, Hughston JC (1987) Current concepts review: pigmented villonodular synovitis. J Bone Joint Surg Am 69:942–949

    PubMed  CAS  Google Scholar 

  14. Flandry FC, Hughston JC, Jacobson KE, Barrack RL, McCann SB, Kurtz DM (1994) Surgical treatment of diffuse pigmented synovitis of the knee. Clin Orthop Relat Res 300:183–192

    PubMed  Google Scholar 

  15. Granowitz SP, D’Antonio J, Mankin HL (1976) The pathogenesis and long-term results of pigmented villonodular synovitis. Clin Orthop Relat Res 114:335–351

    PubMed  Google Scholar 

  16. Mendenhall WM, Mendenhall CM, Reith JD, Scarborough MT, Gibbs CP, Mendenhall NP (2006) Pigmented villonodular synovitis. Am J Clin Oncol 29:548–550

    Article  PubMed  Google Scholar 

  17. Ogilvie-Harris DJ, McLean J, Zarnett MJ (1992) Pigmented villonodular synovitis of the knee. The results of arthroscopic synovectomy, partial arthroscopic synovectomy and arthroscopic local excision. J Bone Joint Surg Am 74:119–123

    PubMed  CAS  Google Scholar 

  18. Rao AS, Vigorita VJ (1984) Pigmented villonodular synovitis (giant cell tumor of the tendon sheath and the synovial membrane). A review of eighty-one cases. J Bone Joint Surg Am 66:76–94

    PubMed  CAS  Google Scholar 

  19. Schwartz HS, Unni KK, Pritchard DJ (1989) Pigmented villonodular synovitis. Clin Orthop Relat Res 247:243–255

    PubMed  Google Scholar 

  20. Sharma V, Cheng EY (2009) Outcomes after excision of pigmented villonodular synovitis of the knee. Clin Orthop Relat Res 467:2852–2858

    Article  PubMed  Google Scholar 

  21. Vastel L, Lambert P, De Pinieux G, Charrois O, Kerboull M, Courpied JP (2005) Surgical treatment of pigmented villonodular synovitis of the hip. J Bone Joint Surg Am 87(5):1019–1024

    Article  PubMed  Google Scholar 

  22. Cotten A, Flipo RM, Chastanet P, Desvigne-Noulet MC, Duquesnoy B, Delcambre B (1995) Pigmented villonodular synovitis of the hip: a review of radiographic features in 58 patients. Skeletal Radiol 24:1–6

    Article  PubMed  CAS  Google Scholar 

  23. Della Valle AG, Piccaluga F, Potter HG, Salvati EA, Pusso R (2001) Pigmented villonodular synovitis of the hip. Clin Orthop Relat Res 388:187–199

    Article  Google Scholar 

  24. Yoo JJ, Kwon YS, Koo KH, Yoon KS, Min BW, Kim HJ (2009) Cementless total hip arthroplasty performed in patients with pigmented villonodular synovitis. J Arthroplasty 25:552–557

    Article  PubMed  Google Scholar 

  25. Tyler WK, Vidal AF, Williams RJ, Healey JH (2006) Pigmented villonodular synovitis. J Am Acad Orthop Surg 14:376–385

    PubMed  Google Scholar 

  26. De Ponti A, Sansone V, Malcherè M (2003) Result of arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy 19:602–607

    Article  PubMed  Google Scholar 

  27. Liu C, Zhao J, Chen L (2009) Clinical results of arthroscopic treatment for localized pigmented villonodular synovitis of knee. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 23:1042–1044

    PubMed  Google Scholar 

  28. Gumpel JM, Shawe DJ (1991) Diffuse pigmented villonodular synovitis: non-surgical management. Ann Rheum Diss 50:531–533

    Article  CAS  Google Scholar 

  29. O’Sullivan B, Cummings B, Catton C, Bell R, Davis A, Fornasier V, Goldberg R (1995) Outcome following radiation treatment for high-risk pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys 32:777–786

    Article  PubMed  Google Scholar 

  30. Wiss DA (1982) Recurrent villonodular synivitis of the knee. Successful treatment with Yttrium-90. Clin Orthop Relat Res 169:139–144

    PubMed  Google Scholar 

  31. Kampen WU, Voth M, Pinkert J, Krause A (2007) Therapeutic status of radiosynoviorthesis of the knee with yttrium [90Y] colloid in rheumatoid arthritis and related indications. Rheumatology 46:16–24

    Article  PubMed  CAS  Google Scholar 

  32. O’Sullivan MM, Yates DB, Pritchard MH (1987) Yttrium 90 synovectomy—a new treatment of villonodular synovitis [letter]. Br J Rheumatol 26:71–72

