Loosening of Total Knee Arthroplasty Associated with Pigmented Villonodular Synovitis: Case Presentation and Literature Review
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Published:
Oct 17, 2024
Keywords:
Pigmented villonodular synovitis, total knee arthroplasty, revision total knee arthroplasty, hemarthrosis
Main Article Content
Abstract
Introduction: Pigmented villonodular synovitis (PVNS) in patients with total knee arthroplasty (TKA) is a rare condition with an unclear etiology that can cause pain, hemarthrosis, or, less commonly, prosthetic loosening. We present the case of a 54-year-old male patient with a left TKA who developed pain and joint effusion three months postoperatively. Radiographs showed signs of loosening, and due to suspicion of infection, a two-stage revision surgery was performed one year after the initial procedure. Pathological synovial tissue was identified, and a radical synovectomy was carried out during the first stage of revision. Histopathological analysis confirmed PVNS. At three years postoperatively, the patient exhibited satisfactory functional recovery with no signs of recurrence.
Conclusion: Considering PVNS as a differential diagnosis in cases of postoperative pain and hemarthrosis is crucial for early diagnosis and appropriate treatment.
Conclusion: Considering PVNS as a differential diagnosis in cases of postoperative pain and hemarthrosis is crucial for early diagnosis and appropriate treatment.
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How to Cite
Nicolino, T., Pérez Abdala, J. I., García-Mansilla, I., & Astoul Bonorino, J. (2024). Loosening of Total Knee Arthroplasty Associated with Pigmented Villonodular Synovitis: Case Presentation and Literature Review. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(5), 528-537. https://doi.org/10.15417/issn.1852-7434.2024.89.5.1964
Section
Case Presentations
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References
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17. Mohanlal P, Pillai D, Jain S. A rare case of pigmented villonodular synovitis after unicompartmental knee
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18. Zhang Y, Joyce M, Schils J, Bauer TW. Coexisting sarcoidal granulomatous inflammation and diffuse tenosynovial giant cell tumor of the knee after a total knee replacement: a case report. Skeletal Radiol 2016;45(12):1735-40. https://doi.org/10.1007/s00256-016-2492-6
19. Tan YC, Tan JY, Tsitskaris K. Systematic review: total knee arthroplasty (TKA) in patients with pigmented
villonodular synovitis (PVNS). Knee Surg Relat Res 2021;33(1):6. https://doi.org/10.1186/s43019-021-00088-1
20. Panciera A, Colangelo A, Di Martino A, Ferri R, Bulzacki Bogucki BD, Cecchin D, et al. Total knee arthroplasty
in pigmented villonodular synovitis osteoarthritis: a systematic review of literature. Musculoskelet Surg
2024;108(2):145-52. https://doi.org/10.1007/s12306-023-00793-y
21. Lin W, Dai Y, Niu J, Yang G, Li M, Wang F. Pigmented villonodular synovitis does not influence the outcomes
following cruciate-retaining total knee arthroplasty: a case-control study with minimum 5-year follow-up. J Orthop Surg Res 2020;15(1):388. https://doi.org/10.1186/s13018-020-01933-x
22. Casp AJ, Browne JA, Durig NE, Werner BC. Complications after total knee arthroplasty in patients with pigmented villonodular synovitis. J Arthroplasty 2019;34(1):36-9. https://doi.org/10.1016/j.arth.2018.08.041
review and proposed treatment algorithm. JBJS Rev 2016;4(7):e3. https://doi.org/10.2106/JBJS.RVW.15.00086
2. Makino A, Múscolo DL, Costa Paz M, Ayerza M. Sinovitis vellonodular pigmentada localizada de rodilla:
diagnóstico con resonancia magnética y su tratamiento artroscópico. Rev Asoc Argent Ortop Traumatol 1997;62(2):257-63. Disponible en: https://aaot.org.ar/revista/1993_2002/1997/1997_2/620214.pdf
3. Söder S, Sesselmann S, Aigner T , Oehler S, Agaimy A. Tenosynovial giant cell tumour (pigmented villonodular
synovitis-)-like changes in periprosthetic interface membranes. Virchows Arch 2016;468(2):231-8.
https://doi.org/10.1007/s00428-015-1874-9
4. Krenn V, Morawietz L, Perino G, Kienapfel H, Ascherl R, Hassenpflug GJ, et al. Revised histopathological
consensus classification of joint implant related pathology. Pathol Res Pract 2014;210(12):779-86.
https://doi,org/10.1016/j.prp.2014.09.017
5. Tosun HB, Uludağ A, Serbest S, Gümüştaş S, Erdoğdu IH. A rare case of extensive diffuse nonpigmented
villonodular synovitis as a cause of total knee arthroplasty failure. Int J Surg Case Rep 2014;5(7):419-23.
