Pigmented villonodular synovitis does not influence the outcomes following cruciate-retaining total knee arthroplasty: a case-control study with minimum 5-year follow-up

Abstract

Background Pigmented villonodular synovitis (PVNS) is a rare synovial disease with benign hyperplasia, which has been successfully treated with total knee arthroplasty (TKA). The purpose of this study was to investigate the middle-term follow-up outcomes of cruciate-retaining (CR) TKA in patients with PVNS. Methods From January 2012 to December 2014, a retrospective study was conducted in 17 patients with PVNS who underwent CR TKA as PVNS group. During this period, we also selected 68 patients with osteoarthritis who underwent CR TKA (control group) for comparison. The two groups matched in a 1:4 ratio based on age, sex, body mass index, and follow-up time. The range of motion, Knee Society Score, revision rate, disease recurrence, wound complications, and the survivorship curve of Kaplan-Meier implant were assessed between the two groups. Results All patients were followed up at least 5 years. There was no difference in range of motion and Knee Society Score between the two groups before surgery and at last follow-up after surgery (p > 0.05). In the PVNS group, no patients with the recurrence of PVNS were found at the last follow-up, one patient underwent revision surgery due to periprosthetic fracture, and three patients had stiffness one year after surgery (17.6% vs 1.5%, p = 0.005; ROM 16–81°), but no revision was needed. At 7 years, the implant survivorship was 90.0% in the PVNS group and 96.6% in the control group (p = 0.54). Conclusions This study demonstrated that the function of patients with PVNS who underwent CR TKA had been significantly improved, and the survival rate of implants in these patients was similar to the patients with OA. Consequently, the patients with PVNS who underwent CR TKA might be an achievable option. However, these patients should pay more attention to the occurrence of postoperative stiffness complications.

Total knee arthroplasty in pigmented villonodular synovitis osteoarthritis: a systematic review of literature

“…From the selected studies, the first goal was to highlight the design and degree of constraint of the prosthetic implants adopted by authors in PVNS osteoarthritis. Most of papers reported the use of non-constrained design implant such as posterior stabilized (PS) or cruciate retaining (CR) models, obtaining satisfying outcomes [ 2 – 4 , 20 , 21 , 24 , 25 ]. Although these implant designs lead to comparable results in clinical and functional scores improvement, in PVNS osteoarthritis, PS system may be preferable over the CR one, as it allows a more extensive joint exposure, necessary to perform an accurate synovial debridement [ 4 , 20 , 21 ].…”