title: The effect of surgical synovectomy and radiotherapy on the rate of recurrence of pigmented villonodular synovitis of the knee: an individual patient meta-analysis.
abstract: Pigmented villonodular synovitis (PVNS) is a rare proliferative process of the synovium which most commonly affects the knee and occurs in either a localised (LPVNS) or a diffuse form (DPVNS). The effect of different methods of surgical synovectomy and adjuvant radiotherapy on the rate of recurrence is unclear. We conducted a systematic review and identified 35 observational studies in English which reported the use of surgical synovectomy to treat PVNS of the knee. A meta-analysis included 630 patients, 137 (21.8%) of whom had a recurrence after synovectomy. For patients with DPVNS, low-quality evidence found that the rate of recurrence was reduced by both open synovectomy (odds ration (OR) = 0.47; 95% CI 0.25 to 0.90; p = 0.024) and combined open and arthroscopic synovectomy (OR = 0.19, 95% CI = 0.06 to 0.58; p = 0.003) compared with arthroscopic surgery. Very low-quality evidence found that the rate of recurrence of DPVNS was reduced by peri-operative radiotherapy (OR = 0.31, 95% CI 0.14 to 0.70; p = 0.01). Very low-quality evidence suggested that the rate of recurrence of LPVNS was not related to the surgical approach. This meta-analysis suggests that open synovectomy or synovectomy combined with peri-operative radiotherapy for DPVNS is associated with a reduced rate of recurrence. Large long-term prospective multicentre observational studies, with a focus on both rate of recurrence and function, are required to confirm these findings.
authors.affiliation: University of Toronto, 149 College Street, Room 508A, Toronto, Ontario, M5T 1P5, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Mollon
authors.affiliation: University of Toronto, 149 College Street, Room 508A, Toronto, Ontario, M5T 1P5, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Lee
authors.affiliation: McMaster University , Room HSC 2V9, 1280 Main St West, Hamilton Ontario, L8S 4K1, Canada.
authors.forename: J W
authors.initials: JW
authors.lastname: Busse
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Griffin
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada.
authors.forename: P C
authors.initials: PC
authors.lastname: Ferguson
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada.
authors.forename: J S
authors.initials: JS
authors.lastname: Wunder
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Theodoropoulos
mesh_terms: D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D018714:Radiotherapy, Adjuvant; D000074402:Synovectomy; D013586:Synovitis, Pigmented Villonodular / Q000532:radiotherapy* / Q000601:surgery*
keywords: giant cell tumour; pigmented villonodular synovitis; radiation; synovectomy