Efficacy Analysis Of Synoviectomy For Pigmented Villonodular Synovitis Of Knee Joint

Objective:To study the effect of synoviectomy in the treatment of pigmented villonodular synovitis(PVNS)of the knee,and to compare the effect of open synoviectomy with arthroscopic synoviectomy,in order to further provide a reference for the selection of surgical methods for patients with Pigmented villonodular synovitis of the knee.Methods:Retrospective analysis was performed on 24 patients with pigmented villonodular synovitis of the knee who received open synoviectomy via arthrotomy or arthroscopic synoviectomy via arthroscopy from January 2014 to December 2020 in the Department of Orthopedics,Bethune Hospital Affiliated to Shanxi Medical University.According to the surgical methods,they were divided into open surgery group and arthroscopic surgery group.The general information of the patients was recorded and collected,and the patients were required to be reexamined regularly after surgery.The recurrence rate was calculated based on the patients’ symptoms,signs and MRI or pathological examination.The knee function of each patient was evaluated preoperatively and at the last follow-up.The scoring system used the knee Lyshlom score.Paired t test was performed for Lysholm score of knee joint of patients at preoperative and last follow-up using SPSS24.0 statistical software.The standard value α =0.05,P < 0.05,indicated statistically significant difference.Results:All the 24 patients with pigmented villonodular synovitis of the knee included in this study had unilateral knee lesions,of which 8 cases involved the popliteal fossa tissue after the synovial tissue was broken through,and 6 cases had a history of knee trauma.There were 14 cases in females(58%)and 10 cases in males(42%).Their age ranges from 26 to 63 years,with an average age of 41 years.The preoperative course was 6 to85 months,with an average of 31 months.There were 13 patients in the open surgery group and 11 patients in the arthroscopic surgery group,and 8 patients in the open surgery group had additional open incision behind the knee due to diseased synovial tissue entering the popliteal fossa.None of the 24 patients had significant vascular and nerve injury,non-healing and delayed healing of the wound,infection,deep venous thrombosis of lower limbs and other related complications.The follow-up time of 24 patients ranged from 6 to 81 months,with an average of 32 months.24 patients were observed in 3 patients after knee joint pain,swelling,and by MRI or pathological examination diagnosis of postoperative recurrence,postoperative recurrence rate was 13%(3/24),the open surgery group of 13 patients had 2 cases of patients with recurrence of the communist party of China,the postoperative recurrence rate was 15%(2/13),and arthroscopic treatment of 11 patients,only 1 case of recurrence of patients,postoperative recurrence rate was 9%(1/11).The recurrence time of the 3patients was 16 months(open surgery group),34 months(arthroscopic surgery group)and 52 months(open surgery group),respectively,and the average recurrence time was34 months after surgery.A total of 5 patients(21%,5/24)developed joint stiffness,including 4 patients(31%,4/13)in the open surgery group and only 1 patient(9%,1/11)in the arthroscopic surgery group.The preoperative Lysholm score of the knee joint in the open surgery group was(43±6.25)points,while that in the arthroscopic surgery group was(45±7.63)points,and the difference was not statistically significant(t=16.473,P > 0.05).At the last follow-up,the Lysholm score of the knee joint in the open surgery group was(78±8.65)points,which was higher than that before surgery(43 ± 6.25)points,and the difference was statistically significant(t=26.842,P< 0.05).At the last follow-up,the Lysholm score of the knee joint in the arthroscopic surgery group was(93±4.25)points,which was higher than that before surgery(45±7.63)points,and the difference was statistically significant(t=13.357,P< 0.05).The knee Lysholm score of the arthroscopic surgery group at the last follow-up was(93±4.25)points,which was higher than that of the open surgery group at the last follow-up(78±8.65)points,and the difference was statistically significant(t=23.256,P< 0.05).Conclusion:Synoviectomy is reliable in the treatment of pigmented villonodular synovitis of the knee,and there is no significant difference in the postoperative recurrence rate between open synoviectomy and arthroscopic synoviectomy in the treatment of pigmented villonodular synovitis of the knee,but the incidence of postoperative joint stiffness in the patients with pigmented villonodular synovitis of the knee undergoing arthroscopic synoviectomy is lower,and the postoperative knee function is better.