title: Treatment of diffuse pigmented villonodular synovitis of the knee with combined surgical and radiosynovectomy.
abstract: Treatment of extensive diffuse pigmented villonodular synovitis (PVNS) of large joints by isolated surgical resection is unsatisfactory, with high rates of local recurrence. Post-synovectomy adjuvant treatment with external beam radiation therapy or intra-articular injection of radioactive material as yttrium-90 ((90)Y) yielded better results. Between January 2005 and January 2007, 12 patients (eight men and four women aged 19-49 years) with extensive diffuse PVNS of the knee were treated. All patients had an adjuvant post-operative external beam radiation therapy (2,600-3,000 cGy) conventionally fractionated 200 cGy/fraction, five fractions/week, 6-8 weeks after surgery. Mean follow-up time was 27 months (range from 20 to 36 months). All patients were followed up using clinical assessment, magnetic resonance imaging, and plain X-ray. In all patients, neither evidence of disease recurrence nor progression of bone or articular destruction was noted. No complications were noticed after surgery or after post-operative external beam radiation therapy. A combination of debulking surgery using anterior and posterior approach with adjuvant post-operative external beam radiation therapy for extensive diffuse PVNS of the knee joint is a reliable treatment method, with good results in regard to the incidence of local recurrence and functional outcome.
authors.affiliation: Orthopaedic Department, Ain Shams University, Demerdash Hospital, Abbasseia Square, Cairo, Egypt. wgnassar@hotmail.com
authors.forename: Wael A M
authors.initials: WA
authors.lastname: Nassar
authors.forename: Ayman Abdelaziz
authors.initials: AA
authors.lastname: Bassiony
authors.forename: Hesham A
authors.initials: HA
authors.lastname: Elghazaly