PIGMENTED VILLONODULAR SYNOVITIS - CASE-R EPORTS AND REVIEW OF THE LITERATURE

Because this disease is so rare the optimum treatment of pigmented vil lonodular synovitis (PVNS), in particular the diffuse form differs in the literature. The most important surgical procedures are arthroscopi c and open synovectomy. The prevention of disease progression, as well as joint destruction and dysfunction, depends upon the early diagnosi s of PVNS. During 1994 and 1995, we treated four cases of PVNS surgica lly and followed the patients for a time period of more than 12 months . Two patients were treated with complete synovectomy, one patient und erwent partial synovial resection, and in the final case an arthrodesi s was performed. Our results indicate that an MRI is essential for dia gnosis and treatment planning. For the localized form of PVNS, it appe ars that a partial synovectomy is appropriate. However, in the event o f diagnostic uncertainty or obvious diffuse involvement of the synoviu m, a total synovectomy is indicated because of the high recurrence rat e. In our study all four patients had disease involving secondary bony lesions and, in one case, joint destruction. Based on bur findings, i t is clear that early surgical therapy is the only recommended curativ e intervention. The decision regarding the surgical approach, arthrosc opic versus open, depends on the form of PVNS, the extent of the disea se and secondary changes of the joint.