[Effectiveness of arthroscopy and/or arthrotomy therapy for diffuse pigmented villonodular synovitis of the knee].
OBJECTIVE
To investigate the method and the effectiveness of arthroscopy and/or arthrotomy combined with postoperative radiotherapy for diffuse pigmented villonodular synovitis (PVNS) of the knee.


METHODS
Between September 2000 and August 2010, 97 patients with diffuse PVNS of the knee were treated. There were 38 males and 59 females with a median age of 33 years (range, 8-75 years). The disease duration ranged from 1 week to 30 years, including 52 left knees and 45 right knees. There were 10 recurrent cases. The extention and flexion of the knee joint were (1.9 +/- 2.3) degrees and (122.9 +/- 5.6) degrees, respectively; the Lysholm score was 43.2 +/- 6.7; and the International Knee Documentation Committee (IKDC) score was 53.2 +/- 5.7, preoperatively. According to the scope and degree of the knee joint lesions, simultaneous anterior and posterior synovectomy was performed under arthroscopy in 82 cases, synovectomy under arthroscopy and removal of posterior extraarticular lesion by arthrotomy in 3 cases, synovectomy and the soft tissue lesions resection under arthroscopy in 9 cases, and staging resection and bone graft in 3 cases. After operation, 76 patients received postoperative radiotherapy.


RESULTS
Popliteal artery was injuryed in 1 case and the branch of popliteal veins were injuryed in 3 cases during operation. Intra-articular hemorrhage occurred in 1 case at 3 days after operation. The other patients achieved healing of incision by first intention without nerve damage and other complications. All patients were followed up 1 year and 3 months to 11 years and 2 months (median, 61 months) postoperatively. During follow-up, 89 cases had no relapse. At 15 months after operation, the extention and flexion of the knee joint were (0.2 +/- 1.3) degrees and (135.9 +/- 6.6) degrees, respectively; the Lysholm score was 89.8 +/- 5.8; and the IKDC score was 87.8 +/- 5.8. All indexes were significantly improved when compared with the preoperative ones (P < 0.05). At 6 months to 8 years postoperatively, 8 cases had occurrence, and they had slight limitation of the range of motion but had no pain and swelling of the knees after reoperation.


CONCLUSIONS
According to the scope and degree of the knee joint lesions, arthroscopy and/or arthrotomy combined with postoperative radiotherapy should be chosen for diffuse PVNS of the knee so as to obtain good effectiveness. Radiotherapy and enough total radiation dose are important factors to insure no recurrence.
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan 610041, PR China.
Dong
D
Liu
Qi
Q
Li
Xie
X
Jiang
Xin
X
Tang
Jian
J
Li
D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D016025:Bone Transplantation; D002648:Child; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D055502:Secondary Prevention; D000074402:Synovectomy; D013586:Synovitis, Pigmented Villonodular / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult