Villonodular synovitis: pigmented and nonpigmented variations

During the past 20 years, 34 cases of pigmented villonodular synovitis have been seen at Jackson Memorial Hospital, University of Miami Medical Center. There were 18 cases in the knee, eight in the hip, one in the elbow, two in the finger, three in the ankle, one in the wrist, and one in the sternoclavicular joint. In reviewing the pathology slides, it was difficult to differentiate fibrous histiocytoma from villonodular synovitis. The cause is considered to be inflammatory. The treatment is subtotal synovial resection with joint replacement as necessary. Recurrences after synovectomy are rare, with none in our series of 34, and only two cases lost to follow-up. I believe synovectomy and debridement to be the treatment of choice, although in the hip, the more destructive pressures involving the acetabulum may force the replacement of the total joint. Radiation therapy has not been used in the treatment of this condition at the University of Miami.