Two to 10 years' follow-up of arthroscopic management of pigmented villonodular synovitis in the hip: A case series

摘要

Purpose The purpose of this study was to evaluate the results of arthroscopic treatment for pigmented villonodular synovitis (PVNS) of the hip. Methods All patients undergoing hip arthroscopy are prospectively assessed with a modified Harris Hip Score preoperatively and postoperatively at 3, 12, 24, 60, and 120 months. Thirteen patients were identified with histologically confirmed PVNS and minimum 2-year follow-up. These procedures were performed between 2001 and 2008, during which time a total of 1,640 arthroscopic procedures were performed. There was 100% follow-up at a mean of 63 months (range, 24 to 120 months). There were 9 female and 4 male patients with a mean age of 27 years (range, 14 to 46 years). The pattern of involvement was diffuse in 3 patients, nodular in 3, and combined in 7. Concomitant pathology included 7 articular cartilage lesions (3 grade III and 4 grade IV), 6 labral tears, and 4 cases with femoroacetabular impingement. Results The mean improvement in the Harris Hip Score was 27 points (62 points preoperatively and 89 points postoperatively) (SD, 17 points), with a range of 3 to 56 points. The mean improvement based on pattern of disease was as follows: diffuse, 30 points (SD, 23 points); nodular, 25 points (SD, 18 points); and combined, 26 points (SD, 0.70 points). There were no complications, but one patient was converted to a total hip arthroplasty at 6 years postoperatively. Conclusions In this cohort the results of arthroscopic management of PVNS have been favorable with minimal morbidity. Arthroscopy may be necessary to substantiate the diagnosis, as well as to assess and address other accompanying damage. The procedure must include both the central and peripheral compartments. The secondary damage and prelude to osteoarthritis cannot be reversed and, when severe, make the less invasive nature of the arthroscopic approach especially appealing. Level of Evidence Level IV, therapeutic case series.