The use of surgery and yttrium 90 in the management of extensive and diffuse pigmented villonodular synovitis of large joints

Objective. The surgical treatment of extensive diffuse pigmented villonodular synovitis (PVNS) of large joints alone is unsatisfactory, with high rates of local recurrence. Postsynovectomy adjuvant treatment with external beam radiation therapy or intra-articular injection of yttrium 90 (Y-90) yielded better results. We report our experience with 10 cases treated with debulking surgery followed by intra-articular injection of Y-90. Patients and methods. Between January 1989 and June 1998, 10 patients (eight males and two females aged 15-49 yr) with extensive diffuse PVNS were treated. In six patients the knee joint, in three patients the ankle joint, and in one patient the hip joint were involved. The 10 patients underwent 15 operations, one patient had three surgical procedures, and three patients underwent two surgeries (the intervals between re-operations for local recurrence were 2-4 yr). All patients had an intra-articular injection of 15-25 mCi (555-925 MBq) Y-90, 6-8 weeks after the last surgery. Results. Mean follow-up time was 6 yr (range 2.5-12 yr). All patients were followed using repeated computerized tomography (CT) scans, magnetic resonance imaging (MRI), plain X-ray films and bone scans semi-annually. In nine patients, neither evidence of disease nor progression of bone or articular destruction were noted. In one patient, stabilization of disease was achieved with no further evidence of bony or articular damage. No complications were noticed after surgery or after the intra-articular 90Y injection. Conclusion. A combination of debulking surgery with intra-articular injection of Y-90 for extensive diffuse PVNS of major joints is a reliable treatment method, with good results.