Aims

Intra-articular ⁹⁰Yttrium (⁹⁰Y) is an adjunct to surgical treatment by synovectomy for patients with diffuse-type tenosynovial giant-cell tumour (dtTGCT) of the knee, with variable success rates. Clinical information is, however, sparse and its value remains unclear. We investigated the long-term outcome of patients who underwent synovectomy with and without adjuvant treatment with ⁹⁰Yttrium.

Aims

Approved by the Food and Drug Administration in 2004, the Phase III Oxford Medial Partial Knee is used to treat anteromedial osteoarthritis (AMOA) in patients with an intact anterior cruciate ligament. This unicompartmental knee arthroplasty (UKA) is relatively new in the United States, and therefore long-term American results are lacking.

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.

Cite this article: Bone Joint J 2015;97-B:550–7.

Giant cell tumours (GCT) of the synovium and tendon sheath can be classified into two forms: localised (giant cell tumour of the tendon sheath, or nodular tenosynovitis) and diffuse (diffuse-type giant cell tumour or pigmented villonodular synovitis). The former principally affects the small joints. It presents as a solitary slow-growing tumour with a characteristic appearance on MRI and is treated by surgical excision. There is a significant risk of multiple recurrences with aggressive diffuse disease. A multidisciplinary approach with dedicated MRI, histological assessment and planned surgery with either adjuvant radiotherapy or systemic targeted therapy is required to improve outcomes in recurrent and refractory diffuse-type GCT.

Although arthroscopic synovectomy through several portals has been advocated as an alternative to arthrotomy, there is a significant risk of inadequate excision and recurrence, particularly in the posterior compartment of the knee. For local disease partial arthroscopic synovectomy may be sufficient, at the risk of recurrence. For both local and diffuse intra-articular disease open surgery is advised for recurrent disease. Marginal excision with focal disease will suffice, not dissimilar to the treatment of GCT of tendon sheath. For recurrent and extra-articular soft-tissue disease adjuvant therapy, including intra-articular radioactive colloid or moderate-dose external beam radiotherapy, should be considered.

Introduction: Substitution treatment and radiosynoviorthesis has a leading role in preventing irreversible hemophilic arthropaties. Aim: The aim of the study is to evaluate the effects of radiosynovectomy on the length of intervals between subsequent bleedings in patients with hemophilic synovitis. Materials and Methods: 33 joints were treated with radiosynovectomy in 28 patients with bleeding disorders. 90Y colloid was used in knees and 186Re colloid for elbow, shoulder and ankle. 20 patients were on prophylaxis. X-rays of treated joints were evaluated on Peterson scale between 0 (normal) and 13 (severe joint destruction). In observation period (range 6 – 44 months) bleeding episodes were recorded and data statistically analyzed. Results: Before RS, the average interval between haemorrhages was 16.4 days. Immediately after RS, the average interval between haemorrhages more than tripled. Namely, the average length of the first non-bleeding interval after RS was almost 60 days. In the period covering the first five bleeding episodes after RS, the average non-bleeding interval increased to 47.1 days. Therapeutic effects of RS considerably depend on location (joint) of bleeding, damage of the joint and of the patient. But controlling for location and damage of the joint and age of the patient, after RS every sub sequent non-bleeding interval was 11% shorter (p=0.05) than previous non-bleeding interval. After more than 10 bleeding episodes had occurred since RS, the non-bleeding intervals were no longer significantly shorter than before RS (at p=0.05). Therapeutic response to RS could be, therefore, observed in the period of more than 430 days after the procedure. Conclusion: Radiosynovectomy significantly reduces hemorrhages in target joints for the average period of 14 months. It is more efficient in patients with less affected joints and less efficient in younger patients. The therapeutic effect of RS diminished with the elapse of time