Short-term results of synovectomy and total knee arthroplasty in patients with diffuse-type pigmented villonodular synovitis

Authors

  • Aakash Bansal Department of Orthopaedics, GMC Kota, Rajasthan, India
  • R. P. Meena Department of Orthopaedics, GMC Kota, Rajasthan, India
  • Prince Singh Department of Orthopaedics, GMC Kota, Rajasthan, India
  • Umesh Kumar Meena Department of Orthopaedics, GMC Kota, Rajasthan, India
  • Bhavyaraj Singh Yadav Department of Orthopaedics, GMC Kota, Rajasthan, India
  • Rohit Kharalwa Department of Orthopaedics, GMC Kota, Rajasthan, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20252645

Keywords:

Total knee replacement, Synovectomy, Diffuse pigmented villonodular synovitis

Abstract

Background: Diffuse-type pigmented villonodular synovitis (D-PVNS) is a rare, benign proliferative condition that affects the knee joint, often leading to subchondral bone erosion, cyst formation, and ultimately secondary osteoarthritis. This study aimed to assess the short-term clinical outcomes of synovectomy combined with total knee arthroplasty (TKA) in patients diagnosed with D-PVNS.

Methods: This study was conducted in the department of orthopaedics at government medical college, Kota, between 2020 and 2025, 28 patients with histopathologically confirmed D-PVNS of the knee underwent synovectomy followed by TKA. Clinical and operative data were recorded perioperatively and throughout follow-up to evaluate surgical effectiveness.

Results: There were no intraoperative complications. The mean operative time was 73.4 minutes (range: 47-115 minutes), and the average estimated blood loss was 223.9 mL (range: 50-600 mL). Patients were followed up for an average of 58.7 months (range: 36-84 months). Range of motion improved from a mean of 86.1°±11.3° preoperatively (range: 60°-100°) to 107°±11.4° postoperatively (range: 90°-130°). The average knee society clinical score increased from 38.9±9.5 to 84.4±6.1, while the functional score improved from 48.9±13.1 to 84.6±6.1 (p<0.05). Postoperative radiographs revealed no signs of prosthesis loosening, dislocation, or periprosthetic fracture.

Conclusions: Synovectomy combined with total knee replacement offers favorable short-term outcomes in managing D-PVNS of the knee, with significant improvements in joint function and stability and no major complications observed during follow-up.

Metrics

Metrics Loading ...

Author Biographies

R. P. Meena, Department of Orthopaedics, GMC Kota, Rajasthan, India

Departnment of Orthopaedics, Senior Professor and Head of Departnment

Prince Singh, Department of Orthopaedics, GMC Kota, Rajasthan, India

Junior Resident,Departnment Of Orthopaedics

Umesh Kumar Meena, Department of Orthopaedics, GMC Kota, Rajasthan, India

Assistant Professor,Departnment of Orthopaedics 

Bhavyaraj Singh Yadav, Department of Orthopaedics, GMC Kota, Rajasthan, India

Junior Resident, Departnment Of Orthopaedics

Rohit Kharalwa, Department of Orthopaedics, GMC Kota, Rajasthan, India

Junior Resident, Departnment Of Orthopaedics 

References

Miller WE. Villonodular synovitis: pigmented and nonpigmented variations. South Med J. 1982;75(09):1084-6. DOI: https://doi.org/10.1097/00007611-198209000-00014

Granowitz SP, Mankin HJ. Localized pigmented villonodular synovitis of the knee. Report of five cases. J Bone Joint Surg Am. 1967;49 (01):122-8. DOI: https://doi.org/10.2106/00004623-196749010-00010

Murphey MD, Rhee JH, Lewis RB, Fanburg-Smith JC, Flemming DJ, Walker EA. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics. 2008;28(05):1493-518. DOI: https://doi.org/10.1148/rg.285085134

Frassica FJ, Khanna JA, McCarthy EF. The role of MR imaging in soft tissue tumor evaluation: perspective of the orthopedic oncologist and musculoskeletal pathologist. Magn Reson Imaging Clin N Am. 2000;8(04):915-27. DOI: https://doi.org/10.1016/S1064-9689(21)00650-4

Schreuder HW. Long-term follow-up results of primary and recurrent pigmented villonodular synovitis. Rheumatology (Oxford). 2014;53(11):2063-70. DOI: https://doi.org/10.1093/rheumatology/keu230

Flandry F, Hughston JC, McCann SB, Kurtz DM. Diagnostic features of diffuse pigmented villonodular synovitis of the knee. Clin Orthop Relat Res. 1994;(298):212-20. DOI: https://doi.org/10.1097/00003086-199401000-00028

Chin KR, Barr SJ, Winalski C, Zurakowski D, Brick GW. Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Joint Surg Am. 2002;84(12):2192-202. DOI: https://doi.org/10.2106/00004623-200212000-00011

Muñoz FA, Gonzalez-Navarro B, Lopez-Prats FA. Cruciate-retaining vs posterior-stabilized primary total arthroplasty. clinical outcome comparison with a minimum follow-up of 10 years. J Arthroplasty 2018;33(08):2491-5. DOI: https://doi.org/10.1016/j.arth.2018.02.094

