PVNS is a benign tumor that originates from the synovial
tissue of the joint, the soft tissue lining the tendons
and the bursa (a fluid filled saclike bodily cavity between
the tendons and bones that ensures smooth motion). This
benign synovial tumor becomes pigmented when haemosiderin
from the blood gets deposited within it. It is found mostly
in the knee and hip, but has been less commonly identified
in most other joints, and affects either sex, mainly between
the ages of 20 and 45.
PVNS is locally aggressive, and may spread to erode adjacent
bone and tissue structures, sometimes reaching out of the
confines of the joint capsule, if it is not treated early.
It is sometimes known to grow into the adjacent bone structures
themselves by following the vascular (blood vessel) channels
of the bone. However, on average, the disease is not identified
correctly until about 4 and a half years after presentation,
as it is similar to many other joint conditions such as
inflammatory arthritis or ligament instability, and is
much more subtly detectable. Early diagnosis of the
disease requires meticulous examination of the radiographic
imagery (x-ray, and MRIs) of the joint, of the symptoms,
and is confirmed by biopsy.
Symptoms can include stiffness and swelling of the joint
due to extra fluid created by the synovial lining, a popping
sensation when in motion, pain, tenderness, and a loss
of range of motion: patients have a slightly decreased
ability to flex and extend the joint. Normally, symptoms
are monoarticualr (in one knee or one side of the hip)
and start slowly, becoming sporadic in the later stages
of PVNS. The tumor can occur in two severities: diffuse,
affecting the entire synovium or nodular, only affecting
a localized area.
Case Study: D.R. - Diffuse PVNS Synovectomy and
Total Knee Replacement
In April 2004, D.R. , a 66 year old athletic individual
came to The Stone Clinic for a right knee evaluation.
He had been diagnosed in 2001 with diffuse PVNS and underwent
an arthroscopic synovectomy in 2002. Extensive meniscal
and bone damage was observed and total knee replacement
was recommended. He decided to continue his active lifestyle
in hopes of avoiding total knee replacement. Yet, in
2004, his soreness increased significantly and he couldn’t
ride the stationary bike for more than 20 minutes, or
walk more than one-half mile. This is when he approached
The Stone Clinic and Dr. Stone for further evaluation.
His PVNS had recurred and become diffuse, eroding the surrounding
meniscal and bone structures. He was in need of synovectomy,
resection of tumor, neuroplasty and total knee replacement
-- the whole package. The pigmented hyperplastic synovium
was separated from the rest of the joint (Figure 1) and then
completely removed (Figure 2). Extensive osteoarthritis was
present (Figure 3), and total knee replacement was performed.
diffuse PVNS tumor after synoviym being separated from
the knee joint
Osteoarthritis present after resection of tumor and synovectomy
He is now recovered, having a well placed knee replacement
and no sign of PVNS recurrence.