Treatment of Diffuse Pigmented Villonodular Synovitis of the Knee with Combined Surgical and Radiosynovectomy

Abstract

Treatment of extensive diffuse pigmented villonodular synovitis (PVNS) of large joints by isolated surgical resection is unsatisfactory, with high rates of local recurrence. Post-synovectomy adjuvant treatment with external beam radiation therapy or intra-articular injection of radioactive material as yttrium-90 ( 90 Y) yielded better results. Between January 2005 and January 2007, 12 patients (eight men and four women aged 19-49 years) with extensive diffuse PVNS of the knee were treated. All patients had an adjuvant postoperative external beam radiation therapy (2,600-3,000 cGy) conventionally fractionated 200 cGy/fraction, five fractions/ week, 6-8 weeks after surgery. Mean follow-up time was 27 months (range from 20 to 36 months). All patients were followed up using clinical assessment, magnetic resonance imaging, and plain X-ray. In all patients, neither evidence of disease recurrence nor progression of bone or articular destruction was noted. No complications were noticed after surgery or after post-operative external beam radiation therapy. A combination of debulking surgery using anterior and posterior approach with adjuvant post-operative external beam radiation therapy for extensive diffuse PVNS of the knee joint is a reliable treatment method, with good results in regard to the incidence of local recurrence and functional outcome.

Pigmented Villonodular Synovitis for Combined Therapy

“…No complications of surgery or RT were recorded. The functional outcome of the involved joint in all patients was good according to Enneking's criteria (postoperative score 85%) [30].…”

“…Several recent publications showed favorable effect of external beam RT as a postoperative treatment [11,12,18,[28][29][30][31]. The GCG-BD group conducted a pattern-of-care study to analyze the RT for PVNS [12].…”

Evaluation of patients with diffuse pigmented villonodular synovitis of knee with functional scoring systems after surgery and radiosynovectomy

“…Of nine patients in the series, eight were disease free and one had local recurrence [18]. Nassar et al used external beam radiotherapy after debulking surgery and reported no disease recurrence or progression of bone or articular destruction in any patient, nor any complication related to the surgical procedure or radiotherapy [19].…”

Radiosynovectomy in Rheumatic Diseases

“…The numerous papers show significant improvement of efficacy of RS [3][4][5][6][7][8][9][10]. This method was first used in 1952 in patients with rheumatoid arthritis [11].…”