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.
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Authors | B Mollon, A Lee, J W Busse, A M Griffin, P C Ferguson, J S Wunder, J Theodoropoulos |
Journal | The bone & joint journal
(Bone Joint J)
Vol. 97-B
Issue 4
Pg. 550-7
(Apr 2015)
ISSN: 2049-4408 [Electronic] England |
PMID | 25820897
(Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
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Copyright | ©2015 The British Editorial Society of Bone & Joint Surgery. |
Topics |
- Humans
- Knee Joint
(surgery)
- Neoplasm Recurrence, Local
- Radiotherapy, Adjuvant
- Synovectomy
- Synovitis, Pigmented Villonodular
(radiotherapy, surgery)
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