Advertisement for orthosearch.org.uk
Results 1 - 20 of 65
Results per page:
The Bone & Joint Journal
Vol. 95-B, Issue 3 | Pages 384 - 390
1 Mar 2013
Stevenson JD Jaiswal A Gregory JJ Mangham DC Cribb G Cool P

Pigmented villonodular synovitis (PVNS) is a rare benign disease of the synovium of joints and tendon sheaths, which may be locally aggressive. We present 18 patients with diffuse-type PVNS of the foot and ankle followed for a mean of 5.1 years (2 to 11.8). There were seven men and 11 women, with a mean age of 42 years (18 to 73). A total of 13 patients underwent open or arthroscopic synovectomy, without post-operative radiotherapy. One had surgery at the referring unit before presentation with residual tibiotalar PVNS. The four patients who were managed non-operatively remain symptomatically controlled and under clinical and radiological surveillance. At final follow-up the mean Musculoskeletal Tumour Society score was 93.8% (95% confidence interval (CI) 85 to 100), the mean Toronto Extremity Salvage Score was 92 (95% CI 82 to 100) and the mean American Academy of Orthopaedic Surgeons foot and ankle score was 89 (95% CI 79 to 100). The lesion in the patient with residual PVNS resolved radiologically without further intervention six years after surgery. Targeted synovectomy without adjuvant radiotherapy can result in excellent outcomes, without recurrence. Asymptomatic patients can be successfully managed non-operatively. This is the first series to report clinical outcome scores for patients with diffuse-type PVNS of the foot and ankle. Cite this article: Bone Joint J 2013;95-B:384–90


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 7 | Pages 995 - 997
1 Jul 2011
Li LM Jeffery J

Pigmented villonodular synovitis (PVNS) is a rare benign neoplastic proliferation of synovial tissue which is typically localised and usually responds well to surgery and/or radiotherapy. We present a case of unusually aggressive of PVNS of the hip in a 73-year-old woman


The Journal of Bone & Joint Surgery British Volume
Vol. 50-B, Issue 2 | Pages 290 - 305
1 May 1968
Byers PD Cotton RE Deacon OW Lowy M Newman PH Sissons HA Thomson AD

1. The literature on pigmented villonodular synovitis has been reviewed and a series of eighty additional cases is reported. 2. The condition usually presents either as a nodule in a finger or knee, or as a diffuse lesion in a knee. The lesions, although benign, sometimes erode or invade the tissue of adjacent bones. 3. Distinction from malignant synovioma can be made on the basis of the macroscopic appearance of the lesion at operation (relationship to joints or tendon sheaths: villonodular appearance: pigmentation), and by histological examination. 4. Treatment of the nodular form by excision is satisfactory but extensive synovectomy for diffuse lesions of the knee gives poor results. 5. The etiology of pigmented villonodular synovitis is unknown, but it appears to be a self-limiting process, possibly inflammatory in nature


The Bone & Joint Journal
Vol. 97-B, Issue 4 | Pages 550 - 557
1 Apr 2015
Mollon B Lee A Busse JW Griffin AM Ferguson PC Wunder JS Theodoropoulos J

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


The Journal of Bone & Joint Surgery British Volume
Vol. 50-B, Issue 2 | Pages 306 - 311
1 May 1968
Scott PM

1. Five cases of pigmented villonodular synovitis with associated lesions within bone are recorded, two in the hip, two in the knee and one in the elbow. 2. The mode of formation of these intraosseous lesions is explained and methods of treatment are discussed


The Journal of Bone & Joint Surgery British Volume
Vol. 67-B, Issue 4 | Pages 564 - 566
1 Aug 1985
Howie C Smith G Christie J Gregg P

Torsion and subsequent ischaemia is a well-recognised cause of symptoms and morbidity in general surgery. We present three cases of solitary pigmented villonodular tumours of the knee which were found to have undergone torsion. We believe these to be the first intra-articular tumours in which torsion has been reported


The Journal of Bone & Joint Surgery British Volume
Vol. 50-B, Issue 2 | Pages 312 - 317
1 May 1968
Schajowicz F Blumenfeld I

