Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Hip Using Puncture Capsulotomy
Pigmented villonodular synovitis (PVNS) is a monoarticular, benign tumor arising from the synovium. Although classically treated with open synovectomy, arthroscopic treatment has demonstrated good clinical outcomes. The arthroscopic management of hip PVNS has been described as technically challengin...
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| Format: | Article |
| Language: | English |
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Elsevier
2019-06-01
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| Series: | Arthroscopy Techniques |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2212628719300362 |
| _version_ | 1819063407865757696 |
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| author | Mark R. Nazal, M.P.H. Ali Parsa, M.D. Scott D. Martin, M.D. |
| author_facet | Mark R. Nazal, M.P.H. Ali Parsa, M.D. Scott D. Martin, M.D. |
| author_sort | Mark R. Nazal, M.P.H. |
| collection | DOAJ |
| description | Pigmented villonodular synovitis (PVNS) is a monoarticular, benign tumor arising from the synovium. Although classically treated with open synovectomy, arthroscopic treatment has demonstrated good clinical outcomes. The arthroscopic management of hip PVNS has been described as technically challenging due to difficulty obtaining the appropriate exposure. The purpose of this technical report is to describe a novel technique that allows for sound excision of PVNS during hip arthroscopy using a puncture capsulotomy. Full visualization throughout the central and peripheral compartments is key to achieving meticulous surgical excision and ablation, with careful attention to the medial and lateral synovial folds and gutters. It is important to avoid chondral injury by using a high outflow rate of irrigation to maintain a constant temperature, to ablate the blood supply of nodular lesions, and to not use a shaver as this may disseminate tumor cells. Multifactorial advancements in hip arthroscopy have permitted adequate visualization and exposure of PVNS lesions, making them amenable to arthroscopic synovectomy. Puncture capsulotomy does not require capsular closure, preserves the iliofemoral ligament, and minimizes exposure of extra-articular structures to the hip joint environment. Recurrence rates are lower in arthroscopic management compared with open management, at 7.7% and 17.8%, respectively. |
| first_indexed | 2024-12-21T15:14:11Z |
| format | Article |
| id | doaj.art-40ed54d697e8474b968b3be7a41218a4 |
| institution | Directory Open Access Journal |
| issn | 2212-6287 |
| language | English |
| last_indexed | 2024-12-21T15:14:11Z |
| publishDate | 2019-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroscopy Techniques |
| spelling | doaj.art-40ed54d697e8474b968b3be7a41218a42022-12-21T18:59:13ZengElsevierArthroscopy Techniques2212-62872019-06-0186e641e646Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Hip Using Puncture CapsulotomyMark R. Nazal, M.P.H.0Ali Parsa, M.D.1Scott D. Martin, M.D.2Sport Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.ASport Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.A; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Address correspondence to Ali Parsa, M.D., Suite 400, 175 Cambridge St, Boston, MA, 02118, U.S.A.Sport Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.APigmented villonodular synovitis (PVNS) is a monoarticular, benign tumor arising from the synovium. Although classically treated with open synovectomy, arthroscopic treatment has demonstrated good clinical outcomes. The arthroscopic management of hip PVNS has been described as technically challenging due to difficulty obtaining the appropriate exposure. The purpose of this technical report is to describe a novel technique that allows for sound excision of PVNS during hip arthroscopy using a puncture capsulotomy. Full visualization throughout the central and peripheral compartments is key to achieving meticulous surgical excision and ablation, with careful attention to the medial and lateral synovial folds and gutters. It is important to avoid chondral injury by using a high outflow rate of irrigation to maintain a constant temperature, to ablate the blood supply of nodular lesions, and to not use a shaver as this may disseminate tumor cells. Multifactorial advancements in hip arthroscopy have permitted adequate visualization and exposure of PVNS lesions, making them amenable to arthroscopic synovectomy. Puncture capsulotomy does not require capsular closure, preserves the iliofemoral ligament, and minimizes exposure of extra-articular structures to the hip joint environment. Recurrence rates are lower in arthroscopic management compared with open management, at 7.7% and 17.8%, respectively.http://www.sciencedirect.com/science/article/pii/S2212628719300362 |
| spellingShingle | Mark R. Nazal, M.P.H. Ali Parsa, M.D. Scott D. Martin, M.D. Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Hip Using Puncture Capsulotomy Arthroscopy Techniques |
| title | Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Hip Using Puncture Capsulotomy |
| title_full | Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Hip Using Puncture Capsulotomy |
| title_fullStr | Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Hip Using Puncture Capsulotomy |
| title_full_unstemmed | Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Hip Using Puncture Capsulotomy |
| title_short | Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Hip Using Puncture Capsulotomy |
| title_sort | arthroscopic treatment of pigmented villonodular synovitis of the hip using puncture capsulotomy |
| url | http://www.sciencedirect.com/science/article/pii/S2212628719300362 |
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