the Cure for Pigmented Villonodular Synovitis in the Knee

Q: the Cure for Pigmented Villonodular Synovitis in the Knee

Hello： In response to your question... <br>pigmented villonodular synovitis can be categorized into two types. <br>The first type is localized and nodular. <br>Clinically, it presents as a single mass or multiple masses that are distinctly separated from the adjacent synovium. <b

Cure of Pigmented Villonodular Synovitis of the Knee Joint

Hello Dr.
Li, I would like to ask a question.
After undergoing surgery four times, I was diagnosed by a physician with pigmented villonodular synovitis of the knee joint.
The doctor at Hospital A, where I had my surgeries, mentioned that there are numerous tumors inside and that the entire knee would need to be opened up to remove the entire synovium, and he could not guarantee a cure.
After being referred, I consulted with a physician at Hospital B, who stated that this condition can be cured, but it requires postoperative radiation therapy to achieve a cure; otherwise, surgery alone will lead to recurrence.
I would like to know if the radiation therapy referred to is cobalt-60? What side effects can be expected after radiation therapy, especially in the joint area? Will it affect my ability to walk in the future? Thank you for your clarification, doctor.

You have an endless supply of knives., 20~29 year old female. Ask Date: 2005/01/03

Dr. Li Wenlin reply Orthopedics

Hello: In response to your question...
pigmented villonodular synovitis can be categorized into two types.
The first type is localized and nodular.
Clinically, it presents as a single mass or multiple masses that are distinctly separated from the adjacent synovium.
The second type is diffuse and is not easily distinguishable from the surrounding synovium.

Regarding treatment, the first type, which is localized, requires excision with a safe margin; in addition to completely removing the obvious nodules, a certain safe margin is taken outward.
The second type, which is diffuse, necessitates total synovectomy of the knee joint.

In terms of surgery alone, whether it is a localized excision or total excision, the recurrence rate is 15%.
Some advocate for postoperative radiation therapy, but its actual effectiveness is uncertain.
The side effects of surgical treatment and radiation therapy include joint stiffness; however, with proper rehabilitation and psychological support, there generally won't be significant functional loss.

Keelung Hospital, Department of Health, Executive Yuan, Li Wen-Lin.

Reply Date: 2005/01/03

More Info

Pigmented Villonodular Synovitis (PVNS) is a rare, benign condition characterized by the proliferation of the synovial membrane in the joints, particularly the knee. It can lead to joint pain, swelling, and decreased range of motion. The treatment for PVNS typically involves surgical intervention to remove the affected synovial tissue, but as you've experienced, recurrence is common.
In your case, having undergone four surgeries indicates a challenging situation, as PVNS can be quite persistent. The recommendation from the first hospital to perform a complete synovectomy (removal of the synovial membrane) is a standard approach, but it does not guarantee that the disease will not return. The second opinion from the second hospital suggesting that radiation therapy post-surgery could lead to a cure is also a recognized treatment strategy.
Radiation therapy, often using isotopes like Cobalt-60, is employed to target any remaining PVNS cells after surgical removal. This treatment aims to reduce the likelihood of recurrence by damaging the DNA of the proliferating cells, thereby inhibiting their ability to grow and multiply.
Regarding your concerns about the side effects of radiation therapy, it is important to note that while radiation can be effective, it does come with potential risks. Common side effects include:
1. Skin Reactions: The area treated with radiation may become red, irritated, or sensitive. This is similar to a sunburn and usually resolves after treatment is completed.

2. Fatigue: Many patients experience fatigue during and after radiation therapy, which can last for several weeks.

3. Joint Stiffness: There may be an increase in stiffness in the treated joint, which can affect mobility. This is particularly concerning in a weight-bearing joint like the knee.

4. Long-term Effects: There is a risk of developing osteoarthritis in the treated joint over time, as radiation can affect the surrounding healthy tissues and cartilage. This could potentially impact your future mobility and quality of life.

5. Secondary Cancers: Although rare, there is a slight risk of developing secondary malignancies in the area that received radiation.

In terms of your walking ability post-treatment, while many patients do regain function, the degree of recovery can vary significantly based on individual circumstances, the extent of the disease, and the effectiveness of the treatment. It is crucial to engage in a rehabilitation program post-surgery and radiation to optimize recovery and maintain joint function.

Given your history and the complexity of your case, it is advisable to have a thorough discussion with your healthcare team about the potential benefits and risks of radiation therapy. They can provide personalized insights based on your specific situation and help you make an informed decision.

In conclusion, while PVNS can be a challenging condition to manage, combining surgical intervention with radiation therapy has shown promise in reducing recurrence rates. However, it is essential to weigh the potential side effects and long-term implications on joint health and mobility. Regular follow-ups and a proactive approach to rehabilitation will be key in managing your recovery and maintaining your quality of life.

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