Managing Extensive Pigmented Villonodular Synovitis with Wide Resection and Endoprosthesis Replacement at the Elbow...

Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder of the synovium, characterized by hemosiderin deposition. Two distinct forms of PVNS are recognized: diffuse and localized. The precise surgical management of the diffuse type remains a matter of debate. This discussion examines limb salvage through endoprosthetic reconstruction for diffuse PVNS.

Two cases of extensive PVNS underwent endoprosthetic reconstruction of the elbow and ankle joints, respectively. Functional outcome scores were recorded as predictors of the results.

Both patients made favorable recoveries. Three years after surgery, the patient with the elbow endoprosthesis received an MSTS score of 80% and a TESS score of 85%, while the patient with the ankle prosthesis attained an 80% score in both MSTS and TESS.

Managing extensive and recurrent PVNS is challenging. Total synovectomy combined with adjuvant intraarticular radiation therapy reduces the risk of recurrence. However, wide resection with endoprosthesis replacement may be considered in cases of persistent disease with extra-articular involvement.