Lei P, Sun R, Liu H, Zhu J, Wen T, Hu Y. Prognosis of advanced tenosynovial giant cell tumor of the knee diagnosed during total knee arthroplasty. J Arthroplasty. 2017;32(06):1850-5. DOI: https://doi.org/10.1016/j.arth.2016.12.053

Flandry FC, Hughston JC, Jacobson KE, Barrack RL, McCann SB, Kurtz DM. Surgical treatment of diffuse pigmented villonodular synovitis of the knee. Clin Orthop Relat Res. 1994;(300):183-92. DOI: https://doi.org/10.1097/00003086-199403000-00024

Safaee M, Oh T, Sun MZ, Andrew TP, McDermott MW, El-Sayed IH, et al. Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: a case series and systematic review. Head Neck. 2015;37(08):1213-24. DOI: https://doi.org/10.1002/hed.23717

True VL, Monsell FP, Smith TA, Simon CP, David JG, Marion ES, et al. A severe systemic presentation of pigmented villonodular synovitis in a child with underlying Chediak-Higashi syndrome. J Pediatr Orthop B. 2015;24(06):526-9. DOI: https://doi.org/10.1097/BPB.0000000000000190

Ottaviani S, Ayral X, Dougados M, Gossec L. Pigmented villonodular synovitis: a retrospective single-center study of 122 cases and review of the literature. Semin Arthritis Rheum. 2011;40(06):539-46. DOI: https://doi.org/10.1016/j.semarthrit.2010.07.005

de Carvalho LH Jr, Soares LF, Gonçalves MB, Temponi EF, de MeloSilva O Jr. Long-term success in the treatment of diffuse pigmented villonodular synovitis of the knee with subtotal synovectomy and radiotherapy. Arthroscopy. 2012;28(09):1271-4. DOI: https://doi.org/10.1016/j.arthro.2012.02.007

Nishida Y, Tsukushi S, Nakashima H, Hideshi S, Yoshihisa Y, Hiroshi U, et al. Osteochondral destruction in pigmented villonodular synovitis during the clinical course. J Rheumatol. 2012;39(02):345-51. DOI: https://doi.org/10.3899/jrheum.110730

Palmerini E, Staals EL, Maki RG, Stefano P, Angela C, Marco G, et al. Tenosynovial giant cell tumour/pigmented villonodular synovitis: outcome of 294 patients before the era of kinase inhibitors. Eur J Cancer. 2015;51(02):210-17. DOI: https://doi.org/10.1016/j.ejca.2014.11.001

Chiari C, Pirich C, Brannath W, Kotz R, Trieb K. What affects the recurrence and clinical outcome of pigmented villonodular synovitis? Clin Orthop Relat Res. 2006;450(450):172-8. DOI: https://doi.org/10.1097/01.blo.0000224051.01873.fb

Chin KR, Brick GW. Extraarticular pigmented villonodular synovitis: a cause for failed knee arthroscopy. Clin Orthop Relat Res. 2002;(404):330-8. DOI: https://doi.org/10.1097/00003086-200211000-00049

Staals EL, Ferrari S, Donati DM, Palmerini E. Diffuse-type tenosynovial giant cell tumour: Current treatment concepts and future perspectives. Eur J Cancer. 2016;63:34-40. DOI: https://doi.org/10.1016/j.ejca.2016.04.022

Loriaut P, Djian P, Boyer T, Bonvarlet JP, Delin C, Makridis KG. Arthroscopic treatment of localized pigmented villonodular synovitis of the knee. Knee Surg Sports Traumatol Arthrosc. 2012;20(08):1550-3. DOI: https://doi.org/10.1007/s00167-011-1747-y

Colman MW, Ye J, Weiss KR, Goodman MA, McGough RL III. Does combined open and arthroscopic synovectomy for diffuse PVNS of the knee improve recurrence rates? Clin Orthop Relat Res. 2013;471(03):883-90. DOI: https://doi.org/10.1007/s11999-012-2589-8

Flandry F, Hughston JC. Pigmented villonodular synovitis. J Bone Joint Surg Am. 1987;69(06):942-9. DOI: https://doi.org/10.2106/00004623-198769060-00026

Mankin H, Trahan C, Hornicek F. Pigmented villonodular synovitis of joints. J Surg Oncol. 2011;103(05):386-9. DOI: https://doi.org/10.1002/jso.21835

Hamlin BR, Duffy GP, Trousdale RT, Morrey BF. Total knee arthroplasty in patients who have pigmented villonodular synovitis. J Bone Joint Surg Am. 1998;80(01):76-82. DOI: https://doi.org/10.2106/00004623-199801000-00013

Houdek MT, Scorianz M, Wyles CC, Trousdale RT, Sim FH, Taunton MJ. Long-term outcome of knee arthroplasty in the setting of pigmented villonodular synovitis. Knee. 2017;24(04):851-5. DOI: https://doi.org/10.1016/j.knee.2017.04.019

Downloads

Published

2025-08-25

How to Cite

Bansal, A., Meena, R. P., Singh, P., Meena, U. K., Yadav, B. S., & Kharalwa, R. (2025). Short-term results of synovectomy and total knee arthroplasty in patients with diffuse-type pigmented villonodular synovitis. International Journal of Research in Orthopaedics, 11(5), 1155–1160. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20252645

Issue

Section

Original Research Articles