A case of unusually extensive pigmented villonodular synovitis of the wrist with involvement of bone, particularly of the distal end of the radius, is reported. The clinical and radiographic evidence suggested a diagnosis of primary bone tumour, possibly a giant-cell tumour with sarcomatous transformation


The Journal of Bone & Joint Surgery British Volume
Vol. 56-B, Issue 1 | Pages 69 - 77
1 Feb 1974
Gershuni-Gordon DH Axer A

1. Synovitis was induced in the hip joints of fifty-six rabbits by the intra-articular injection of surgical talc. The opposite hip joint and eleven suitable"sham" operations served as controls. 2. The results in the hips injected with talc were as follows. Widening of the medial joint space and sometimes acetabular changes were seen; enlargement of the femoral head and neck in two planes was found, with, in most cases, flattening of the superior aspect of the head; there was thickening of the joint cartilage and sometimes deformity of the capital epiphysis; thickening of the cartilage was the main cause of the coxa magna, cervix magna and ischium magnum. 3. The embryology, micro-anatomy and development of the hip joint is reviewed and attention is drawn to the configuration of the layers of germinal cartilage cells. The effect of an induced synovitis in producing hyperplasia of the joint cartilage, incongruity of the articulating surfaces and subsequent subluxation is discussed


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 4 | Pages 682 - 683
1 Jul 1996
VERNON-ROBERTS B


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 1 | Pages 168 - 168
1 Jan 1996
SHENOY RM


The Bone & Joint Journal
Vol. 103-B, Issue 4 | Pages 788 - 794
1 Apr 2021
Spierenburg G Lancaster ST van der Heijden L Mastboom MJL Gelderblom H Pratap S van de Sande MAJ Gibbons CLMH

Aims

Tenosynovial giant cell tumour (TGCT) is one of the most common soft-tissue tumours of the foot and ankle and can behave in a locally aggressive manner. Tumour control can be difficult, despite the various methods of treatment available. Since treatment guidelines are lacking, the aim of this study was to review the multidisciplinary management by presenting the largest series of TGCT of the foot and ankle to date from two specialized sarcoma centres.

Methods

The Oxford Tumour Registry and the Leiden University Medical Centre Sarcoma Registry were retrospectively reviewed for patients with histologically proven foot and ankle TGCT diagnosed between January 2002 and August 2019.


The Journal of Bone & Joint Surgery British Volume
Vol. 48-B, Issue 1 | Pages 1 - 3
1 Feb 1966
Mason M


The Journal of Bone & Joint Surgery British Volume
Vol. 48-B, Issue 1 | Pages 56 - 63
1 Feb 1966
Mann TS

1. Five elderly patients who suffered acute synovitis of one or both knee joints are reported.

2. All showed radiological evidence in several joints of cartilage calcification.

3. It is suggested that the synovitis in each case was due to calcium irritation of the synovial membrane.

4. In three of the patients it is shown that the synovial fluid calcium content was raised during the acute attack.

5. In all patients acute symptoms were relieved by aspiration of the effusion.


The Journal of Bone & Joint Surgery British Volume
Vol. 52-B, Issue 1 | Pages 100 - 107
1 Feb 1970
Hardinge K

A careful study of children with transient synovitis of the hip has failed to establish any connection with infection by staphylococci or streptococci, with allergy, with viral infection and with trauma.


The Journal of Bone & Joint Surgery British Volume
Vol. 45-B, Issue 3 | Pages 471 - 476
1 Aug 1963
Adams JA

1. Transient synovitis is an acute, and at times exudative, condition of the synovial membrane.

2. There is no particular association with injury or with upper respiratory infection.

3. The course is short and benign with complete resolution. The occasional hip with chronic or recurrent symptoms can be distinguished from Legg-Perthes' disease by the shorter history, normal radiographs and the complete resolution.

