PVNS of the Knee – Pigmented Villonodular Synovitis

What is PVNS of the Knee?

PVNS is the acronym for pigmented villonodular synovitis. PVNS of the knee is a relatively common condition in adults and can cause painful symptoms such as pain, tenderness and stiffness in the joint. PVNS can occur in any joint, but is most often found in the knee. Dr. Benedict Nwachukwu, orthopedic knee specialist serving patients in Manhattan, New York City and the surrounding New York boroughs is well trained and highly experienced in treating the uncommon and complex condition of PVNS in the knee.

Nodular PVNS causing mechanical symptoms in the knee joint

What Causes PVNS in the Knee?

Pigmented villonodular synovitis is caused by abnormal growth of the tissue that lines the knee joint known as the synovium. The synovium is an internal membrane within the joint that helps the joint move freely. In PVNS, the synovium grows abnormally, causing inflammation. The condition is a tumor-like growth process called neoplastic, and is a benign non-malignant growth which ultimately leads to chronic knee pain associated with joint damage and arthritis.

Is PVNS Rare?

PVNS in the knee and in any other joint is a very rare condition affecting only 2 in 1-million people. For this reason, it’s important to consult with Dr. Nwachukwu, who has experience treating this painful condition. He can successfully treat patients with this rare condition.

What are the symptoms of PVNS in the Knee?

Most commonly, adults ages 50 and over have symptoms of PVNS and the disease has the potential to progress rapidly. Symptoms typically include:

• Rapid swelling of the joint
• Moderate or mild pain in the knee
• Pain that worsens with movement
• Decrease in range of motion, inability to fully bend or straighten the knee
• Catching or locking sensation in the knee
• Weakness in the knee, feeling like the knee will collapse
• Warmth or tenderness over the joint

How is PVNS diagnosed?

Proper diagnosis from a skilled orthopedic specialist such as Dr. Nwachukwu is vital to receiving proper treatment. For patients in New York, PVNS is diagnosed based on MRI scans, XRs can be obtained to assess for joint status and any degeneration. If an injury has occurred and an X-ray or MRI has been ordered, periarticular erosions and/or loose bodies may be seen and treatment will need to be prescribed. A current MRI is helpful in assessing the extent of PVNS the knee and allowing appropriate decisions to be made regarding treatment.

How is pigmented villonodular synovitis treated?

There is not an effective non-surgical treatment for pigmented villonodular synovitis. Thus, most cases are handled surgically in order to obtain a definitive diagnosis and prevent progression to joint destruction. Dr. Nwachukwu may use one or more of the following:

• Arthroscopic Knee Surgery: A minimally invasive procedure that uses several small incisions. Dr. Nwachukwu uses a small surgical camera, placed inside the knee through one of the incisions and then uses small, specialized instruments, placed in other incisions to operate within the knee. During the PVNS procedure, he will remove the tumor and the damaged areas of the joint lining. This is called a synovectomy.
• Open Surgery: On occasion, arthroscopic surgery does not allow Dr. Nwachukwu enough room to remove the entire tumor in the knee. If this is the case, he will perform an open procedure which uses a slightly larger incision instead of several small incisions. This will allow him to see the entire joint space, where he can visualize the entire tumor in the front or the back of the knee.
• Joint Replacement Surgery: If PVNS has caused enough damage and arthritis has caused the joint to become unrepairable, Dr. Nwachukwu can replace all or part of it. Once the damaged areas are removed, new components can be used to replace the joint. PVNS doesn’t typically return after joint replacement.
• Tendon Repair: PVNS can damage the tendon in the knee. If this occurs, Dr. Nwachukwu can repair the tendon by sewing it back together. If the tendon has been damaged beyond repair, he will replace the tendon with a graft.
• Biologic Medicine: Dr. Nwachukwu can suggest several biologic options for treating PVNS in the knee. Because each case of PVNS is very individualized, a consultation with Dr. Nwachukwu regarding Biologic Therapies is a great first step in treating your PVNS.

How long is the recovery after PVNS arthroscopic surgery?

Following arthroscopic synovectomy, patients can bear weight as tolerated and recovery often takes 6 weeks or more. During this recovery time, patients will be encouraged to participate in physical therapy with a qualified therapist. Physical therapy will continue to help the patient maintain full range of motion of the knee as well as to strengthen the surrounding muscles. Recovery time will vary, based on the patient’s age, health and type of PVNS as well as treatment. In general, most patients with a minimal treatment return to their normal work, sports and play activities within a few months.

For more resources on pigmented villonodular synovitis (PVNS) of the knee and the treatment options available, please contact the office of Benedict Nwachukwu, MD, orthopedic knee specialist serving Manhattan, New York City and surrounding New York boroughs.