1
|
Smith SC, Snyder GM. Orthopedic management of a patient with pigmented villonodular synovitis. JAAPA 2022; 35:1-4. [PMID: 36282584 DOI: 10.1097/01.jaa.0000885160.53208.1d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT Pigmented villonodular synovitis (PVNS), sometimes also called tenosynovial giant cell tumor, is a rare, slow-growing, benign soft-tissue disorder. PVNS most commonly affects the knee and is associated with painful hemarthrosis and joint swelling. The condition also can affect the hip, ankle, shoulder, or elbow. This article reviews practice guidelines for PVNS, diagnosis, and surgical and nonsurgical treatments.
Collapse
Affiliation(s)
- Shawn C Smith
- Shawn C. Smith and Garrett M. Snyder practice orthopedics at Banner Health's Skyline Medical Pavilion in Loveland, Colo. The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | |
Collapse
|
2
|
Dalla-Torre R, Crenn V, Menu P, Isidor B, Guillot P, Le Goff B, Geffroy L, Dauty M, Fouasson-Chailloux A. Imatinib, a New Adjuvant Medical Treatment for Multifocal Villonodular Synovitis Associated to Noonan Syndrome: A Case Report and Literature Review. Front Med (Lausanne) 2022; 8:817873. [PMID: 35111788 PMCID: PMC8802824 DOI: 10.3389/fmed.2021.817873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Noonan syndrome (NS) is an autosomal dominant multisystem disorder caused by the dysregulation of the Rat Sarcoma/Mitogen-activated protein kinase (RAS/MAPK) pathway and characterized by short stature, heart defects, pectus excavatum, webbed neck, learning disabilities, cryptorchidism, and facial dysmorphia. Villonodular synovitis is a joint disorder most common in young adults characterized by an abnormal proliferation of the synovial membrane. Multifocal Villonodular synovitis is a rare disease whose recurrent nature can make its management particularly difficult. Currently, there is no systemic therapy recommended in diffuse and recurrent forms, especially because of the fear of long-term side effects in patients, who are usually young. Yet, tyrosine kinase inhibitors seem promising to reduce the effects of an aberrant colony stimulating factor-1 (CSF-1) production at the origin of the synovial nodule proliferation. We present here the case of a 21-year-old woman with NS associated to diffuse multifocal villonodular synovitis (DMVS). Our clinical case provides therapeutic experience in this very rare association. Indeed, in association with surgery, the patient improved considerably: she had complete daily life autonomy, knee joint amplitudes of 100° in flexion and 0° in extension and was able to walk for 10 min without any technical assistance. To our knowledge, this is the first case of a patient suffering from DMVS associated with a Noonan syndrome treated with Glivec® (oral administration at a dosage of 340 mg/m2 in children, until disease regression) on a long-term basis.
Collapse
Affiliation(s)
- Romain Dalla-Torre
- CHU Nantes, Service de Médecine Physique et de Réadaptation Locomotrice, University Hospital of Nantes, Nantes, France
- CHU Nantes, Service de Rhumatologie, University Hospital of Nantes, Nantes, France
| | - Vincent Crenn
- CHU de Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, Hôtel-Dieu, Nantes, France
| | - Pierre Menu
- CHU Nantes, Service de Médecine Physique et de Réadaptation Locomotrice, University Hospital of Nantes, Nantes, France
- CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France
- INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton – Nantes University, Nantes, France
- IRMS, Institut Régional de Médecine du Sport, Hôpital Saint Jacques, Nantes, France
| | - Bertrand Isidor
- CHU Nantes, Service de Génétique Médicale, University Hospital of Nantes, Nantes, France
| | - Pascale Guillot
- CHU Nantes, Service de Rhumatologie, University Hospital of Nantes, Nantes, France
| | - Benoit Le Goff
- CHU Nantes, Service de Rhumatologie, University Hospital of Nantes, Nantes, France
| | - Loic Geffroy
- Chirurgie Orthopédique, Santé Atlantique, Saint Herblain, France
| | - Marc Dauty
- CHU Nantes, Service de Médecine Physique et de Réadaptation Locomotrice, University Hospital of Nantes, Nantes, France
- CHU de Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, Hôtel-Dieu, Nantes, France
- CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France
- INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton – Nantes University, Nantes, France
| | - Alban Fouasson-Chailloux
- CHU Nantes, Service de Médecine Physique et de Réadaptation Locomotrice, University Hospital of Nantes, Nantes, France
- CHU de Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, Hôtel-Dieu, Nantes, France
- CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France
- INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton – Nantes University, Nantes, France
- *Correspondence: Alban Fouasson-Chailloux
| |
Collapse
|
3
|
Zhao WQ, Zhao B, Li WS, Assan I. Subtalar joint pigmented villonodular synovitis misdiagnosed at the first visit: A case report. World J Clin Cases 2021; 9:1379-1385. [PMID: 33644205 PMCID: PMC7896681 DOI: 10.12998/wjcc.v9.i6.1379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/08/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is an uncommon disease that usually occurs in large joints, and involvement of the subtalar joint is rare. The lack of comprehensive knowledge of subtalar joint PVNS could lead to misdiagnosis.
CASE SUMMARY We present a 64-year-old woman who, at her first visit, complained of discomfort in the right ankle when she walked. Based on the physical signs and X-ray report, the physician failed to make the suspected diagnosis of PVNS. Eighteen months later, the patient returned with a complaint of a mass in her right lateral malleolus with intermittent blunt pain. The X-ray presented an osteophyte formation and soft tissue calcification at the margin of the subtalar joint. The laboratory tests were normal, whereas magnetic resonance imaging (MRI) showed a low-intensity area on both T1- and T2-weighted images. A suspected diagnosis of PVNS was made and later confirmed by postoperative pathology. Subsequently, the patient received radiotherapy with 32 Gy in 16 fractions. At 6 mo postoperatively, the patient only complained of discomfort after walking three blocks. The American Orthopedic Foot and Ankle Society Ankle–Hindfoot score was 97.
CONCLUSION MRI is necessary for the diagnosis of PVNS. Early soft tissue calcification and painless joint swelling should be of concern.
Collapse
Affiliation(s)
- Wen-Qian Zhao
- Department of Traditional Chinese Medicine, The People's Hospital of Shouguang City, Shouguang 262700, Shandong Province, China
| | - Bin Zhao
- Department of Orthopedics, Shouguang Hospital of Traditional Chinese Medicine, Shouguang 262700, Shandong Province, China
| | - Wan-Sheng Li
- Department of General Surgery, Shouguang Hospital of Traditional Chinese Medicine, Shouguang 262700, Shandong Province, China
| | - Isaac Assan
- School of International Education, Weifang Medical University, Weifang 261053, Shandong Province, China
| |
Collapse
|
4
|
Novikov D, Richardson MW, Ho C, Gould ES, Khan FA. A Rare Incidence of Pigmented Villonodular Synovitis of the Ankle in an Adolescent. J Foot Ankle Surg 2019; 57:1263-1266. [PMID: 30146337 DOI: 10.1053/j.jfas.2018.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Indexed: 02/03/2023]
Abstract
Pigmented villonodular synovitis mostly affects the knee and other large joints such as the hip. Although the disease is most commonly found in adult patients aged 30 to 40 years, rare cases in children and the elderly have been reported. We present the case of an 11-year-old female who was found to have biopsy-proven pigmented villonodular synovitis in her subtalar joint in 2012. Five years after surgical excision, the patient has continued to be involved in competitive dancing and cheerleading without any pain in her ankle. Moreover, follow-up magnetic resonance imaging studies showed no evidence of recurrence. Our case report emphasizes that the disease should not be solely considered in the middle-age population but should be included in the differential diagnosis of the pediatric patient.
