Loosening of Total Knee Arthroplasty Associated with Pigmented Villonodular Synovitis: Case Presentation and Literature Review

  • Tomás Nicolino Knee Arthroscopy and Arthroplasty Sector, Instituto de Ortopedia y Traumatología “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina https://orcid.org/0000-0002-9550-3713
  • Juan Ignacio Pérez Abdala Knee Arthroscopy and Arthroplasty Sector, Instituto de Ortopedia y Traumatología “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina https://orcid.org/0000-0002-5398-6876
  • Ignacio García-Mansilla Knee Arthroscopy and Arthroplasty Sector, Instituto de Ortopedia y Traumatología “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina https://orcid.org/0000-0002-7247-3734
  • Juan Astoul Bonorino Knee Arthroscopy and Arthroplasty Sector, Instituto de Ortopedia y Traumatología “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina https://orcid.org/0000-0001-6798-8242
Keywords: Pigmented villonodular synovitis, total knee arthroplasty, revision total knee arthroplasty, hemarthrosis

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.

Downloads

Download data is not yet available.

Author Biographies

Tomás Nicolino, Knee Arthroscopy and Arthroplasty Sector, Instituto de Ortopedia y Traumatología “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina
Knee Arthroscopy and Arthroplasty Sector, Instituto de Ortopedia y Traumatología “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina
Juan Ignacio Pérez Abdala, Knee Arthroscopy and Arthroplasty Sector, Instituto de Ortopedia y Traumatología “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina
Knee Arthroscopy and Arthroplasty Sector, Instituto de Ortopedia y Traumatología “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina
Ignacio García-Mansilla, Knee Arthroscopy and Arthroplasty Sector, Instituto de Ortopedia y Traumatología “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina
Knee Arthroscopy and Arthroplasty Sector, Instituto de Ortopedia y Traumatología “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina
Juan Astoul Bonorino, Knee Arthroscopy and Arthroplasty Sector, Instituto de Ortopedia y Traumatología “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina
Knee Arthroscopy and Arthroplasty Sector, Instituto de Ortopedia y Traumatología “Prof. Dr. Carlos E. Ottolenghi”, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina

References

Stephan SR, Shallop B, Lackman R, Kim TWB, Mulcahey MK. Pigmented villonodular synovitis: A comprehensive

review and proposed treatment algorithm. JBJS Rev 2016;4(7):e3. https://doi.org/10.2106/JBJS.RVW.15.00086

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

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

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

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

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

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

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

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

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

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

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

Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989;(248):9-12. PMID: 2805470

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

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

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

;25(5):375-84. https://doi.org/10.1007/s00292-004-0710-9

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

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

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

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

;108(2):145-52. https://doi.org/10.1007/s12306-023-00793-y

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

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

Published
2024-10-17
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