Dataset Information

Open or Arthroscopic Synovectomy Is the Preferred Management Option in Pigmented Villonodular Synovitis of the Hip Joint Without Evidence of Degeneration: A Systematic Review of 20 Studies.

ABSTRACT:

Purpose

To provide an up-to-date systematic review on the treatment options for pigmented villonodular synovitis (PVNS) of the hip and provide a grade of recommendation using standardized systems.

Methods

A systematic search of PubMed, Embase, Web of Science, and The Cochrane Library from the date of inception of each database through December 4, 2021, was performed. Studies that described the outcomes of treatment of hip PVNS were identified. These outcomes were discussed and synthesized by three reviewers, and a grade of recommendation was assigned.

Results

Twenty studies were identified. Seven studies described arthroscopic synovectomy, eight studies described open synovectomy, nine studies described arthroplasty, and one study described osmic acid synoviorthesis. Synovectomy, either open or arthroscopic, had similar rates of disease recurrence. Hip arthroplasty had low rates of disease recurrence compared to synovectomy; however, it was associated with significant risk of aseptic loosening in the longer term.

Conclusion

Synovectomy, either open or arthroscopic based on surgeon preference, is favored in the treatment of hip PVNS if there is no evidence of joint space narrowing. Arthroplasty should be considered in cases with joint space narrowing or recurrence following joint preservation therapy. There is insufficient evidence to support synoviorthesis either as monotherapy or adjuvant therapy.

Level of evidence

IV, systematic review of Level III and IV studies.

SUBMITTER: Cheok T

PROVIDER: S-EPMC9596911 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Open or Arthroscopic Synovectomy Is the Preferred Management Option in Pigmented Villonodular Synovitis of the Hip Joint Without Evidence of Degeneration: A Systematic Review of 20 Studies.

Cheok Tim T Wills Kenneth K Berman Morgan M Jennings Matthew Phillip MP Poonnoose Pradeep Mathew PM

Arthroscopy, sports medicine, and rehabilitation 20220817 5

<h4>Purpose</h4>To provide an up-to-date systematic review on the treatment options for pigmented villonodular synovitis (PVNS) of the hip and provide a grade of recommendation using standardized systems.<h4>Methods</h4>A systematic search of PubMed, Embase, Web of Science, and The Cochrane Library from the date of inception of each database through December 4, 2021, was performed. Studies that described the outcomes of treatment of hip PVNS were identified. These outcomes were discussed and syn ...[more]

PMID: 36312712

Similar Datasets

Project description:The current treatment of choice for diffuse-type pigmented villonodular synovitis (PVNS) is surgical excision. Complete synovectomy is necessary because of the local aggressiveness of the disease, with a significant recurrence rate and a minor chance of malignant transformation. The recurrence rate is even greater in those cases with extra-articular extension. Arthroscopic and endoscopic synovectomy have the advantage of avoidance of extensive soft-tissue dissection, which is associated with open synovectomy. The purpose of this Technical Note is to describe the details of combined arthroscopic and endoscopic synovectomy as treatment for diffuse PVNS of the ankle. By a combination of different arthroscopic and endoscopic approaches of the ankle region, a complete synovectomy of both intra-articular and extra-articular components of diffuse-type PVNS is feasible. Technique Video Video 1 Combined arthroscopic and endoscopic synovectomy for diffuse pigmented villonodular synovitis (PVNS) of the left ankle. The patient is in the supine position for the anterior ankle arthroscopy and endoscopy and then placed in a prone position for the posterior ankle arthroscopy and endoscopy. Anterior ankle arthroscopy is performed to resect the inflamed synovium of the anterior ankle recess and the bony erosions at the talar neck are debrided. With the anteromedial portal as the viewing portal and the anterolateral portal as the working portal, the inflamed synovium of the anterolateral ankle is resected. Then, the arthroscope is switched to the anterolateral portal, and synovectomy of the anteromedial ankle is performed with the shaver via the anteromedial portal. After that, the anterior ankle capsule is stripped from distal tibia and extra-articular PVNS of the anterior ankle is resected. Posterior ankle endoscopy is performed via the posteromedial and posterolateral portals. Synovectomy of flexor hallucis longus is performed with the posterolateral portal as the viewing portal and posteromedial portal as the working portal. This is followed by posterior ankle capsulotomy and synovectomy of the posterior ankle recess. With the posteromedial portal as the viewing portal, synovectomy of the posterolateral ankle recess and the distal tibiofibular syndesmosis is performed with the shaver via the posterolateral portal. Then, the scope is switched to the posterolateral portal and synovectomy of the posteromedial ankle is performed. Inflamed synovium around the tibial nerve is carefully removed with an arthroscopic punch. If there is suspicion of extension of PVNS into the tarsal tunnel, endoscopy of the tibial nerve is performed.