Collapse
Affiliation(s)
- David Novikov
- Medical Student, Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Meghan W Richardson
- Resident, Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Corey Ho
- Fellow, Department of Radiology, Stony Brook University Hospital, Stony Brook, NY
| | - Elaine S Gould
- Clinical Professor, Department of Radiology & Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Fazel A Khan
- Assistant Professor, Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY.
| |
Collapse
|
5
|
Multifocal Pigmented Villonodular Synovitis in the Noonan Syndrome. Case Rep Orthop 2018; 2018:7698052. [PMID: 30631623 PMCID: PMC6305014 DOI: 10.1155/2018/7698052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/24/2018] [Accepted: 11/25/2018] [Indexed: 11/24/2022] Open
Abstract
Noonan-like/multiple giant cell lesion (NS/MGCL) is a rare condition overlapping with Noonan syndrome. Once thought to be a specific and separate entity, it is now suggested to be a variant of the Noonan syndrome spectrum. We report the case of an 8-year-old boy with a typical clinical picture of Noonan syndrome with a de novo germline mutation of PTPN11 (c.854 T>C). During his follow-up, the patient developed multifocal pigmented villonodular synovitis which first affected the left knee and shortly after both elbows.
Collapse
|
6
|
Kia C, O'Brien DF, Ziegler C, Pacheco R, Forouhar F, Williams V. An unusual case of pigmented villonodular synovitis after total knee arthroplasty presenting with recurrent hemarthrosis. Arthroplast Today 2018; 4:426-430. [PMID: 30560170 PMCID: PMC6287230 DOI: 10.1016/j.artd.2018.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/19/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a benign proliferative joint disease, which is a rare finding after total knee arthroplasty (TKA). There is currently no link between PVNS and TKA, and it has been described infrequently in the literature. Its presentation has varied along with the time that it presents postoperatively. We describe a case of a patient who presents with recurrent hemarthrosis 4 years after TKA. The patient had no previous history of PVNS and had an arthroscopy 1 year after the index operation with no evidence of synovitis. We present details of the first case with a review of imaging and pathology and a brief review of the literature on PVNS occurring after TKA.
Collapse
Affiliation(s)
- Cameron Kia
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Daniel F O'Brien
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Connor Ziegler
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Rafael Pacheco
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Faripour Forouhar
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Vincent Williams
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| |
Collapse
|
7
|
Kapoor C, Jhaveri M, Soni R, Shah M, Rathi P, Golwala P. Pigmented Villonodular Synovitis of the Knee Joint: A Case Report. Cureus 2016; 8:e816. [PMID: 27843734 PMCID: PMC5101109 DOI: 10.7759/cureus.816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a rare, benign, but potentially locally aggressive and recurrent condition characterized by synovial proliferation and hemosiderin deposition inside the joints, tendon sheaths, and bursae. It usually affects the large joints such as hip, knee, and ankle. We report a case of PVNS of the knee joint in a young female which was treated by subtotal synovectomy alone without the use of adjuvants. At the 14-month follow-up, the patient was pain free and had no signs of disease recurrence.
Collapse
Affiliation(s)
- Chirag Kapoor
- Orthopaedics, Sumandeep Vidyapeeth, Vadodara, Gujarat
| | | | - Rishit Soni
- Orthopaedics, Sumandeep Vidyapeeth, Vadodara, Gujarat
| | - Malkesh Shah
- Orthopaedics, Sumandeep Vidyapeeth, Vadodara, Gujarat
| | - Parth Rathi
- Orthopaedics, Sumandeep Vidyapeeth, Vadodara, Gujarat
| | | |
Collapse
|
8
|
Erickson BJ, Campbell K, Cvetanovich GL, Harris JD, Bach BR, Sherman SL. Nonligamentous Soft Tissue Pathology About the Knee: A Review. Orthopedics 2016; 39:32-42. [PMID: 26709560 DOI: 10.3928/01477447-20151218-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/20/2015] [Indexed: 02/03/2023]
Abstract
Knee pain is one of the most frequent complaints evaluated by orthopedic surgeons. It encompasses a broad range of pathology and can present in a variety of ways. Most of this pain can be attributed to essential structures of the knee, including the menisci, cruciate or collateral ligaments, and articular cartilage. However, there are underrecognized structures in and around the knee that can frequently be a cause of knee pathology and pain. Knee pain stemming from these structures may be missed or incorrectly diagnosed, and these patients often present for second and third opinions because of failure to diagnose and treat the underlying pathology. The synovial plica, suprapatellar pouch, lateral retinaculum, infrapatellar fat pad, and infrapatellar branch of the saphenous nerve are less common but still significant causes of knee pain. Although initial treatment involves various nonoperative modalities, operative treatment is often warranted. Operative and nonoperative management of these soft tissue structures may occur in isolation or with concomitant procedures, including knee ligament reconstruction, total knee arthroplasty, tibial tuberosity osteotomy, or lysis of adhesions. With proper recognition of the role of these structures in knee pain, the orthopedic surgeon can offer a valuable primary or adjunctive treatment option for patients with knee pain, especially those without localizing signs of meniscal, ligamentous, or cartilage damage.
