Short-Term Outcomes of Synovectomy and Total Knee Replacement in Patients with Diffuse-Type Pigmented Villonodular Synovitis

Abstract

Diffuse-type pigmented villonodular synovitis is a rare benign disease that causes disorders of the knee, including erosion of subchondral bone and cyst formation, with eventual osteoarthritis. The purpose of this study was to evaluate the short-term outcomes of synovectomy and total knee replacement in patients with the diffuse type of pigmented villonodular synovitis. From November 2011 to May 2015, we performed synovectomy and total knee replacement in 28 patients with diffuse pigmented villonodular synovitis diagnosed on the basis of histopathology of biopsy specimens. Clinical data were collected perioperatively and during follow-up for evaluation of surgical efficacy. No intraoperative complications were encountered. Mean operative duration was 73.4 minutes (range: 47–115 minutes); mean estimated blood loss was 223.9 mL (range: 50–600 mL). The mean duration of follow-up was 58.7 months (range: 36–84 months). Mean range of motion improved from 86.1 ± 11.3 degrees (range: 60–100 degrees) to 107 ± 11.4 degrees (range: 90–130 degrees). Average Knee Society clinical scores improved from 38.9 ± 9.5 (range: 17–54) to 84.4 ± 6.1 (range: 75–98); functional scores improved from 48.9 ± 13.1 (range: 25–80) to 84.6 ± 6.1 (range: 75–95; p < 0.05 for both). Postoperative radiographs showed no signs of prosthesis loosening, periprosthetic fractures, or dislocation. The short-term efficacy of synovectomy and total knee replacement in treating patients with diffuse pigmented villonodular synovitis was satisfactory.

Systematic review: total knee arthroplasty (TKA) in patients with pigmented villonodular synovitis (PVNS)

“…Casp et al [12] and Verspoor et al [16] did not provide the pre-operative KSS. Pre-operative and post-operative range of motion Both studies by Lei et al [14] and Su et al [15] showed an average of a 32°improvement in post-operative ROM. Houdek et al [13] reported no significant changes in the pre-operative and post-operative ROM (p = 0.72).…”

“…Authors Houdek et al [13] reported a total of 10 patients, with four patients having disease recurrence, three patients with component loosening and osteolysis, and the remaining indications were tibial-component fracture, instability and deep infection. Authors Lei et al and Su et al did not report on revision rates in their studies [14,15].…”

“…The range of follow-up in these studies was from 0.2 to 35 years. Using the STROBE checklist, the four articles by Houdek et al [13], Casp et al [12], Lei et al [14] and Su et al [15] scored a maximum score of 100%. The article by Verspoor et al [16] scored 97% as there was no usage of sensitivity analyses.…”

“…Recurrence "Symptoms of disease recurrence" was defined by authors Houdek et al [13] as recurrent effusions, lytic formations and hemarthrosis. Authors Su et al [15] defined it as worsening pain with or without a decrease in ROM or the finding of a new palpable mass. All patients included in the study were followed up in clinic and were monitored for disease recurrence.…”

“…All patients included in the study were followed up in clinic and were monitored for disease recurrence. Houdek et al [13] utilized plain radiography to diagnose recurrence, Verspoor et al [16] utilized joint ultrasound and Su et al [15] utilized magnetic resonance imaging (MRI). Excluding the Casp et al [17] paper, which did not report on recurrence rates, the recurrence rate following TKA in our review was 7.1% (seven patients), six patients from the Houdek et al [13] study and one patient from the Verspoor et al study [16]; with a mean of 6 years (range 2-12 years).…”