https://doi.org/10.1016/j.ijscr.2014.04.031
6. Kia C, O’Brien DF, Ziegler C, Pacheco R, Forouhar F, Williams V. An unusual case of pigmented villonodular
synovitis after total knee arthroplasty presenting with recurrent hemarthrosis. Arthroplast Today 2018;4(4):426-30. https://doi.org/10.1016/j.artd.2018.06.006
7. Camp CL, Yuan BJ, Wood AJ, Lewallen DG. Pigmented villonodular synovitis diagnosed during revision total knee arthroplasty for flexion instability and patellar fracture. Knee 2016;23(2):338-41.
https://doi.org/10.1016/j.knee.2015.11.007
8. Chung BJ, Park YB. Pigmented villonodular synovitis after TKA associated with tibial component loosening.
Orthopedics 2011;34(8):e418-e420. https://doi.org/10.3928/01477447-20110627-27
9. Oni JK, Cavallo RJ. A rare case of diffuse pigmented villonodular synovitis after total knee arthroplasty. J
Arthroplasty 2011;26(6):978.e9-978.e11. https://doi.org/10.1016/j.arth.2010.11.006
10. Ballard WT, Clark CR, Callaghan JJ. Recurrent spontaneous hemarthrosis nine years after a total knee arthroplasty. A presentation with pigmented villonodular synovitis. J Bone Joint Surg Am 1993;75(5):764-7.
https://doi.org/10.2106/00004623-199305000-00018
11. Bunting D, Kampa R, Pattison R. An unusual case of pigmented villonodular synovitis after total knee arthroplasty. J Arthroplasty 2007;22(8):1229-31. https://doi.org/10.1016/j.arth.2006.11.022
12. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat
Res 1989;(248):13-4. PMID: 2805470
13. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989;(248):9-12. PMID: 2805470
14. Ma XM, Xia CY, Fu PL, Liu HM, Yu HY, He J. Unusual cases of pigmented villonodular synovitis after
arthroplasty. Int J Clin Exp Med 2014;7(4):1150-4. PMID: 24955198
15. Onodera T, Tanji H, Majima T, Kamishima T, Minami A. An unusual case of pigmented villonodular synovitis after unicompartmental knee arthroplasty. Int J Case Rep Images 2012;3(9):9-12. https://doi.org/10.5348/ijcri201209173CR
16. Morawietz L, Gehrke T, Classen RA, Barden B, Otto M, Hansen T, et al. Vorschlag für eine KonsensusKlassifikation der periprothetischen Membran gelockerter Hüft- und Knieendoprothesen [Proposal for the classification of the periprosthetic membrane from loosened hip and knee endoprostheses]. Der Pathologe
2004;25(5):375-84. https://doi.org/10.1007/s00292-004-0710-9
17. Mohanlal P, Pillai D, Jain S. A rare case of pigmented villonodular synovitis after unicompartmental knee
replacement: a case report. Cases J 2009;2:9076. https://doi.org/10.1186/1757-1626-2-9076
18. Zhang Y, Joyce M, Schils J, Bauer TW. Coexisting sarcoidal granulomatous inflammation and diffuse tenosynovial giant cell tumor of the knee after a total knee replacement: a case report. Skeletal Radiol 2016;45(12):1735-40. https://doi.org/10.1007/s00256-016-2492-6
19. Tan YC, Tan JY, Tsitskaris K. Systematic review: total knee arthroplasty (TKA) in patients with pigmented
villonodular synovitis (PVNS). Knee Surg Relat Res 2021;33(1):6. https://doi.org/10.1186/s43019-021-00088-1
20. Panciera A, Colangelo A, Di Martino A, Ferri R, Bulzacki Bogucki BD, Cecchin D, et al. Total knee arthroplasty
in pigmented villonodular synovitis osteoarthritis: a systematic review of literature. Musculoskelet Surg
2024;108(2):145-52. https://doi.org/10.1007/s12306-023-00793-y
21. Lin W, Dai Y, Niu J, Yang G, Li M, Wang F. Pigmented villonodular synovitis does not influence the outcomes
following cruciate-retaining total knee arthroplasty: a case-control study with minimum 5-year follow-up. J Orthop Surg Res 2020;15(1):388. https://doi.org/10.1186/s13018-020-01933-x
22. Casp AJ, Browne JA, Durig NE, Werner BC. Complications after total knee arthroplasty in patients with pigmented villonodular synovitis. J Arthroplasty 2019;34(1):36-9. https://doi.org/10.1016/j.arth.2018.08.041