Collapse
|
9
|
Imaging of Hip Pain: From Radiography to Cross-Sectional Imaging Techniques. Radiol Res Pract 2016; 2016:6369237. [PMID: 26885391 PMCID: PMC4738697 DOI: 10.1155/2016/6369237] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/17/2015] [Accepted: 12/20/2015] [Indexed: 12/16/2022] Open
Abstract
Hip pain can have multiple causes, including intra-articular, juxta-articular, and referred pain, mainly from spine or sacroiliac joints. In this review, we discuss the causes of intra-articular hip pain from childhood to adulthood and the role of the appropriate imaging techniques according to clinical suspicion and age of the patient. Stress is put on the findings of radiographs, currently considered the first imaging technique, not only in older people with degenerative disease but also in young people without osteoarthritis. In this case plain radiography allows categorization of the hip as normal or dysplastic or with impingement signs, pincer, cam, or a combination of both.
Collapse
|
10
|
Ma X, Shi G, Xia C, Liu H, He J, Jin W. Pigmented villonodular synovitis: a retrospective study of seventy five cases (eighty one joints). INTERNATIONAL ORTHOPAEDICS 2013; 37:1165-70. [PMID: 23503697 DOI: 10.1007/s00264-013-1858-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Pigmented villonodular synovitis (PVNS) is a relatively rare, benign proliferation lesion of the synovium of large joints, but there is not much information available about the disease's aetiology, clinical history, differential diagnosis, treatment, and long-term effects. We conducted a study to analyse these aspects of PVNS. METHODS We reviewed all clinical data for 75 patients with PVNS (81 joints) who were treated either by synovectomy alone or synovectomy plus arthroplasty. RESULTS In all cases, the diagnosis of PVNS was confirmed by pathological examination. The ratio of males to females was 27:48, and the average age of patients was 46 years (range, 15-80 years). Lesions were located in the knee, hip, or ankle, and pain and swelling were the main symptoms. Of 75 patients, 42 had a history of trauma to the involved joint. Forty-one patients (43 joints) underwent synovectomy alone, and 34 patients (38 joints) underwent synovectomy and arthroplasty together. Of the 75 patients, 61 had full follow-up data. Twelve patients had recurrent legions detected by pathological examinations; four patients had more than two recurrences. Moreover, five patients developed PVNS after arthroplasty. CONCLUSIONS PVNS occurs most often in middle-aged women and most frequently involves the knee, followed by the hip and ankle. The disease's etiology is varied and unclear. Surgical excision alone or with arthroplasty is an effective treatment, but there is a high rate of recurrence.
