Pigmented Villonodular Synovitis After TKA Associated With Tibial Component Loosening

Abstract

There is no known causal link between total knee arthroplasty (TKA) and pigmented villonodular synovitis (PVNS). There also is no known relationship between PVNS and implant loosening after TKA in the literature. This article presents a case of PVNS in a patient undergoing revision TKA for tibial component loosening. A 74-year-old woman who had undergone cemented bilateral TKA 5 years earlier presented with painful swelling in her right knee. At the time of the primary TKA, no abnormal signs were found in the synovial membrane. Routine follow-up radiographs did not indicate implant loosening. At the patient's final follow-up examination before revision surgery, a radiolucent lesion was found below the tibial component. During revision surgery, there was focal proliferation of the synovial tissue with heavy pigmentation around the anteromedial part of the tibial component. The abnormal tissue was removed, and the tibial component was exchanged. The articular surface of the polyethylene was not damaged, and backside wear was not found. For the revision surgery, 5-mm thick medial metal block and extension stem were used. Histological analysis of the resected tissue revealed the typical appearance of PVNS. We present a typical case of PVNS found during revision TKA 5 years after primary TKA. It is hoped this report will encourage surgeons to consider PVNS in the differential diagnosis of patients who present with painful swelling of the knee and to consider PVNS as one of the causes of implant loosening after TKA. Further research about causal factors between PVNS and implant loosening are needed.

A rare case of extensive diffuse nonpigmented villonodular synovitis as a cause of total knee arthroplasty failure

“…The causal relationship between TKA and PVNS remains unknown. In addition, it has not been explained how failure and loosening after TKA is caused by PVNS 13 . An idiosyncratic reaction in certain patients to fine wear debris was assumed in the single case described so far 8 .…”

“…7 Although it was reported that non-PNVS may occur after replacement knee arthroplasty, 4,7,8 all villonodular synovitis cases after arthroplasty in the English-language literature are pigmented. 3,6,13 …”

An unusual case of pigmented villonodular synovitis after total knee arthroplasty presenting with recurrent hemarthrosis

“…PVNS is a locally aggressive proliferative disorder of the synovium that is a rare complication after TKA [7] , [8] , [9] , [10] , [11] . The etiology of PVNS is unclear, although recurrent hemorrhage, neoplasm, and trauma have been reported as possible causes [14] .…”

“…Despite it being a benign process, recurrence rate after initial resection has been noted between 8% and 60% [6] . PVNS after total knee arthroplasty (TKA) is very rare, with limited case reports available [7] , [8] , [9] , [10] , [11] . Currently there are no published reports describing PVNS 4 years after a primary TKA with recurrent hemarthrosis and no evidence of synovitis 1 year after surgery.…”

The Role of Synovectomy in Total Knee Arthroplasty: A Prospective Analysis of 30 Cases

“…Chung et al 7 and Brian R. Hamlin et al 8 have reported cases of the failures due to aseptic loosening and recurrence of the disease in case of PVNS. In Mannucci PM et al 3 study, they performed total synovectomy in all patients and they found that in the majority of cases (53%), there was no recurrence of haemarthrosis; in the others, the condition was reduced (40%) or unchanged (7%).…”