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. 2014;5(7):419-23.
doi: 10.1016/j.ijscr.2014.04.031. Epub 2014 May 13.

A rare case of extensive diffuse nonpigmented villonodular synovitis as a cause of total knee arthroplasty failure

Hacı Bayram Tosun  1 , Abuzer Uludağ  2 , Sancar Serbest  3 , Seyitali Gümüştaş  2 , Ibrahim Halil Erdoğdu  4
Affiliations

A rare case of extensive diffuse nonpigmented villonodular synovitis as a cause of total knee arthroplasty failure

Hacı Bayram Tosun et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Nonpigmented villonodular synovitis (non-PVNS) is a benign proliferative disease involving the synovium. It is a rare condition that is little recognized. Non-PVNS has been reported as a cause of total knee replacement failure.

Presentation of case: We report a case of extensive diffuse non-PVNS in a patient with tibial component loosening after total knee replacement and review the related literature.

Discussion: It is reported that pigmented villonodular synovitis (PVNS) occurs less frequently than non-PVNS after knee replacement. However, there are many more case reports of PVNS than non-PVNS after knee arthroplasty in the English-language literature.

Conclusion: Previously, there were no reported cases of extensive diffuse non-PVNS after total knee arthroplasty (TKA). This case study highlights an unusual case of non-PVNS as a cause of TKA failure. We propose that non-PVNS should be considered as a differential diagnosis in patients after TKA who present with recurrent pain and effusion/hemarthrosis of the knee, and that it is one of the causes of implant loosening after TKA.

Keywords: Component loosening; Nonpigmented villonodular synovitis; Revision knee arthroplasty; Total synovectomy.

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Figures

Fig. 1
Fig. 1
Pre-operative anteroposterior (a) and lateral (b) radiographs of the knee show loosening and osteolysis under the tibial component in the medial compartment.
Fig. 2
Fig. 2
Perfusion, blood pool, static phase, and anteroposterior whole-body images (three-phase bone imaging using technetium 99 m methylene diphosphonate). Periprosthetic hyperperfusion, hyperemia, and increased periprosthetic activity are seen around the tibial component of a right total knee replacement.
Fig. 3
Fig. 3
Before (a) and after (b) synovectomy. Intra-operative photographs of the knee show diffuse papillae and nodules in the proliferating synovium, with yellow-brown areas (typical appearance of villonodular synovitis).
Fig. 4
Fig. 4
Post-operative anteroposterior (a) and lateral (b) radiographs of the knee show acceptable alignment and a well-fixed tibial component after revision total knee replacement.
Fig. 5
Fig. 5
(a) Photomicrograph of the specimen shows the synovial cell layer which is formed from different sized and shaped cellular areas surrounding the papillary villous structures (hematoxylin and eosin (H&E) staining, original magnification 40×). (b) Photomicrograph showing synovial proliferation with multinucleated giant cells, histiocytes, and a small number of lymphocytes under synovial cell structures surrounding the papillary villous (H&E, original magnification 40×). (c) Immunohistochemically there is diffuse infiltration of CD68-positive histiocytes (original magnification 20×).
See this image and copyright information in PMC

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