Radiosynovectomy in pigmented villonodular synovitis

Background: Pigmented villonodular synovitis (PVS) is a very rare disorder characterized by a slowly progressive benign proliferation of synovial tiss ue. As yet, the mainstay of its treatment has been surgical or athroscopic synovectomy. However, the relapse rates reported ore relatively high, rangi ng between 8% and 46%. The aim of this study was to evaluate the efficacy o f a combined treatment with radiosynovectomy (RS) and surgical synovectomy. Method: We studied the effect of thirteen radiosynovectomies performed in eleven pigmented villonodular synovitis patients with Y-90 citrate or Re-18 6 sulfide. All patients had undergone intraarticular radiation therapy with in 6 months after surgical synovectomy. Eight patients suffered from pigmen ted villonodular synovitis in the knee, the remaining three from pigmented villonodular synovitis in the hip. Two of eleven patients had to be treated twice, due to a relapse of symptoms occurring four months after the first treatment. Therapy responses were evaluated one year after the initial radi osynovectomy. Clinical response was assessed on three-point rating scores e valuating the degree of hydrops, rubor, and motility as well as the degree of pain, these four parameters were then averaged to on overall clinical sc ore (CS). We also quantified the relative uptake of Tc-99m-diphosphonate in the joint involved on the blood pool (BUR) and delayed images (DUR). Resul ts: Clinical score decreased from 5.45 +/- 1.04 to 1.18 +/- 1.16 at one yea r after treatment (p < 0.005), and the blood pool from 0.51 +/- 0.36 to 0.0 8 +/- 0.44 (p < 0.005). Delayed images were not significantly changed: 0.66 +/- 0.71 versus 0.66 +/- 0.73 (p = 0.3). Conclusion: A combination of surg ical synovectomy with radiosynovectomy is highly efficacious in treating cl inical symptoms of pigmented villonodular synovitis. It also improves bone scintigraphic signs of inflammation, but has no influence on late diphospho nate uptake.