Clinical Effect Of Surgery Combined Radiotherapy In Pigmented Villonodular Synovitis

Objective:To compare the clinical effects of arthroscopic synovectomy under joint articular cavity postoperative radiotherapy with arthroscopic synovectomy alone to treat the diffused pigmented villonodular synovitis of the knee joint,and summarize thr effective treatment way to reduce the disease recurrence.Methods:57 cases of diffused pigmented villonodular synovitis of the knee which were diagnosed by MRI, arthroscopy and pathological examination had been treated from January 2009 to October 2014. All the 57 cases were monoarticular and these patients got two kinds of treatments:30 cases were only treated by arthroscopic synovectomy, including16 males and 14 females,with a mean age of (36.4+13.70);27 cases were treated by arthroscopic synovectomy associated with intra-articular radiotherapy, including 17 males and 10 females, with a mean age of (36.6 ± 14.31). The Lysholm score system and the International Knee Documentation Committee (IKDC) 2000 score system were used to evaluate the clinical outcome for all the patients. In the follow-up survey, every patient should be tested through the ROM(range of mothion), the recurrence, complications and the Lysholm score and the IKDC 2000 score.Results:All the patients got a mean follow-up period (31.3±17.80) months. There were no statistically differences between the two groups in terms of genders and ages. In the group where patients treated by arthroscopic synovectomy:the Lysholm score was 48.8±8.67 preoperatively and 83.4±5.99 at the last follow-up. There was significant statistical differences (t=17.986, P<0.05). And the preoperative IKDC 2000 score was 54.2±6.84and 84.6±6.63 at the last follow-up. There was significant statistical differences (t=17.961, P<0.05).The group of patients treated by arthroscopic synovectomy associated with intra-articular radiotherapy:the Lysholm score was 49.0 ± 9. llpreoperatively and 85.1±5.91 at the last follow-up. There was significant statistical differences between the two periods (t=17.283, P<0.05), and the IKDC 2000 score was 52.3±7.20 preoperatively and 85.8 ±6.61 at the last follow-up (t=17.819, p<0.05). The ROM of the knee in the group of patients treated by arthroscopic synovectomy:(54.5± 18.82) ± preoperatively, and (118.5+12.61) ± at the last follow-up. There were significant statistical differences between the two periods (t=15.470, P<0.05). The ROM of the knee in the group of patients treated by arthroscopic synovectomy associated with intra-articular radiotherapy: (55.3±18.74) ° preoperatively, and (119.6±13.37) ° at the last follow-up (t=14.513, P<0.05). About the recurrence rate:9 patients suffered recurrence in the patients treated by arthroscopic synovectomy; 2 patients suffered recurrence in the patients treated by arthroscopic synovectomy associated with intra-articular radiotherapy. There were significant statistical differences between the two groups on the recurrence rate(X2=5.747, P<0.05).3 patients suffered slight edema,2 patients suffered slight pain, but no patient underwent infection in the patients treated by arthroscopic synovectomy. Among the patients treated by arthroscopic synovectomy associated with intra-articular radiotherapy, 6 patients suffered obvious pain,4 patients got skin pigmentation and 4 patients suffered slight edema. There were significant statistical differences between the two groups on the complications rate (X2=6.518, P<0.05).Conclussion:It can significantly reduce the recurrence under the treatment of arthroscopic synovectomy under joint articular cavity postoperative radiotherapy in the diffused pigmented villonodular synovitis of the knee joint, and the founction score is similar, but its complications is higher than arthroscopic synovectomy alone.