Advertisement

Mid-Term Results of Arthroscopic Synovectomy for Pigmented Villonodular Synovitis of the Hip

Published:February 13, 2020DOI:https://doi.org/10.1016/j.arthro.2020.01.059

      Purpose

      To analyze mid-term outcomes after arthroscopic synovectomy of both diffuse and nodular hip pigmented villonodular synovitis (PVNS).

      Methods

      This is a retrospective case series of patients that underwent hip arthroscopy for hip PVNS with a single senior surgeon between 2007 and 2016. Inclusion criteria were magnetic resonance imaging evidence, arthroscopic visualization, and/or histologic confirmation of PVNS; and a minimum of 3 years of follow-up. Concomitant pathology such as femoroacetabular impingement also was treated at the time of surgery. Primary outcome measures were recurrence of hip PVNS and the rate of revision hip surgery. Secondary outcomes were complications, visual analog scale pain score, pain relief, and patient satisfaction, and 6 patient-reported outcome measures were collected at latest follow-up.

      Results

      In a case series of 14 patients consisting of 6 (42.9%) male and 8 (57.1%) female patients, the mean operative age was 32.69 ± 12.73 years with a mean follow-up was 6.66 ± 1.87 years. PVNS type was determined intraoperatively: 5 (35.7%) patients had diffuse hip PVNS and 9 (64.3%) had nodular type. There was only 1 case (7.14%) of recurrence that was treated arthroscopically and no cases (0%) progressed to revision open synovectomy or arthroplasty. Mean patient-reported outcome measure scores were notable for a modified Harris Hip Score of 74.08 ± 16.84. The mean visual analog scale pain score decreased by 4.9 ± 1.7, which was significant with a P < .001, with a larger decrease in patients with localized type.

      Conclusions

      This study presents a large case series of hip PVNS managed arthroscopically with mid-term follow-up of slightly over 6.5 years. The survival rate was 93%, with only 1 (7%) recurrence and 0 (0%) progression to revision open synovectomy or arthroplasty with 0 (0%) complications. We conclude that arthroscopic synovectomy is a reliable and effective treatment of hip PVNS.

