Pigmented Villonodular Synovitis (PVNS) of the Hip Managed with Arthroscopic Synovectomy: An Analysis of 14 Cases with an Average of 6-year Follow-up

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1 Pigmented Villonodular Synovitis (PVNS) of the Hip Managed with Arthroscopic Synovectomy: An Analysis of 14 Cases with an Average of 6-year Follow-up Mark R. Nazal*, Ali Parsa, Scott D. Martin Sports Medicine, Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School Boston, MA, USA *Presenting Author: Mark R. Nazal Corresponding Author: Mark R. Nazal,

2 Disclosures The authors have no disclosures, conflicts of interest, or competing interests to make.

Background Pigmented Villonodular Synovitis (PVNS) is a monoarticular, benign tenosynovial giant cell tumor, derived from synovial tissue Incidence: rare, 1.

3 Background Pigmented Villonodular Synovitis (PVNS) is a monoarticular, benign tenosynovial giant cell tumor, derived from synovial tissue Incidence: rare, 1.8 cases per million people Location: Knee is most common, followed by the Hip 15% of cases Variable presentation: Synovial Involvement: Localized vs Diffused Level of Aggression: Slow, Benign vs Invasive, Malignant-like Morphology: Villous vs Nodular Villous type or thread-like PVNS lesions on arthroscopic view (black arrow)

Background Typically seen on MRI after a patient presents with insidious joint pain Classically treated with open synovectomy, arthroscopic management has shown promise with favorable outcomes and

4 Background Typically seen on MRI after a patient presents with insidious joint pain Classically treated with open synovectomy, arthroscopic management has shown promise with favorable outcomes and acceptable recurrence rates Purpose: To add to the paucity of literature on the arthroscopic management of hip PVNS, by demonstrating favorable outcomes and low recurrence at an average of 6-year follow-up Globous type PVNS lesions on arthroscopic view (asterisk)

5 Methods Retrospective cohort analysis of all patients who underwent hip arthroscopy between July 2008 and August 2013; PROMs and VAS pain score were Prospectively collected PVNS was identified preoperatively based on MRI or intraoperatively after unexpected PVNS was identified during arthroscopy for another pathology Inclusion: hip arthroscopy, biopsy-proven PVNS, and follow-up of a minimum of 3-years Exclusion: <3-years follow-up, incomplete PROMs Outcomes: Recurrence of PVNS Revision: arthroscopy or arthroplasty PROMs: mhhs modified Harris Hip Score; NAHS Non-Arthritic Hip Score; LEFS Lower Extremity Function Score; HOS Hip Outcome Score; ihot-33 International Hip Outcome Tool Pain, Patient Satisfaction and Complications

(A) MRI T1-weighted sagittal image of the right hip, demonstrating hypo-intense blooming artifact (white arrow) with infiltration of the entire joint space (asterisk and

6 (A) MRI T1-weighted sagittal image of the right hip, demonstrating hypo-intense blooming artifact (white arrow) with infiltration of the entire joint space (asterisk and double asterisk) (B) MRI T1-weighted sagittal image of the right hip, demonstrating the significant amount of posterior invasion (double asterisk) of the peripheral compartment.

7 Results Total cohort: 14 hips (14 unique patients) Avg Age: 33.4 ± 4.17 years Male: 6 (43%) vs Female: 8 (57%) Mean patient follow-up: 6.7 ± 1.87 years Range: months Morphology: Diffuse type: 5 (36%) Nodular type: 9 (64%) Patient Satisfaction: Yes 14 (100%) Would choose the same treatment again?: Yes 14 (100%)

8 Results Table 1. PROMs at Latest Follow-up Total Cohort Diffuse vs Nodular Result Diffuse Type Nodular Type p-value mhhs 74.1 ± ± ± NAHS 78.9 ± ± ± LEFS 64.9 ± ± ± HOS ADL 57.5 ± ± ± HOS SSS 73.7 ± ± ± ihot ± ± ± * = p-value < 0.05 *** = p-value < ** = p-value < 0.01

9 Results Table 2. Pain Score and PVNS Recurrence Total Cohort Diffuse vs Nodular Total p-value Diffuse Type Nodular Type p-value Pain Relief Yes 12 (86%) 0.016* 5 (100%) 7(78%) VAS Pain Score Preoperative 8.1 ± ± ± Postoperative 3.2 ± ± ± ** Difference -4.9 ± x10-8 *** -5.4 ± ± *** Recurrence 1 (7%) (0%) 1 (11%) Revision Arthroscopy 1 (7%) (0%) 1 (11%) Arthroplasty 0 (0%) -- 0 (0%) 0 (0%) -- * = p-value < 0.05 *** = p-value < ** = p-value < 0.01

10 Limitations This study has a small sample size and further investigation with larger cohorts is necessary There was no comparison group because all patients that presented with hip PVNS were treated similarly, there was no cohort of patients treated with open synovectomy However, there is only one other study that we are aware of that has a similar sample size and follow-up beyond 5-years: Byrd et al with 13 patients with a mean f/u of 63 months This study adds to the paucity of literature on arthroscopic managed hip PVNS, with 14 patients with a mean f/u of 79 months.

11 Conclusion Conclusion: Arthroscopic management of hip PVNS is a promising surgical approach that provides safe, reliable, and durable favorable outcomes To our knowledge, this is the one of the largest cohorts of arthroscopic-managed hip PVNS with the longest reported follow-up of: average of 6.7 years PROMs show Fair hip functionality, with no difference between Diffuse and Nodular Statistically Significant: 86% patients reported relief of pain VAS pain score decreased by 4.9 points Greater pain reduction in Diffuse type PVNS 0 major or minor complications Only 1 (7%) recurrence, managed with a revision arthroscopy 100% Patient Satisfaction, 100% would choose the treatment again

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Risk Factors for 30-Day Readmission Following Hip Arthroscopy

Risk Factors for 30-Day Readmission Following Hip Arthroscopy Matthew Hartwell, MD Allison Morgan, BA Daniel Johnson, MD Richard Nicolay, MD Ryan Selley, MD Michael Terry, MD Vehniah Tjong, MD Disclosures