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

Abstract

Background To determine the functional outcomes, complications and revision rates following total knee arthroplasty (TKA) in patients with pigmented villonodular synovitis (PVNS). Materials and methods We conducted a systematic review of the literature. Five studies with a total of 552 TKAs were included for analysis. The methodological quality of the articles was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scale. Functional outcomes, complications and revision rates were assessed. The mean age was 61 years (range 33–94 years) and the mean follow-up period was 61.1 months (range 0.2–35 years). Results All the studies reported improvement in knee function following TKA. Post-operative stiffness was the most frequently reported complication, affecting 32.7% (n = 32) of patients in our review. Symptomatic recurrence of PVNS, component loosening, tibial-component fracture, instability and periprosthetic infection were the main factors leading to the need for revision TKA. Conclusion The findings of this review support the use of TKA to alleviate the functional limitations and pain due to knee degeneration in patients with PVNS. The operating surgeon should be aware of the increased risk of post-operative stiffness, as well as a potentially higher risk of infection. Implant survival should also be considered inferior to the one expected for the general population undergoing TKA.

Methodological quality, risk of bias, and reporting quality: A confusion persists

“…For example, some authors have reported the STROBE reporting checklist as a scale. 11 The findings reported here suggest that there may be important weaknesses in the background of the authors regarding their knowledge of the methodological aspects of research. It appears that some may have just adopted an approach in their systematic reviews based on what has already been done in the past without questioning its validity.…”

Higher incidence of diffuse Pigmented Villonodular Synovitis in patients with ruptured cruciate ligament: A case report

“…The combined anterior arthroscopic and posterior open synovectomy in the knee could be a good option because some researches have shown that the recurrence rate of it is lower than arthroscopic synovectomy and open synovectomy. In addition, if there is a destructive change in the joint surface that cannot be treated by synovectomy alone, total knee arthroplasty can provide a reliable improvement in function, but the risk of knee stiffness is significantly increased after total knee arthroplasty which should be noted [25] , [26] .…”

Evaluation and Management of Intra-Articular Tumors of the Knee

“…14 It has been shown that this patient population has a higher rate of complication after undergoing TKA, and PVNS recurrence was seen in 12% of patients at the 10-year post-operative time point, all requiring re-operation. 23 24 Casp et al performed a database review comparing the clinical outcomes of patients undergoing TKA for PVNS versus osteoarthritis from 2007 to 2016. They found that the PVNS patients had a higher rate of post-operative complications, most notably higher rates of stiffness at 1 year (odds ratio 1.48, p = 0.023) and infection at 2 years (odds ratio 1.73, p = 0.011).…”