      Level of Evidence

      Case Series, Level IV.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Upadhyaya S.
        • Alpaugh K.
        • Martin S.D.
        Highly erosive tenosynovial giant cell tumor of the hip treated with arthroscopic synovectomy.
        Orthop J Harvard Med Sch. 2015; 16: 75-81
        • Kokoszka P.
        • Woźniak W.
        • Łapaj Ł.
        • Kruczyński J.
        Pigmented villonodular synovitis—various manifestations, inconsistent terminology and treatment. Cases study.
        Ortop Traumatol Rehabil. 2017; 19: 79-88
        • van der Heijden L.
        • Piner S.R.
        • van de Sande M.A.J.
        Pigmented villonodular synovitis: A crowdsourcing study of two hundred and seventy two patients.
        Int Orthop. 2016; 40: 2459-2468
        • Vastel L.
        • Lambert P.
        • De Pinieux G.
        • Charrois O.
        • Kerboull M.
        • Courpied J.-P.
        Surgical treatment of pigmented villonodular synovitis of the hip.
        J Bone Joint Surg Am. 2005; 87: 1019-1024
        • Chassaignac C.
        Cancer de la gaine des tendons.
        Gaz Hop Cive Milit. 1852; 47: 185-186
        • Targett J.
        Giant cell tumors of the integuments.
        Trans Pathol Soc Lond. 1897; 48: 230-235
        • Jaffe H.
        Pigmented villonodular synovitis, bursitis, and tenosynovitis.
        Arch Pathol. 1941; 31: 731-765
        • Granowitz S.P.
        • Mankin H.J.
        Localized pigmented villonodular synovitis of the knee. Report of five cases.
        J Bone Joint Surg Am. 1967; 49: 122-128
        • Aurégan J.-C.
        • Klouche S.
        • Bohu Y.
        • Lefèvre N.
        • Herman S.
        • Hardy P.
        Treatment of pigmented villonodular synovitis of the knee.
        Arthrosc J Arthrosc Relat Surg. 2014; 30: 1327-1341
        • Fletcher C.D.M.
        • Bridge J.A.
        • Hogendoorn P.
        WHO classification of tumours of soft tissue and bone.
        International Agency for Research on Cancer (IARC) (UN, Lyon, France2013
        • Brodbeck W.G.
        • Anderson J.M.
        Giant cell formation and function.
        Curr Opin Hematol. 2009; 16: 53-57
        • Myers B.W.
        • Masi A.T.
        Pigmented villonodular synovitis and tenosynovitis: A clinical epidemiologic study of 166 cases and literature review.
        Medicine (Baltimore). 1980; 59: 223-238
        • Flandry F.C.
        • Hughston J.C.
        • Jacobson K.E.
        • Barrack R.L.
        • McCann S.B.
        • Kurtz D.M.
        Surgical treatment of diffuse pigmented villonodular synovitis of the knee.
        Clin Orthop Relat Res. 1994; 300: 183-192
        • de Visser E.
        • Veth R.P.
        • Pruszczynski M.
        • Wobbes T.
        • Van de Putte L.B.
        Diffuse and localized pigmented villonodular synovitis: Evaluation of treatment of 38 patients.
        Arch Orthop Trauma Surg. 1999; 119: 401-404
        • Chin K.R.
        • Barr S.J.
        • Winalski C.
        • Zurakowski D.
        • Brick G.W.
        Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee.
        J Bone Joint Surg Am. 2002; 84-A: 2192-2202
        • Johansson J.E.
        • Ajjoub S.
        • Coughlin L.P.
        • Wener J.A.
        • Cruess R.L.
        Pigmented villonodular synovitis of joints.
        Clin Orthop Relat Res. 1982; 163: 159-166
        • Ogilvie-Harris D.J.
        • McLean J.
        • Zarnett M.E.
        Pigmented villonodular synovitis of the knee. The results of total arthroscopic synovectomy, partial, arthroscopic synovectomy, and arthroscopic local excision.
        J Bone Joint Surg Am. 1992; 74: 119-123
        • Lui T.H.
        • Stephen L.W.Y.
        A case of co-existing pigmented villonodular synovitis and tuberculosis infection of the foot and ankle.
        Arch Orthop Trauma Surg. 2008; 128: 769-772
        • Dines J.S.
        • DeBerardino T.M.
        • Wells J.L.
        • et al.
        Long-term follow-up of surgically treated localized pigmented villonodular synovitis of the knee.
        Arthrosc J Arthrosc Relat Surg. 2007; 23: 930-937
        • Byers P.D.
        • Cotton R.E.
        • Deacon O.W.
        • et al.
        The diagnosis and treatment of pigmented villonodular synovitis.
        J Bone Joint Surg Br. 1968; 50: 290-305
        • Rao A.S.
        • Vigorita V.J.
        Pigmented villonodular synovitis (giant-cell tumor of the tendon sheath and synovial membrane). A review of eighty-one cases.
        J Bone Joint Surg Am. 1984; 66: 76-94
        • 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: 172-178
        • Schwartz H.S.
        • Unni K.K.
        • Pritchard D.J.
        Pigmented villonodular synovitis. A retrospective review of affected large joints.
        Clin Orthop Relat Res. 1989; 247: 243-255
        • Nazal M.R.
