PVNS of the Knee, Treatment

What is PVNS of the Knee?

Pigmented villonodular synovitis or PVNS of the knee is a condition which can cause painful symptoms in the knee. Knee tenderness, pain and stiffness in the joint is caused when the synovium (a layer of tissue that lines the joints) thickens and overgrows. The overgrowing tissue results in a tumor that is not cancerous, but can become progressive, causing damage in the knee which leads to arthritis. PVNS can occur in any joint in the body but is most commonly seen in the knee. Dr. Benedict Nwachukwu, orthopedic knee surgeon 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.

What is the treatment for PVNS of the knee?

Pigmented villonodular synovitis in the knee is best treated by surgery. The goal of PVNS treatment is to remove the tumor, overgrown synovium, and the damaged areas of the joint lining. Depending on the progression of knee PVNS, Dr. Nwachukwu may perform one or more of the following surgical treatments:

• Arthroscopic synovectomy: Dr. Nwachukwu will most commonly perform knee arthroscopy in order to remove PVNS. Arthroscopy is a minimally invasive type of treatment that uses a camera to look inside the knee and remove the damaged or overgrown synovium from the joint.
• Tendon Repair: PVNS of the knee can damage the tendons in the knee if this occurs, Dr. Nwachukwu will repair a torn tendon by sewing it back together.
• Tendon Reconstruction: If the tendon has been damaged beyond repair, Dr. Nwachukwu he will replace the tendon with a graft from the patient (autograft) or from a tissue bank (allograft).
• Knee Arthroplasty: Also called a total knee replacement. If left untreated, PVNS can create enough joint damage in the knee to cause arthritis. If the joint becomes unrepairable, Dr. Nwachukwu can replace all or a portion of the knee. Once the damaged areas are removed, new metal and plastic components called a prosthesis, can be used to replace the knee joint.
• Radiation: Radiation therapy has been beneficial in shrinking PVNS tumors and is sometimes used to treat widespread, diffuse PVNS. Radiation is usually reserved for patients who have not been successful with standard surgery techniques.
• Drug or Biologic Therapy: Recently there have been studies using drug or biologic therapy for PVNS of the knee. Dr. Nwachukwu can discuss if these options are right for you, as well as the risks and benefits of each option.

How is PVNS treatment performed?

Dr. Nwachukwu will perform the best possible treatment for your type of knee pigmented villonodular synovitis. He takes into consideration the patient age, activity level and how far the PVNS has progressed. The treatment will be performed using one of the following methods:

• Arthroscopic Knee Surgery: A minimally invasive procedure that uses several small incisions. Dr. Nwachukwu uses a small surgical camera, called an arthroscope, which is placed inside the knee through a small incision and then uses small, specialized instruments, placed in other incisions to operate within the knee.
• Open Knee Surgery: On occasion, arthroscopic surgery does not allow Dr. Nwachukwu enough room to remove the entire PVNS tumor in the knee. If this is the case, he will perform an open knee surgery which uses a slightly larger incision instead of several small incisions. Open knee surgery allows for better visualization of the entire joint space, where he can locate and remove the entire tumor in the front or the back of the knee.

Does knee PVNS come back?

If the patient is treated with joint replacement, PVNS does not typically return. Localized PVNS very rarely returns in the knee after surgery. However, diffuse PVNS (where the condition more wide-spread and involves the whole joint) has a higher risk of returning. 10 – 30% of patients with diffuse PVNS may need a joint replacement due to joint degeneration and recurrence. Diffuse PVNS patients will also need to follow up with Dr. Nwachukwu for several years.

What is the recovery time after PVNS surgery?

The recovery time after PVNS surgery will vary greatly, depending on the surgical procedure used.  In general patients in the New York area can expect the following from each procedure:

• Arthroscopic synovectomy:
  • Patients can bear weight as tolerated.
  • Recovery often takes 6+ weeks.
  • Physical therapy is essential for full recovery.
  • Normal work, sports and play can occur within a few months.
• Total Knee Replacement:
  • Patients should follow the post-surgical protocols given by Dr. Nwachukwu.
  • Rehabilitation begins with passive motion exercises and progresses to active motion exercises.
  • Physical therapy is progressive and will establish strength and range of motion.
  • Normal daily activities are allowed 3-6 weeks after surgery.
  • Unrestricted activities can occur 3-4 months after surgery.
  • It can take up to a year for the knee to function at a pre-injury level.

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