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Functional improvement and low recurrence rate after combined staged synovectomy and external radiotherapy for diffuse pigmented villonodular synovitis of the knee: a minimum 2 years’ follow-up case series
  1. Mohamed ElAttar,
  2. Hossam Fathi,
  3. Fahmy Samir Fahmy
  1. Orthopedic Surgery Department, Zagazig University Faculty of Human Medicine, Zagazig, Egypt
  1. Correspondence to Dr Mohamed ElAttar, Orthopedic surgery Department, Zagazig University Faculty of Human Medicine, Zagazig 44519, Egypt; attar2006{at}


Objective Treatment of diffuse pigmented villonodular synovitis (DPVNS) of the knee is problematic and controversial with a high rate of morbidities and local recurrence. The purpose of this study is functional evaluation of patients with diffuse knee PVNS treated with combined surgical and external radiosynovectomy.

Methods Between June 2011 and May 2015, twelve patients (four males and eight females) with DPVNS of the knee were treated by staged surgical synovectomy (arthroscopic anterior and open posterior) followed by low-dose external radiation. SF-36, Musculoskeletal Tumor Society (MSTS), Lysholm, International Knee Documentation Committee (IKDC) scores and range of motion (ROM) were assessed preoperatively and at the final follow-up.

Results After a mean follow-up period of 46.7±15 (25–72) months, there were statistically significant improvement of ROM from 72.5±17.6 to 94.2±7.01, Lysholm score from 42.8±5.2 to 78.1±5.1, IKDC from 39.6±8.3 to 75.3±6, MSTS from 5.6±2.7 to 19.7±6.06 and SF-36 score from 29.4±7.5 to 72.3±17.5. Apart from limited range of motion, three mild complications were encountered (superficial wound infection, repeated effusion and transient neuropraxia).

Conclusion Combined staged synovectomy and external radiotherapy provide functional improvement of the knee and quality of patients’ lives with low rate of recurrence for knee DPVNS cases.

Level of evidence Prospective case series; level IV.

  • staged synovectomy
  • external radiation
  • PVNS
  • diffuse
  • knee

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  • Contributors ME, HF and FSF all had substantial contributions to the design of the work, the acquisition, analysis and interpretation of data for the work. They shared drafting the work or revising it critically for important intellectual content. They finally approved this version to be published, and they agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. ME is also the main surgeon of all the cases.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Faculty ethics committee approval no. 124/2018.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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