title: Osteochondral destruction in pigmented villonodular synovitis during the clinical course.
abstract: OBJECTIVE
  In pigmented villonodular synovitis (PVNS), some cases recur and progress to osteochondral destruction. The aim of our study was to clarify the occurrence of osteochondral destruction according to the location of PVNS during the clinical course.
  
  
  METHODS
  Seventy-two patients with PVNS (43 female, 29 male) with a mean age of 40 years (range 3-87 yrs) had been referred to our institutions. Factors influencing the occurrence of osteochondral destruction were investigated.
  
  
  RESULTS
  Mean followup was 60 months (range 12-190 mo). Adjacent bone change occurred in 24 (42%) of 57 patients, who were evaluated at the time of the first consultation. Eight (89%) of 9 patients with hip lesions initially had bone lesions, significantly more frequently than those with other lesions (p = 0.038). Duration of symptoms was significantly correlated with the occurrence of bone lesions in diffuse knee lesions (p = 0.005). During followup, patients with location in the knee had a significantly higher incidence of osteoarthritic change (73%) compared to those with foot and ankle involvement (p = 0.027). Re-operation was more frequently required for knee lesions due to the high recurrence rate (32%). Patients who required re-operation had significantly more marked osteoarthritic change in knees (p = 0.001) during followup than those who did not.
  
  
  CONCLUSIONS
  For PVNS arising in knees, repeated recurrences followed by re-operation resulted in the progression of osteoarthritic change. PVNS arising in hips, feet, and ankles developed bone lesions initially, probably due to the limited volume of these joints. The indications for re-operation for recurrent knee lesions require careful consideration regarding progression of osteoarthritic change.
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan. ynishida@med.nagoya-u.ac.jp
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nishida
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tsukushi
authors.forename: Hiroatsu
authors.initials: H
authors.lastname: Nakashima
authors.forename: Hideshi
authors.initials: H
authors.lastname: Sugiura
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Yamada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Urakawa
authors.forename: Eisuke
authors.initials: E
authors.lastname: Arai
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005528:Foot / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010007:Osteochondritis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011859:Radiography; D012008:Recurrence; D013586:Synovitis, Pigmented Villonodular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult