Table 1.
Summary of Studies in Patients With TGCT in Knee
| Study (No. of pts) | Study Design (Tx Period), LOE | Dx, F/U | Tx | Efficacya | Complicationsa |
| Surgery | |||||
| Colman et al14 (n = 48) | Retrospective cohort (1993-2011) LOE: III |
Diffuse PVNS F/U: 40b mo |
All arthroscopic Sv (n = 26) versus open/arthroscopic Sv (n = 11) versus open/open Sv (n = 11) | Recurrence: total (50%); all arthroscopic (62%); open/arthroscopic (9%); open/open (64%) (P = 0.008) Multiple recurrences: total (27%); all arthroscopic (35%); open/arthroscopic (0%); open/open (36%) (P = 0.07) |
All arthroscopic: hemarthrosis (8%); DVT (4%) Open/arthroscopic: hemarthrosis (9%); stiffness requiring MUA (9%) Open/open: superficial wound infection (9%) |
| Georgiannos et al15 (n = 44) | Retrospective cohort (1990-2006) LOE: III |
Localized PVNS F/U: 12c yr |
Arthroscopically assisted mini-open partial Sv (n = 21) versus arthroscopic excision of lesion (n = 23) | From preop to last follow-up, mean Lysholm and Ogilvie-Harris scores improved in both groups (P < 0.05); no differences between groups (P = 0.06) Recurrence: mini-open partial Sv (4.8%); arthroscopic excision of lesion (0) (P = 0.1) |
CRPS: mini-open partial Sv (10%); arthroscopic excision of lesion (0) (P = 0.06) No other complications |
| Gu et al16 (n = 41) | Retrospective cohort (2002-2010) LOE: III |
Diffuse PVNS F/U: 2.9c yr |
Anteroposterior open surgical resection (n = 20) versus modified multidirectional arthroscopic surgery (n = 21) | IKDC and Lysholm scores were similar between groups preop and higher in arthroscopic surgery group at 1-yr and 3-yr postop (P < 0.001) Recurrence: open surgery (22%); arthroscopic surgery (6%) (P ≥ 0.05) |
Postop bleeding (mL): open surgery (332 ± 79); arthroscopic surgery (154 ± 44) (P < 0.001) Complications: NR |
| Jabalameli et al17 (n = 26) | Retrospective cohort (1996-2012) LOE: III |
Localized PVNS (n = 11) or diffuse PVNS (n = 15) F/U: 4.6c yr |
Subtotal Sv (n = 5) or total Sv (n = 21) | Recurrence: 7.7% Mean KSS: preop (63.1 ± 6.7); postop (77.8 ± 9.3) (P < 0.009) |
No postop knee instability, infection, or neurovascular injury |
| Jain et al18 (n = 40) | Retrospective cohort (1987-2012) LOE: III |
Localized PVNS (n = 11) or diffuse PVNS (n = 29) F/U: 7c yr |
Local excision for localized PVNS; arthroscopic Sv for diffuse PVNS | Recurrence: first (30%; 3-12 mo postop); second (12%; 14-18 mo postop); third (5%; 2-yr postop) RFS: 1-yr (69%); 2-yr (82%); 5-yr (57%) |
No postop infection, neurovascular damage, DVT, or wound healing |
| Keyhani et al19 (n = 21) | Retrospective cohort (2009-2012) LOE: III |
Diffuse PVNS F/U: 5c yr |
Arthroscopic complete Sv | Local recurrence: 10% (without clinical signs during follow-up) ROM:c preop (83 ± 6), postop (127 ± 7) (P < 0.001) Lysholm score:c preop (49 ± 2), postop (81 ± 4) (P < 0.001) IKDC score:c preop (47 ± 1), postop (79 ± 1) (P < 0.001) |
No op or postop complications (ie, no swelling, infection, joint stiffness, or neurovascular lesions) |
| Patel et al20 (n = 214) | Retrospective cohort (2002-2015) LOE: III |
Localized PVNS (n = 100) or diffuse PVNS (n = 114) F/U: 25c mo |
Surgery (n = 184 pts; 86%): arthroscopic Sv (n = 23); combined arthroscopic and open Sv (n = 4); open anterior or posterior Sv (n = 46); open anterior and posterior Sv (n = 42); open localized Sv (n = 65); distal femur arthroplasty (n = 1); TKA (n = 3) Conservative management (n = 28; 13%): 14% had surgery at later stage |
Successful tx (no need for further surgery): 87.5% Recurrence: first (30%); second (6.5%) Arthroscopic versus open recurrence: localized PVNS (9.1% versus 8.6%; P > 0.05); diffuse PVNS (83.3% versus 44.8%; RR = 1.86; 95% CI, 1.32–2.62; P = 0.0004) |