    Article  PubMed  Google Scholar 

  33. Shabat S, Kollender Y, Merimsky O, Flusser G, Nyska M, Meller I (2002) The use of surgery and yttrium 90 in the management of extensive and diffuse pigmented villonodular synovitis of large joints. Rheumatology 41:1113–1118

    Article  PubMed  CAS  Google Scholar 

  34. Chin KR, Barr SJ, Winalski C, Zurakowski D, Brick GW (2002) Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Joint Surg Am 84:2192–2202

    PubMed  Google Scholar 

  35. Ward WGS, Boles CA, Ball JD, Cline MT (2007) Diffuse pigmented villonodular synovitis: preliminary results with intralesional resection and P32 synoviorthesis. Clin Orthop Relat Res 454:186–191

    Article  PubMed  Google Scholar 

  36. Zook JE, Wurtz DL, Cummings JE, Cardenes HR (2011) Intra-articular chromic phosphate ((32)P) in the treatment of diffuse pigmented villonodular synovitis. Brachytherapy 10(3):190–194

    Article  PubMed  Google Scholar 

  37. Bickels J, Isaakov J, Kollender Y, Meller I (2008) Unacceptable complications following intra-articular injection of yttrium 90 in the ankle joint for diffuse pigmented villonodular synovitis. J Bone Joint Surg Am 90(2):326–328

    Article  PubMed  Google Scholar 

  38. Berger B, Ganswindt U, Bamberg M, Hehr T (2007) External beam radiotherapy as postoperative treatment of diffuse pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys 67:1130–1134

    Article  PubMed  Google Scholar 

  39. Wu CC, Pritsch T, Bickels J, Wienberg T, Malawer MM (2007) Two incision synovectomy and radiation treatment for diffuse pigmented villonodular synovitis of the knee with extra-articular component. Knee 14(2):99–106

    Article  PubMed  CAS  Google Scholar 

  40. Heydt R, Micke O, Berger B, Eich HT, Ackermann H, Seegenschmiedt MH (2010) Radiation therapy for treatment of pigmented villonodular synovitis: results of a national patterns of care study. Int J Radiat Oncol Biol Phys 78:199–204

    Article  Google Scholar 

  41. Horoschak M, Tran PT, Bachireddy P, West RB, Mohler D, Beaulieu CF, Kapp DS, Donaldson SS (2009) External beam radiation therapy enhances local control in pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys 75(1):183–187

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Diakonieklinikum Hamburg, Hohe Weide 17, 20259, Hamburg, Germany

    Juergen Bruns

  2. Department of Orthopedic Surgery I, University of Heidelberg, Schlierbacher Landstr. 200 a, 69118, Heidelberg, Germany

    V. Ewerbeck

  3. Department of Orthopedic Surgery, University Hospital Viena, Währinger Gürtel 18–20, 1090, Wien, Austria

    M. Dominkus & R. Windhager

  4. Department of Orthopedic Surgery, University of Graz, Graz, Austria

    R. Windhager

  5. Department of Orthopedic Surgery, University Schleswig–Holstein, Campus Kiel, Michaelisstr. 1, 24105, Kiel, Germany

    J. Hassenpflug

  6. Department of Orthopedic Surgery Medizinische Hochschule Hannover, im Diakoniekrankenhaus Annastift, Anna-von-Borries-Straße 1–7, 30625, Hannover, Germany

    H. Windhagen

  7. Department of Orthopedic Surgery, University of Frankfurt-Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt am Main, Germany

    L. Hovy

  8. Department of Orthopedic Surgery III, Annastift, Hannover, Germany

    L. Hovy

  9. Department of Orthopedic Surgery, University of Schleswig–Holstein Campus, Luebeck, Germany

    J. Loehr

  10. Department of Orthopedic Surgery, University of Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

    R. Krauspe

  11. Department of Orthopedic Surgery, Ludwig-Maximilian-University Munich, Marchioninistr. 15, 81377, Muenchen, Germany

    H. R. Duerr

Authors
  1. Juergen Bruns
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Ewerbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Dominkus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Windhager
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Hassenpflug
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Windhagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. Hovy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Loehr
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Krauspe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. H. R. Duerr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juergen Bruns.

Additional information

Investigation performed for the “Arbeitsgemeinschaft 4: Tumoren des Haltungs- und Bewegungsapparates” of the German Society of Orthopedics and Orthopaedic Surgery (DGOOC).

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bruns, J., Ewerbeck, V., Dominkus, M. et al. Pigmented villo-nodular synovitis and giant-cell tumor of tendon sheaths: a binational retrospective study. Arch Orthop Trauma Surg 133, 1047–1053 (2013). https://doi.org/10.1007/s00402-013-1770-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-013-1770-1

Keywords

search

Navigation