4. There is no evidence that transient synovitis leads to avascular changes in the femoral head.


The Bone & Joint Journal
Vol. 101-B, Issue 3 | Pages 272 - 280
1 Mar 2019
Verspoor FGM Mastboom MJL Hannink G van der Graaf WTA van de Sande MAJ Schreuder HWB

Aims

The aim of this study was to evaluate health-related quality of life (HRQoL) and joint function in tenosynovial giant cell tumour (TGCT) patients before and after surgical treatment.

Patients and Methods

This prospective cohort study run in two Dutch referral centres assessed patient-reported outcome measures (PROMs; 36-Item Short-Form Health Survey (SF-36), visual analogue scale (VAS) for pain, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)) in 359 consecutive patients with localized- and diffuse-type TGCT of large joints. Patients with recurrent disease (n = 121) and a wait-and-see policy (n = 32) were excluded. Collected data were analyzed at specified time intervals preoperatively (baseline) and/or postoperatively up to five years.


The Bone & Joint Journal
Vol. 100-B, Issue 7 | Pages 984 - 988
1 Jul 2018
Gortzak Y Vitenberg M Frenkel Rutenberg T Kollender Y Dadia S Sternheim A Morag G Farkash U Rath E Kramer M Drexler M

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.

Patients and Methods

All patients with dtTGCT of the knee who underwent synovectomy between 1991 and 2014 were included in the study. Group A patients underwent synovectomy and an intra-articular injection of 90Yttrium between six and eight weeks after surgery. Group B patients underwent surgery alone.


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 2 | Pages 322 - 323
1 Mar 1996
Li PLS Chakrabarti AJ Dowell JK


The Bone & Joint Journal
Vol. 96-B, Issue 8 | Pages 1111 - 1118
1 Aug 2014
van der Heijden L Mastboom MJL Dijkstra PDS van de Sande MAJ

We retrospectively reviewed 30 patients with a diffuse-type giant-cell tumour (Dt-GCT) (previously known as pigmented villonodular synovitis) around the knee in order to assess the influence of the type of surgery on the functional outcome and quality of life (QOL). Between 1980 and 2001, 15 of these tumours had been treated primarily at our tertiary referral centre and 15 had been referred from elsewhere with recurrent lesions.

The mean follow-up was 64 months (24 to 393). Functional outcome and QOL were assessed with range of movement and the Knee injury and Osteoarthritis Outcome Score (KOOS), the Musculoskeletal Tumour Society (MSTS) score, the Toronto Extremity Salvage Score (TESS) and the SF-36 questionnaire. There was recurrence in four of 14 patients treated initially by open synovectomy. Local control was achieved after a second operation in 13 of 14 (93%). Recurrence occurred in 15 of 16 patients treated initially by arthroscopic synovectomy. These patients underwent a mean of 1.8 arthroscopies (one to eight) before open synovectomy. This achieved local control in 8 of 15 (53%) after the first synovectomy and in 12 of 15 (80%) after two. The functional outcome and QOL of patients who had undergone primary arthroscopic synovectomy and its attendant subsequent surgical procedures were compared with those who had had a primary open synovectomy using the following measures: range of movement (114º versus 127º; p = 0.03); KOOS (48 versus 71; p = 0.003); MSTS (19 versus 24; p = 0.02); TESS (75 versus 86; p = 0.03); and SF-36 (62 versus 80; p = 0.01).

Those who had undergone open synovectomy needed fewer subsequent operations. Most patients who had been referred with a recurrence had undergone an initial arthroscopic synovectomy followed by multiple further synovectomies. At the final follow-up of eight years (2 to 32), these patients had impaired function and QOL compared with those who had undergone open synovectomy initially.

We conclude that the natural history of Dt-GCT in patients who are treated by arthroscopic synovectomy has an unfavourable outcome, and that primary open synovectomy should be undertaken to prevent recurrence or residual disease.

Cite this article: Bone Joint J 2014; 96-B:1111–18.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 7 | Pages 882 - 888
1 Jul 2012
van der Heijden L Gibbons CLMH Dijkstra PDS Kroep JR van Rijswijk CSP Nout RA Bradley KM Athanasou NA Hogendoorn PCW van de Sande MAJ

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.