Hemiarthroplasty in a Patient With Pigmented Villonodular Synovitis of the Shoulder

Abstract

We report the 2-year follow-up results of a hemiarthroplasty in a 29-year-old patient with pigmented villonodular synovitis (PVNS) with extra-articular extension and severe bony destruction. The patient presented with diffuse pain and swelling of the right shoulder for several years. Radiographs showed severe osteolytic lesions in the humeral head and neck, greater tuberosity, and a small osteolytic lesion in the glenoid neck area. Further examination with magnetic resonance imaging of the shoulder joint showed a large, lobulated soft tissue mass extending from the subdeltoid area to the chest wall invading the adjacent bony structures. The operative findings included a large, multilobulated, yellowish-brown mass extending from the subdeltoid area to the axillary pouch, subacromial space, and thoracic wall. The mass invaded the anatomical neck area of the humeral head and caused a fracture of the humeral head. We observed a complete rupture of the long head of the biceps tendon, supraspinatus tendon, and infraspinatus tendon, but the subscapularis tendon was partially ruptured. We performed the complete excision and cemented hemiarthroplasty. At 2-year follow-up, no signs of local recurrence were present. The patient had no significant pain and achieved a good functional result.To the best of our knowledge, 1 report with shoulder hemiarthroplasty in PVNS of the shoulder has been published in the English literature. For PVNS of the shoulder with a large extra-articular extension and bony destruction, shoulder arthroplasty with total synovectomy produces the lowest recurrence rates because of better access and excision to the posterior location of the PVNS lesion.

Pigmented Villonodular Synovitis of the Glenohumeral Joint and Biceps Tendon Sheath

“…PVNS of the shoulder is extremely rare and, as such, may evade clinical suspicion and delay diagnosis and treatment. The management of diffuse-type shoulder PVNS may include open or arthroscopic synovectomy and debridement [ 7 , 8 , 10 , 12 , 18 ] versus arthroplasty [ 16 , 19 , 20 ], with the possible adjuvant use of radiation therapy [ 8 ], depending on the severity and extent of disease, presence of extra-articular disease, and surgeon experience.…”

“…Previous case reports have linked shoulder PVNS with massive, often irreparable rotator cuff tears [7][8][9][10][11][12][13][14][15] and chondral lesions [7,10,16,17]. Numerous treatment modalities have been proposed, including open or arthroscopic synovectomy and debridement [7,8,10,12,18] versus arthroplasty [16,19,20], with or without the use of adjuvant radiation [8], depending on the severity and extent of intra-articular disease, presence of extra-articular disease, and surgeon experience. In this case report, we describe a case of insidious PVNS involving the glenohumeral joint and biceps tendon sheath that was treated with arthroscopic synovectomy, debridement, and subpectoral biceps tenodesis.…”

Localized Pigmented Villonodular Synovitis of the Shoulder: A Difficult Diagnosis of a Rare Disorder

“…Various intra-articular and extra-articular sites of origin including specific bursa locations have been identified. The knee is the most commonly affected joint, but rare cases of shoulder joint involvement have been reported [2][3][4][5]7,[9][10][11].…”

“…However, benign soft tissue tumor progression about the shoulder also has consequences. The permanent erosion of bone, joint and soft tissue structures, as well as, progressive rotator cuff tears and neurovascular invasion have been documented [2][3][4][5][6][7][8][9][10][11]. The result of this destruction leads to increasing disability.…”