Collapse
Affiliation(s)
- Xiaomei Ma
- Department of Pathology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China.
| | | | | | | | | | | |
Collapse
|
11
|
Mankin H, Trahan C, Hornicek F. Pigmented villonodular synovitis of joints. J Surg Oncol 2010; 103:386-9. [PMID: 21400520 DOI: 10.1002/jso.21835] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 11/22/2010] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study is to present two series of cases of pigmented villonodular disease of joints (PVNS) treated at different periods. The 215 cases from our hospital are current (1972-2009) and those 62 from the Jaffe collection from 1920 to 1968. METHODS By use of our computerized tumor data system we were able to define age, gender, site, treatment, complications, and outcome. Examination of the material from the Jaffe collection included all of the above primary data but none on treatment and outcome. RESULTS The data for the two systems studied were remarkably similar. The average ages were in mid years and the disorder was more frequent in females. The largest numbers of cases for both series were in the knee and foot and less commonly in hip, shoulder, and hand. The treatments were mostly surgical excision with the exception of the hip which required total hip replacement. The results show only a small number of recurrences, no metastatic disease and no deaths. CONCLUSION Pigmented villonodular disease of joints is a rare entity, mostly occurring in the knee and foot. The principal treatment is surgical excision which is most often successful in these sites but leads to problems at other locations, especially the hip.
Collapse
Affiliation(s)
- Henry Mankin
- Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | | | | |
Collapse
|
12
|
Abstract
We describe a child with pigmented villonodular synovitis initially treated for a presumed hip infection. The correct diagnosis was not made until 2(1/2) years later on a second admission. This is a rare disease with vague presenting symptoms that requires a high index of suspicion. Magnetic resonance imaging and tissue biopsy are usually needed for a definitive diagnosis. Surgery is the primary treatment option; however, the patient described was unusual in that she did well to date with conservative measures.
Collapse
Affiliation(s)
- Aarat M Patel
- Division of Rheumatology, School of Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15201, USA.
| | | | | | | |
Collapse
|
13
|
Park KS, Diwanji SR, Yang HK, Yoon TR, Seon JK. Pigmented villonodular synovitis of the hip presenting as a buttock mass treated by total hip arthroplasty. J Arthroplasty 2010; 25:333.e9-12. [PMID: 19056222 DOI: 10.1016/j.arth.2008.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Accepted: 10/02/2008] [Indexed: 02/01/2023] Open
Abstract
Pigmented villonodular synovitis (PVNS) of the hip is a relatively uncommon benign but locally aggressive disease that should be considered in younger patients presenting with monoarticular joint symptoms. Pigmented villonodular synovitis begins in and usually remains confined within a synovium-lined joint, but rarely, it may extend beyond the joint capsule and present as a soft tissue mass. The authors report a previously unrecognized presentation of PVNS of the hip in a 36-year-old man, who presented with a buttock mass arising from the right hip joint. The patient was treated by synovectomy and total hip arthroplasty.
Collapse
Affiliation(s)
- Kyung Soon Park
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun-Gun, Jeonnam, Republic of Korea
| | | | | | | | | |
Collapse
|
14
|
|
15
|
Disorders of the suprapatellar pouch of the knee. Knee 2008; 15:348-54. [PMID: 18407503 DOI: 10.1016/j.knee.2008.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 01/29/2008] [Accepted: 02/04/2008] [Indexed: 02/02/2023]
Abstract
Proper recognition and treatment of pathological conditions of the suprapatellar pouch of the knee is dependent on the knowledge of normal pouch anatomy and of the various conditions which affect this area of the knee and contribute to knee pain. This article includes a comprehensive review of the surgical anatomy of the pouch, current surgical techniques and review of the common conditions that have a predilection for this often overlooked area of the knee.
