Total Synovectomy and Bone Grafting/Cementation after Curettage of the Bone Lesion in Diffuse Type of Tenosynovial Giant Cell Tumor: A Retrospective Cohort Study‎

Document Type : RESEARCH PAPER

Authors

Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

Abstract

Objectives: Although the diffuse type of tenosynovial giant cell tumor (D-TGCT) is rare, bone 
involvement is common in such lesions. However, the optimal management of bone lesions in D -TGCT 
is not well-described. In this study, we reported the outcomes of total synovectomy, curettage, and 
bone grafting/cementation in the treatment of D-TGCT with subchondral bone involvement. We also 
described the prevalence, demographic, and characteristic features of the lesions.
Methods: In a retrospective study, we included 13 patients with D-TGCT of large joints and associated subchondral 
cyst/cyst-like bone lesions of ≥ 5 mm that were managed with total synovectomy and curettage. Cavities with a bone 
defect of ≤ 30 mm (n=12) were filled with bone grafts. Cavities of > 30 mm (n=1) were augmented with bone cement. 
The limb function was evaluated by the Musculoskeletal Tumor Society (MSTS) score.
Results: The study population consisted of 6 (46.1%) males and 7 (53.9%) females with a mean age of 30 ± 7.9 
years. The most frequent sites of involvement were the knees and ankle joints (n=5 each, 38.5%). The mean followup of the patients was 69.2 ± 32.9 months. The mean MSTS score of the patients was obtained at 98.2 ± 3.2 (range 
90-100). The D-TGCT recurred in two patients, both of which were in the synovium. Postoperative complications 
were three cases of transient pain and one case of knee joint stiffness. While no patient had an osteoarthritic change 
in preoperative radiographs, two patients had osteoarthritic change (grade II) in the last follow-up, one in the knee 
and one in the hip.
Conclusion: Curettage and filling the defect with bone graft or cement are adequate treatments for managing bone 
lesions in D-TGCT.
 Level of evidence: IV

Keywords

Main Subjects

References

1. Burton TM, Ye X, Parker ED, Bancroft T, Healey J. Burden of 
Illness Associated with Tenosynovial Giant Cell Tumors. Clin 
Ther. 2018; 40(4):593-602.e 1. doi: 
10.1016/j.clinthera.2018.03.001.
2. Myers BW, Masi AT, FEIGENBAUM SL. Pigmented 
villonodular synovitis and tenosynovitis: a clinical 
epidemiologic study of 166 cases and literature review. 
Medicine (Baltimore). 1980; 59(3):223-238.
3. Ogilvie-Harris D, McLean J, Zarnett M. Pigmented villonodular 
synovitis of the knee. The results of total arthroscopic 
synovectomy, partial, arthroscopic synovectomy, and 
arthroscopic local excision. J Bone Joint Surg Am. 1992; 
74(1):119-123.
4. Palmerini E, Staals EL, Maki RG, et al. Tenosynovial giant cell 
tumour/pigmented villonodular synovitis: outcome of 294 
patients before the era of kinase inhibitors. Eur J Cancer. 
2015; 51(2):210-217. doi: 10.1016/j.ejca.2014.11.001.
5. Dorwart RH, Genant HK, Johnston WH, Morris JM. Pigmented 
villonodular synovitis of synovial joints: clinical, pathologic, 
and radiologic features. Am J Roentgenol. 1984; 143(4):877-
85. doi: 10.2214/ajr.143.4.877.
6. Shekhar A, Singh S, Patil SS, Tapasvi SR. Osteochondral lesion 
in diffuse pigmented villonodular synovitis of the knee. Knee 
Surg Relat Res. 2019; 31(1):67. doi: 10.5792/ksrr.18.015.
7. Temponi EF, Barros AAG, Paganini VO, Barbosa VAK, Badet R, 
Carvalho LHd. Diffuse pigmented villonodular synovitis in 
knee joint: diagnosis and treatment. Rev Bras Ortop. 2017; 
52:450-457. doi: 10.1016/j.rboe.2017.06.008.
8. Imakiire N, Fujino T, Morii T, et al. Malignant pigmented 
villonodular synovitis in the knee - report of a case with rapid 
clinical progression. Open Orthop J. 2011; 5:13-6. doi: 
10.2174/1874325001105010013. 1. Burton TM, Ye X, Parker ED, Bancroft T, Healey J. Burden of 
Illness Associated with Tenosynovial Giant Cell Tumors. Clin 
Ther. 2018; 40(4):593-602.e 1. doi: 
10.1016/j.clinthera.2018.03.001.
2. Myers BW, Masi AT, FEIGENBAUM SL. Pigmented 
villonodular synovitis and tenosynovitis: a clinical 
epidemiologic study of 166 cases and literature review. 
Medicine (Baltimore). 1980; 59(3):223-238.
3. Ogilvie-Harris D, McLean J, Zarnett M. Pigmented villonodular 
synovitis of the knee. The results of total arthroscopic 
synovectomy, partial, arthroscopic synovectomy, and 
arthroscopic local excision. J Bone Joint Surg Am. 1992; 
74(1):119-123.
4. Palmerini E, Staals EL, Maki RG, et al. Tenosynovial giant cell 
tumour/pigmented villonodular synovitis: outcome of 294 
patients before the era of kinase inhibitors. Eur J Cancer. 
2015; 51(2):210-217. doi: 10.1016/j.ejca.2014.11.001.
5. Dorwart RH, Genant HK, Johnston WH, Morris JM. Pigmented 
villonodular synovitis of synovial joints: clinical, pathologic, 
and radiologic features. Am J Roentgenol. 1984; 143(4):877-
85. doi: 10.2214/ajr.143.4.877.
6. Shekhar A, Singh S, Patil SS, Tapasvi SR. Osteochondral lesion 
in diffuse pigmented villonodular synovitis of the knee. Knee 
Surg Relat Res. 2019; 31(1):67. doi: 10.5792/ksrr.18.015.
7. Temponi EF, Barros AAG, Paganini VO, Barbosa VAK, Badet R, 
Carvalho LHd. Diffuse pigmented villonodular synovitis in 
knee joint: diagnosis and treatment. Rev Bras Ortop. 2017; 
52:450-457. doi: 10.1016/j.rboe.2017.06.008.
8. Imakiire N, Fujino T, Morii T, et al. Malignant pigmented 
villonodular synovitis in the knee - report of a case with rapid 
clinical progression. Open Orthop J. 2011; 5:13-6. doi: 
10.2174/1874325001105010013.

The Archives of Bone and Joint Surgery
Volume 11, Issue 5
May 2023
Pages 342-347

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History

  • Receive Date: 04 September 2022
  • Revise Date: 28 September 2022
  • Accept Date: 05 January 2023

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