J Korean Foot Ankle Soc.  2018 Dec;22(4):173-176. 10.14193/jkfas.2018.22.4.173.

Ankle Arthrodesis for Severe Arthritis Induced by Diffuse-Type Pigmented Villonodular Synovitis: A Case Report

• Kim YK
• Suh JS
• Choi JY

• KMID: 2428659
• DOI: http://doi.org/10.14193/jkfas.2018.22.4.173

Abstract

Pigmented villonodular synovitis (PVNS) is a proliferative disease that affects the synovial joint, tendon and bursa. PVNS can form a nodular structure in any joint, but it most commonly affects the knee joint and is rare in the foot and ankle joint. PVNS is divided into two types. Localized-type PVNS exhibits focal involvement with a nodular mass, while diffuse-type PVNS involves the entire synovium. Synovitis of the affected joint can also destroy cartilage and bone. Diffuse type accounts for 75% of PVNS and has a reported recurrence rate of 12.2% to 46%; aggressive synovectomy is recommended as the most effective treatment. In localized-type PVNS, only arthroscopic partial synovectomy is effective with a lower recurrence rate. We report a patient with severe ankle joint arthritis induced by diffusetype PVNS. The patient was treated by lateral malleolar ostectomy and ankle arthrodesis with a plate and screws via a lateral approach.

Keyword

Ankle; Arthritis; Pigmented villonodular synovitis; Arthrodesis

MeSH Terms

Ankle Joint
Ankle*
Arthritis*
Arthrodesis*
Cartilage
Foot
Humans
Joints
Knee Joint
Recurrence
Synovial Membrane
Synovitis
Synovitis, Pigmented Villonodular*
Tendons

Figure

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  Figure 1. An ankle anteroposterior radiograph with weightbearing (A) shows severe arthritis with varus tilting while lateral radiograph (B) shows anterior translation of the talus. (C, D) Computed tomographic images show joint space obliteration with bony cyst in talus and fibula. (E, F) T2-weighted coronal magnetic resonance images show bony infiltrated synovial mass with low signal intensity.

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  Figure 2. (A) Reddish synovial mass around the ankle joint. (B) Near complete synovectomy was performed through lateral approach. (C) Synovial mass was also infiltrated into tibiofibular articular surface of lateral malleolus.

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  Figure 3. Immediate postoperative radiographs. Anteroposterior (A), mortise (B), and lateral (C) radiographs show a stable plate and screws fixation state.

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  Figure 4. A histopathologic finding reveals pigmented hemosiderin-laden macrophages (H&E stain,×400).

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  Figure 5. (A, B) Radiographs at postoperative 1 year. A complete fusion was achieved.

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