Project description:PurposeThe purpose of this study was to assess the efficacy of arthroscopic intervention on the treatment of pigmented villonodular synovitis (PVNS) patients, with a focus on the potential advantages of this approach in lowering the risk of disease recurrence.MethodsWe performed a systematic review and meta-analysis following the PRISMA 2020 protocol. Our search encompassed five databases, namely PubMed, Embase, Scopus, Web of Science and Cochrane Library. Statistical analysis was conducted on the extracted data by using the R ver. 4.4.0 software. This study included English-language observational studies (case series and cohort studies) published up to 31 March 2024, focusing on in vivo human subjects with at least 2 years of follow-up. Studies with less than 2 years of follow-up, non-arthroscopic treatment methods or addressing PVNS in structures other than the knee were excluded.ResultsWe identified 24 articles, comprising 7 case series and 17 cohort studies, based on title, abstract, and quality assessments. Approximately 16% (95% confidence interval [CI]: 10.4%-24.75%) of knees that underwent arthroscopic surgery were found to be at risk of recurrence. In line with our expectations, sub-group analysis comparing recurrence rates among different subtypes of PVNS found that the diffuse subtype exhibited a higher recurrence rate of 19.4% (95% CI: 10.01%-34.15%), compared to the local subtype, which had a recurrence rate of 9.5% (95% CI: 4.47%-19.01%). Based on the meta-regression analysis, no significant association was found between the recurrence rate and the publication year or patient mean age. However, there was a noticeable rise in the recurrence rate with a longer follow-up period, indicating a probable correlation between extended follow-up and increased recurrence rates.ConclusionOur findings suggest that arthroscopic surgery for PVNS, particularly for the diffuse subtype, results in a higher recurrence rate compared to the localized subtype. However, the inherent challenges in achieving complete resection through arthroscopy, particularly in cases with extensive disease involvement, may contribute to the observed recurrence rates.Level of evidenceLevel III systematic review and meta-analysis.

Project description:PurposeTo review clinical characteristics of pigmented villonodular synovitis (PVNS) in China.MethodsElectronic medical records (EMR) of four Chinese institutes were queried for patients with histologically proven PVNS between January 2005 and February 2014. Their data were collected including gender, age at diagnosis, clinical presentation, affected site, symptom duration, comorbidities, treatment strategy, recurrence and routine laboratories.ResultsA total of 237 patients with biopsy-proven PVNS were investigated. The gender ratio was 1.35 for a female predominance (101 males and 136 females). The average age was 36 years (range, 2 to 83 years). The median delay from initial clinical symptom to diagnosis was 18 months. Main affected areas were the knee (73.84%) and the hip (18.14%). Forty patients had a clear history of joint trauma. Six patients were concurrently diagnosed with PVNS and avascular necrosis (AVN). Five patients suffered from PVNS following implantation of orthopaedic devices including artificial prosthesis, plate and wire. One hundred and twenty-nine patients underwent arthroscopic synovectomy and 108 open synovectomy. Altogether 48 patients (26 males and 22 females) had recurrence of disease. The relapse rate was 24% (knee) and 6.98% (hip), 20.93% (open surgery) and 19.44% (arthroscopy), respectively. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) rate were elevated in 45.83% and 38.41% of the patients respectively.ConclusionsTo our knowledge, this study is the largest sample size of PVNS patients reported as well as the largest sample of PVNS with concurrent AVN reported to date. Our outcomes suggest that PVNS shows a female predominance, occurs mostly between 20-40 years and favors the knee and hip. Recurrence is frequent, particularly in the knee. Serum ESR and CRP may be elevated in some patients. Additionally, the present study supports the theory of an association between PVNS and orthopedic surgery, which is not limited to joint replacement.

Dataset Information

Open or Arthroscopic Synovectomy Is the Preferred Management Option in Pigmented Villonodular Synovitis of the Hip Joint Without Evidence of Degeneration: A Systematic Review of 20 Studies.

Purpose

Methods

Results

Conclusion

Level of evidence

Publications

Open or Arthroscopic Synovectomy Is the Preferred Management Option in Pigmented Villonodular Synovitis of the Hip Joint Without Evidence of Degeneration: A Systematic Review of 20 Studies.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets