What Is the Best Treatment for Pigmented Villonodular Synovitis With Swelling?

Arthur Kavanaugh, MD

Disclosures

October 20, 2005

Question

A 47-year-old white woman presents with right knee villonodular synovitis. Three years ago she underwent synovectomy. Two months ago she presented with right knee pain with impressive swelling. What are the best therapeutic options for this patient?

Luiz Guedes-Barbosa, MD

Response from Arthur Kavanaugh, MD

Pigmented villonodular synovitis (PVN) is often considered a "nonmalignant tumor."[1] Davidson and Bentley[1] reported a case of a nodular variant of pigmented villonodular synovitis of the knee that developed following laser treatment. This case lends weight to the etiologic association with the pathologic processes of the response to trauma. As PVN typically affects one joint, as seems to be the case for this patient, local rather than systemic therapy is often the preferred initial treatment. Surgical resection, typically using an arthroscopic approach, is often temporarily successful; however, recurrence is common, seen in approximately 30% to 50% of cases. Repeat surgical intervention is, of course, one option. Although not used widely in North America, radio-synovectomy has been noted to have prolonged responses anecdotally. Unfortunately, the relative low frequency of occurrence of this condition has resulted in few controlled clinical trials.

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