Postop: 9.8% (of which 89% were from open surgery) Types of postop complications: Superficial wound infection (n = 6); foot drop (n = 3); hemarthrosis (n = 3); stiffness requiring manipulation under anesthesia (n = 2); complex regional pain syndrome (n = 2); blistering from tourniquet (n = 1); DVT (n = 1) |
| van der Heijden et al21 (n = 30) | Retrospective cohort (1980-2011) LOE: III |
DTGCT F/U: 64c mo |
Open Sv (n = 14) or arthroscopic Sv (n = 16) | Recurrence: initial open Sv (n = 4; 29%); initial arthroscopic Sv (n = 15; 94%) Of pts tx'd with initial arthroscopic Sv, 15 underwent open Sv |
Initial open Sv: recurrent hemarthrosis and secondary OA (n = 1); multiple recurrences and OA of knee after 3 open Sv (n = 1) Initial arthroscopic Sv: recurrent disease and OA (n = 2) |
| Verspoor et al22 (n = 91; study also included some demographic data on 13 with PVNS in other areas) |
Retrospective cohort (1985–2011) LOE: III |
Primary and recurrent, localized PVNS (n = 27) or diffuse PVNS (n = 64) F/U: 7.0c yr |
Localized PVNS: All pts treated by open or arthroscopic Sv Diffuse PVNS: Open or arthroscopic synovectomy (n = 53);90yttrium RSO (n = 7); unknown (n = 4) |
Localized PVNS: RFS: 1-yr (83%); 5-yr (69%) Diffuse PVNS: RFS: 1-yr (68%); 5-yr (32%); 10-yr (25%); 15-yr (16%) |
Localized PVNS: Postop: superficial wound infection (n = 1); deep infection (n = 1); femoral nerve neuropathy (n = 1) Diffuse PVNS: Postop: delayed wound healing (n = 2); local paresthesia (n = 1); stiffness (n = 5); superficial wound infections (n = 4); neurolysis (n = 1); hematoma (n = 3); deep wound infections (n = 2); percutaneous fistula (n = 1) |
| Adjuvant 90yttrium RSO | |||||
| Durr et al23 (n = 32 pts who underwent 37 surgeries) Pts included in Capellen et al25 |
Retrospective cohort (1996-2014) LOE: III |
Diffuse PVNS F/U: 49b mo |
All pts had open Sv Adjuvant RSO administered after 26 surgeries (70%) No adjuvant RSO administered after 11 surgeries (30%) |
Recurrence: all pts (24%; 9 surgeries); pts treated with RSO (23%; 6 surgeries); no RSO (27%; 3 surgeries) | NR |
| Gortzak et al 24 (n = 56) |
Retrospective cohort (1991-2014) LOE: III |
Diffuse TGCT F/U: 7.3c yr |
Pts had Sv + RSO (n = 34) or SV alone (n = 22) Types of Sv in RSO versus no RSO groups: open (29% versus 45%); arthroscopy (62% versus 40%); combined (3% versus 4%); unknown (6% versus 9%)—for comparisons, (P > 0.05) |
Residual disease (asymptomatic recurrence): RSO (44%) versus no RSO (50%); (P > 0.05) No significant differences in overall physical health and mental health scores, perception of pain, and patient satisfaction |
Sv + RSO group: none reported Sv alone group: infection (n = 1); skin ulcer from injection (n = 1) Degenerative changes at x-ray: RSO (n = 14; 41%); no RSO (n = 5; 23%)—none warranted treatment |
CI = confidence interval, CRPS = chronic regional pain syndrome, DTGCT = diffuse-type giant cell tumor, DVT = deep vein thrombosis, Dx = diagnosis, F/U = follow-up, IKDC = International Knee Documentation Committee, KSS = Knee Society Score, LOE = level of evidence, MUA = manipulation under anesthesia; NR = not reported, OA = osteoarthritis, op = operative, open/arthroscopic = open posterior with arthroscopic anterior, open/open = open anterior with open posterior, postop = postoperatively, preop = preoperatively, pts = patients, PVNS = pigmented villonodular synovitis, RFS = recurrence-free survival, ROM = range of motion, RR = relative risk, RSO = radiosynoviorthesis, Sv = synovectomy, TGCT = tenosynovial giant cell tumor, TKA = total knee arthroplasty, Tx = treatment
a
Percentage of patients, unless otherwise indicated.
b
Median.
c
Mean or average.