        • Parsa A.
        • Martin S.D.
        Arthroscopic treatment of pigmented villonodular synovitis of the hip using puncture capsulotomy.
        Arthrosc Tech. 2019; 8: e641-e646
        • Cotten A.
        • Flipo R.M.
        • Chastanet P.
        • Desvigne-Noulet M.C.
        • Duquesnoy B.
        • Delcambre B.
        Pigmented villonodular synovitis of the hip: Review of radiographic features in 58 patients.
        Skeletal Radiol. 1995; 24: 1-6
        • Cheng X.G.
        • You Y.H.
        • Liu W.
        • Zhao T.
        • Qu H.
        MRI features of pigmented villonodular synovitis (PVNS).
        Clin Rheumatol. 2004; 23: 31-34
        • Dorwart R.
        • Genant H.
        • Johnston W.
        • Morris J.
        Pigmented villonodular synovitis of synovial joints: clinical, pathologic, and radiologic features.
        AJR Am J Roentgenol. 1984; 143: 877-885
        • Hufeland M.
        • Gesslein M.
        • Perka C.
        • Schröder J.H.
        Long-term outcome of pigmented villonodular synovitis of the hip after joint preserving therapy.
        Arch Orthop Trauma Surg. 2018; 138: 471-477
        • Willimon S.C.
        • Schrader T.
        • Perkins C.A.
        Arthroscopic management of pigmented villonodular synovitis of the hip in children and adolescents.
        Orthop J Sport Med. 2018; 6 (2325967118763118)
        • Byrd J.W.T.
        • Jones K.S.
        • Maiers G.P.
        Two to 10 years’ follow-up of arthroscopic management of pigmented villonodular synovitis in the hip: A case series.
        Arthrosc J Arthrosc Relat Surg. 2013; 29: 1783-1787
        • Ellsworth B.
        • Kamath A.F.
        Open and arthroscopic with mini-open surgical hip approaches for treatment of pigmented villonodular synovitis and concomitant hip pathology.
        Case Rep Orthop. 2017; 2017: 3716360
        • Skelley N.W.
        • Conaway W.K.
        • Martin S.D.
        “In-round” labral repair after acetabular recession using intermittent traction.
        Arthrosc Tech. 2017; 6: e1807-e1813
        • Eisig S.
        • Dorfman H.D.
        • Cusamano R.J.
        • Kantrowitz A.B.
        Pigmented villonodular synovitis of the temporomandibular joint. Case report and review of the literature.
        Oral Surg Oral Med Oral Pathol. 1992; 73: 328-333
        • Kwon J.H.
        • Han J.H.
        • RD V.
        • et al.
        Localized pigmented villonodular synovitis of the proximal tibiofibular joint.
        Knee Surg Relat Res. 2014; 26: 249-252
        • Oh S.W.
        • Lee M.H.
        • Eoh W.
        Pigmented villonodular synovitis on lumbar spine: A case report and literature review.
        J Korean Neurosurg Soc. 2014; 56: 272
        • Griffin A.M.
        • Ferguson P.C.
        • Catton C.N.
        • et al.
        Long-term outcome of the treatment of high-risk tenosynovial giant cell tumor/pigmented villonodular synovitis with radiotherapy and surgery.
        Cancer. 2012; 118: 4901-4909
        • Shabat S.
        • Kollender Y.
        • Merimsky O.
        • et al.
        The use of surgery and yttrium 90 in the management of extensive and diffuse pigmented villonodular synovitis of large joints.
        Rheumatology (Oxford). 2002; 41: 1113-1118
        • Zook J.E.
        • Wurtz D.L.
        • Cummings J.E.
        • Cárdenes H.R.
        Intra-articular chromic phosphate (32P) in the treatment of diffuse pigmented villonodular synovitis.
        Brachytherapy. 2011; 10: 190-194
        • McCormick F.
        • Alpaugh K.
        • Haughom B.
        • Nho S.
        Arthroscopic T-capsulotomy for excision of pigmented villonodular synovitis in the hip.
        Orthopedics. 2015; 38: 237-239
        • Lee S.
        • Haro M.S.
        • Riff A.
        • Bush-Joseph C.A.
        • Nho S.J.
        Arthroscopic technique for the treatment of pigmented villonodular synovitis of the hip.
        Arthrosc Tech. 2015; 4: e41-e46
        • Tibbo M.E.
        • Wyles C.C.
        • Rose P.S.
        • Sim F.H.
        • Houdek M.T.
        • Taunton M.J.
        Long-term outcome of hip arthroplasty in the setting of pigmented villonodular synovitis.
        J Arthroplasty. 2018; 33: 1467-1471
        • Elzohairy M.M.
        Pigmented villonodular synovitis managed by total synovectomy and cementless total hip arthroplasty.
        Eur J Orthop Surg Traumatol. 2018; 28: 1375-1380
        • Yoo J.J.
        • Kwon Y.S.
        • Koo K.-H.
        • Yoon K.S.
        • Min B.W.
        • Kim H.J.
        Cementless total hip arthroplasty performed in patients with pigmented villonodular synovitis.
        J Arthroplasty. 2010; 25: 552-557
        • Mankin H.
        • Trahan C.
        • Hornicek F.
        Pigmented villonodular synovitis of joints.
        J Surg Oncol. 2011; 103: 386-389