Clinical and oncological outcomes after surgical excision of pigmented villonodular synovitis at the foot and ankle

Korim, M.T.; Clarke, David; Allen, Patricia; Richards, Cathy; Ashford, Robert U.

doi:10.1016/j.fas.2014.01.007

Cited by 38 publications

(43 citation statements)

References 18 publications

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“…PVNS clinical reports vary based on the country of origin, regions, ethnic groups and races [ 6 ]. With respect to its gender ratio, a male predominance was reported in United States [ 6 ] and United Kingdom [ 14 , 15 ], but a female predilection in France [ 16 ] and Portugal [ 17 ]. In China, Ma et al [ 3 ] reported the gender ratio (female/male) was 1.78.…”

Section: Introductionmentioning

confidence: 99%

Pigmented Villonodular Synovitis: A Retrospective Multicenter Study of 237 Cases

et al. 2015

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PurposeTo review clinical characteristics of pigmented villonodular synovitis (PVNS) in China.MethodsElectronic medical records (EMR) of four Chinese institutes were queried for patients with histologically proven PVNS between January 2005 and February 2014. Their data were collected including gender, age at diagnosis, clinical presentation, affected site, symptom duration, comorbidities, treatment strategy, recurrence and routine laboratories.ResultsA total of 237 patients with biopsy-proven PVNS were investigated. The gender ratio was 1.35 for a female predominance (101 males and 136 females). The average age was 36 years (range, 2 to 83 years). The median delay from initial clinical symptom to diagnosis was 18 months. Main affected areas were the knee (73.84%) and the hip (18.14%). Forty patients had a clear history of joint trauma. Six patients were concurrently diagnosed with PVNS and avascular necrosis (AVN). Five patients suffered from PVNS following implantation of orthopaedic devices including artificial prosthesis, plate and wire. One hundred and twenty-nine patients underwent arthroscopic synovectomy and 108 open synovectomy. Altogether 48 patients (26 males and 22 females) had recurrence of disease. The relapse rate was 24% (knee) and 6.98% (hip), 20.93% (open surgery) and 19.44% (arthroscopy), respectively. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) rate were elevated in 45.83% and 38.41% of the patients respectively.ConclusionsTo our knowledge, this study is the largest sample size of PVNS patients reported as well as the largest sample of PVNS with concurrent AVN reported to date. Our outcomes suggest that PVNS shows a female predominance, occurs mostly between 20–40 years and favors the knee and hip. Recurrence is frequent, particularly in the knee. Serum ESR and CRP may be elevated in some patients. Additionally, the present study supports the theory of an association between PVNS and orthopedic surgery, which is not limited to joint replacement.

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Section: Introductionmentioning

confidence: 99%

Pigmented Villonodular Synovitis: A Retrospective Multicenter Study of 237 Cases

et al. 2015

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“…PVNS can affect various joints, with 1.8 new cases per million persons per year. 1 Studies from the US and UK report a greater prevalence among males, [2][3][4] whereas retrospective studies in China report a female predominance, 5,6 as do series from France, Portugal, and Italy. [7][8][9] PVNS usually occurs in the age of 30s 3,5,7 or 40s to 50s.…”

Section: Introductionmentioning

confidence: 99%

The Role of Radiotherapy in the Treatment of Pigmented Villonodular Synovitis

Kodiyan¹,

Zlotecki²,

Scarborough³

et al. 2017

Hong Kong J Radiol

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Background: This article reviews our 47-year experience of radiotherapy (RT) as adjuvant treatment for histologically confirmed pigmented villonodular synovitis (PVNS). Methods: We identified seven women and two men with diffuse PVNS of the knee (n = 8) or hip (n = 1) who were treated with postoperative RT between 1969 and 2015 at the University of Florida. The median patient age was 59 (range, 39-79) years. The median follow-up was 5.5 (range, 2.1-26.0) years. All patients received megavoltage external-beam RT using three-dimensional conformal techniques. The median RT dose was 36 (range, 19-45) Gy in a median of 18 (range, 13-36) fractions; four patients received twice-daily fractionation, and five once daily. Results: Of the nine patients, five had clinically and / or radiographically stable disease or were disease-free; three failed to achieve local control; and one had a questionable local recurrence based on magnetic resonance imaging 4 months later. None had acute or long-term complications from RT. Conclusion: Synovectomy and watchful waiting remains the primary management for PVNS. In cases of extensive disease with incomplete excision and / or local recurrence, local RT should be considered.

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“…Surgical excision represents the standard curative treatment for both localized and diffuse PVNS of the foot and ankle [4,5]. However, due to the complex anatomy of the area which allows the spreading of the disease to adjacent articular spaces, the complete excision of the highly proliferative synovium is difficult to achieve, resulting in a significant risk of inadequate excision and recurrence [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Radiosynoviorthesis after Surgery in the Treatment of Patients with Ankle Pigmented Villonodular Synovitis: A Case Series

Iakovou

Symeonidis

Kotrotsios

et al. 2020

JCM

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Pigmented villonodular synovitis (PVNS) of the ankle is a very rare, locally aggressive, proliferative disorder. Although surgical excision represents the standard curative treatment, the PVNS relapse rate is high. We present our study of five young athletes (range 20–36 years) with a histopathological diagnosis of PVNS of the ankle, who were treated by surgery and adjuvant radiosynoviorthesis (RSO). The operation involved either arthroscopic (four patients) or open (one patient) debridement, followed by intraarticular RSO with the radiopharmaceutical erbium-169 (169Er). They were evaluated with the Foot Function Index (FFI) and a visual analog scale (VAS) for pain. At a median follow up period of 47 months (range 36–54 months), all five patients reported marked pain relief with improvements in their daily activities. In particular, the median FFI decreased from 77% (range 71.0%–84.5%) pre-treatment, to 0.5% (range 0%–6%) after treatment. The median VAS score decreased from 4 (range 3–7) to 0 (range 0–1), respectively. Throughout the follow-up period, there were no major complications regarding either therapeutic intervention (arthroscopic or open debridement, RSO). Based on these results, it can be concluded that adjuvant RSO with 169Er following surgical excision is effective and safe in the treatment of PVNS of the ankle.

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Clinical and oncological outcomes after surgical excision of pigmented villonodular synovitis at the foot and ankle

Cited by 38 publications

References 18 publications

Pigmented Villonodular Synovitis: A Retrospective Multicenter Study of 237 Cases

Pigmented Villonodular Synovitis: A Retrospective Multicenter Study of 237 Cases

The Role of Radiotherapy in the Treatment of Pigmented Villonodular Synovitis

Radiosynoviorthesis after Surgery in the Treatment of Patients with Ankle Pigmented Villonodular Synovitis: A Case Series

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