Collapse
|
16
|
Kim SJ, Cho SH, Ko DH. Arthroscopic excision of synovial hemangioma of the hip joint. J Orthop Sci 2008; 13:387-9. [PMID: 18696201 DOI: 10.1007/s00776-007-1232-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 12/18/2007] [Indexed: 11/24/2022]
Affiliation(s)
- Sung-Jae Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | | | | |
Collapse
|
17
|
Pinaroli A, Aït Si Selmi T, Servien E, Neyret P. Prise en charge de la synovite villonodulaire hémopigmentée du genou et de ses récidives. ACTA ACUST UNITED AC 2006; 92:437-47. [PMID: 17088737 DOI: 10.1016/s0035-1040(06)75830-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF THE STUDY The objective of this retrospective study was to analyze clinical observations in pigmented villonodular synovitis (PVNS) of the knee as well as response to treatment in order to better define the diagnostic approach and surgical treatment and follow-up of this rare benign proliferative disease of the synovial observed primarily in the knee joint. MATERIAL AND METHODS Twenty-eight patients (13 men and 15 women) were treated for PVNS in our unit between 1996 and 2004. Twenty patients had diffuse disease and eight localized disease. In the localized forms, symptoms mimicked those provoked by intra-articular foreign bodies or meniscal tears (n = 6) and had been present for 14 months on average at first consultation. Mean age at treatment onset was 40 years (range 20-62). Arthroscopic or open surgery was used for resection. In the diffuse forms, symptoms had begun 15 months on average before first consultation and were mainly spontaneous hemarthrosis or diffuse non-specific knee pain. Mean age at treatment onset was 38 years (range 15-59). Bone lesions were observed in four patients. Synoviorthesis or surgical synovectomy were performed. Mean follow-up was 97 months (range 12-309). Outcome was compared between the different aspects of localized and diffuse PVNS and treatment modalities. RESULTS In the localized forms, there were no complications after surgical treatment and there were no cases of recurrence (one surgical revision at four months following incomplete resection). For the diffuse forms, the cumulative recurrence rate was 50%. Mean time to recurrence was 37 months. Three patients developed a stiff knee after open synovectomy. Surgical treatment was required in four patients seen late after development of bony lesions (total knee arthroplasty in three). Clinical outcome was good with a gain in knee flexion. DISCUSSION MRI is essential for the topographic diagnosis and to guide surgical treatment. In severe or advanced primary diffuse disease or in the event of local recurrence, adjuvant synoviorthesis can be proposed four to eight weeks after initial surgery. The risk of recurrence for diffuse forms warrants an annual MRI for the first four years.
Collapse
Affiliation(s)
- A Pinaroli
- Centre Livet, 8, rue de Margnolles, 69300 Caluire-Lyon
| | | | | | | |
Collapse
|
18
|
Arastu MH, Milani R, Davidson AW, Bousdras K, Sinisi M. Pigmented villo-nodular synovitis: a rare cause of a supra-clavicular fossa mass. Eur J Surg Oncol 2006; 33:812-4. [PMID: 16859872 DOI: 10.1016/j.ejso.2006.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 05/31/2006] [Indexed: 11/18/2022] Open
Affiliation(s)
- M H Arastu
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital Stanmore, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
| | | | | | | | | |
Collapse
|
19
|
Lee MK, Choong PF, Smith PJ, Powell GJ, Slavin JL, Schlicht SM. Pigmented villonodular synovitis of the hip mimicking soft-tissue sarcoma: a case report. J Orthop Surg (Hong Kong) 2006; 14:76-80. [PMID: 16598093 DOI: 10.1177/230949900601400117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pigmented villonodular synovitis is a rare and benign but potentially locally aggressive disease that should be considered in younger patients who present with monoarticular joint symptoms and pathology. We present a 30-year-old Sudanese woman with a huge mass arising from the right hip joint. A multimodality radiological approach to investigation and diagnosis is demonstrated and discussed. Histopathological examination of the resected specimen confirmed the diagnosis of pigmented villonodular synovitis with the mass consisting of a proliferation of fibrohistiocytic cells, abundant haemosiderin, foamy histiocytes, and occasional giant cells. The patient made a good recovery, with mobility aided by arm crutches and a hip abduction brace.
Collapse
Affiliation(s)
- M Ks Lee
- Department of Radiology, St Vincent's Hospital, Fitzroy, Melbourne, Australia.
| | | | | | | | | | | |
Collapse
|
20
|
Gödde S, Kusma M, Dienst M. Arthroskopische Diagnostik und Therapie synovialer Erkrankungen. ARTHROSKOPIE 2006. [DOI: 10.1007/s00142-005-0337-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
21
|
Abstract
Pigmented villonodular synovitis is a benign proliferative lesion of the synovium with unclear etiology. It is a locally aggressive lesion that may invade and destroy surrounding bone and soft tissues and represents a high rate of recurrence despite aggressive treatment modalities. This article describes the new developments in etiology and outlines current approaches for diagnosis and treatment.
Collapse
Affiliation(s)
- Onder Ofluoglu
- Orthopedic Surgery and Trauma Clinic, Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey.
| |
Collapse
|
22
|
Gödde S, Kusma M, Dienst M. [Synovial disorders and loose bodies in the hip joint. Arthroscopic diagnostics and treatment]. DER ORTHOPADE 2005; 35:67-76. [PMID: 16322971 DOI: 10.1007/s00132-005-0894-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Synovial disorders and loose bodies are one of the most common indications for hip arthroscopy. Arthroscopic intervention has been reported for loose bodies, synovial plicae, synovial chondromatosis, pigmented villonodular synovitis (PVNS) as well as rheumatoid and septic arthritis. One major advantage in comparison to radiologic imaging is the ability to inspect, biopsy, and treat within one procedure. In contrast to an arthrotomy, hip arthroscopy avoids the potential risks of extensive surgical exposure and prolonged rehabilitation. Nevertheless, hip arthroscopy cannot be promoted as curative in all synovial disorders. In patients with loose bodies, synovial plicae, initial septic arthritis and, to a certain extent, PVNS curative therapy and "restitutio ad integrum" can be achieved. In contrast, in patients with synovial chondromatosis and rheumatoid arthritis, the goal of hip arthroscopy is to enable the correct diagnosis and to provide symptomatic relief and maintain or improve joint function. Success or failure of arthroscopic treatment depends on proper patient selection and a correct arthroscopic technique.
Collapse
Affiliation(s)
- S Gödde
- Klinik für Orthopädie und orthopädische Chirurgie, Universitätskliniken des Saarlandes, Homburg/Saar.
| | | | | |
Collapse
|
23
|
Affiliation(s)
- Scot E Campbell
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA.
| |
Collapse
|
24
|
Edwards MR, Tibrewal S. Patello-femoral joint pain due to unusual location of localised pigmented villonodular synovitis-a case report. Knee 2004; 11:327-9. [PMID: 15261222 DOI: 10.1016/s0968-0160(03)00078-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2003] [Accepted: 04/11/2003] [Indexed: 02/02/2023]
Abstract
Localised pigmented villonodular synovitis (PVNS) is a rare condition usually affecting the knee. It can be a difficult condition to manage with an average delay in diagnosis of 4.4 years. We describe a case of a localised PVNS lesion interposed between the patello-femoral joint, presenting as 'anterior knee pain'. To our knowledge this has not previously been reported. The lesion was completely excised at arthroscopy resulting in complete resolution of symptoms. Solitary lesions of PVNS should also be considered in the differential diagnosis of unexplained 'anterior knee pain'.
Collapse
Affiliation(s)
- M R Edwards
- Queen Elizabeth Hospital NHS Trust, London, UK.
| | | |
Collapse
|
25
|
Abstract
Hip arthroscopy is being used increasingly for the diagnosis and treatment of hip disorders. MR imaging performed with appropriate technical considerations may aid not only in preoperative planning but in the appropriate selection of patients, which tends to lead to better postoperative results. Although the painful hip is imaged most commonly by radiography, MR imaging is considered the next imaging test of choice for evaluation of most common hip abnormalities in athletes, including labral injuries, ligament injuries, osteochondral injuries, fractures, bursitis, and musculotendinous injuries. MR arthrography can be a particularly useful technique for dedicated assessment of hip joint internal derangements.
Collapse
Affiliation(s)
- Robert D Boutin
- Med-Tel International, 3713 Lillard Drive, Davis, CA 95616, USA
| | | |
Collapse
|