A Case of Pigmented Villonodular Synovitis of Knee Managed by Subtotal Synovectomy

Abstract

A 21 year old Male, House keeper from Nellore, Presented with Complaints of pain & swelling of (R) knee for  1 year ( on & off) more for the past 6 months. No H/O trauma or known contact with pulmonary tuberculosis. Pain was dull aching, not radiating, relieved by medications, aggravated by work & activity, but swelling remained static with progressive decrease in range of motion. There was  H/O night pain and H/O loss of weight 6-8 kgs in 6 months, with No H/O fever, multiple joint pains or similar complaints in family members. He had no addictive habbitis or allergy to any substance/drugs. On examination:- diffusely swellen (rt) knee, with positive patellar tap, synovial thickening was palpable over medial femoral condyle and suprapatellar pouch, without any joint line/bony tenderness.Range of motion was  0-30 degrees and further painful, there was no limb length discrepancy or distal neurovascular deficits.He had antalgic gait. Ultrasound showed synovial effusion.CBC with platelets & ESR were within Normal limits. LFT With Serum Proteins & Cholestrol were within Normal Limits. Fluid tap yielded Straw  yellow coloured fluid, with culture and sensitivity showing  no growth of organisms, AFB & Gram stain analysis were negative, MRI OF (Rt) KNEE showed diffuse thickening of synovium with effusion. Biopsy was taken gene expert was negative for tuberculosis and histopathological examination was found in consistency with villonodular synovitis. We went ahead to do subtotal synovectomy. Post operatively patient had significant pain relief and considerable reduction in swelling. We did not opt for adjuvant radiotherapy as it was possible to remove the affected synovium completely in our patient and because of the potential significant risks like radionecrosis of the soft tissue and infertility involved with radiotherapy in a young male. Patient had 0-100 degrees of pain free knee flexion in 12 month follow up with no signs of recurrence.