PVNS – Pigmented Villonodular Synovitis

What is Pigmented Villonodular Synovitis, or PVNS?

Pigmented villonodular synovitis (PVNS) is condition relatively uncommon in the adult population. It is a painful joint disease that can affect many joints, including the hip, and can be localized to one area of the hip joint or widespread throughout the joint. Synovitis of the hip is caused by abnormal growth of the joint’s lining tissue, known as the synovium. Synovium is the internal lining membrane within mobile and moving joints. The excessive growth of this tissue leads to inflammation of the joint causing hip pain, tenderness and stiffness of the joint. While this condition is a tumor-like growth process (“neoplastic”), it is a benign, non-malignant growth that can ultimately lead to chronic hip pain associated with joint damage and arthritis. Dr. Benedict Nwachukwu, orthopedic hip specialist serving patients in Manhattan, New York City and the surrounding New York boroughs, is well-trained and highly experienced at diagnosing and treating complex and uncommon conditions of the hip like PVNS.

What types of PVNS are there?

There are two types of pigmented villonodular synovitis:

• Localized: Referred to as “nodular” PVNS. Marked by symptoms that are easier to manage, as the pain and swelling occur in just one area of the joint. This type responds well to treatment and is less difficult to treat than diffuse PVNS.
• Non-Localized: Referred to as “diffuse” PVNS. This type is more common than localized PVNS and has a more complex set of symptoms involving the whole joint. Treatment can be complicated.

What are the symptoms of pigmented villonodular synovitis?

Symptoms of PVNS are usually seen in adults under the age of 50 and the disease has the potential to progress rapidly. Symptoms typically include:

• Rapid swelling of the joint,
• Mild to moderate pain in the hip
• Pain that worsens with movement
• Decrease in range of motion
• Joint locking or catching sensation
• The feeling of the hip “giving way” or being unstable

How is PVNS diagnosed?

A proper diagnosis from a skilled orthopedic hip specialist such as Dr. Nwachukwu is vital to receiving proper treatment. For patients in New York, PVNS can often be seen on imaging from an X-ray or an MRI scan. 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 synovitis of the hip and allowing appropriate decisions to be made regarding treatment. In some cases, a surgical biopsy may need to be taken and sent to pathology for an official diagnosis.

How is pigmented villonodular synovitis treated?

There is not an effective non-surgical treatment for pigmented villonodular synovitis (PVNS). Thus, most cases are handled surgically. The surgery to remove the painful, inflamed synovial lining is known as a synovectomy. This can be done partially or in full depending on the extent of synovitis of the hip.

Using an arthroscopic surgical approach, Dr. Nwachukwu will view the localized areas of inflammation and growth and surgically remove the accessible lining using small “key-hole” type incisions. If a total synovectomy is indicated, an open surgery procedure may need to be performed.

What happens after PVNS arthroscopic surgery?

Following a synovectomy, patients are encouraged to avoid full weight-bearing on the affected limb for 4 to 6 weeks to allow the body to recover from the surgery. During this recovery time, patients will avoid certain hip motions but will be allowed to move the hip with the guidance of a therapist. Physical therapy will continue to maintain a full range of motion of the hip 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 return to their normal work and play activities within a few months.

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