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Open anterior synovectomy for diffuse pigmented villonodular synovitis of the knee surgical technique

Overview

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Learn the Open anterior synovectomy for diffuse pigmented villonodular synovitis of the knee surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Open anterior synovectomy for diffuse pigmented villonodular synovitis of the knee surgical procedure.

Pigmented villonodular synovitis (PVNS) is a rare, benign locally aggressive disorder of the synovium of joints, bursae and tendon sheaths and has three main subtypes. The World Health Organisation classifies intra-articular diffuse PVNS as ‘diffuse-type giant cell tumour’ (Dt-GCT), differentiating it from the localised intra-articular form of PVNS and from GCTTS (giant cell tumours of tendon sheaths) commonly encountered in fingers and toes. The histological appearances are similar across all three PVNS sub-types (https://www.sciencedirect.com/science/article/pii/S1877132712000991).

The pathoaetiology of PVNS has been linked to inflammatory, vascular and traumatic causes but chromosomal abnormalities, autonomous growth, bone invasion and the rare malignant transformation of PVNS suggest a neoplastic cause (https://online.boneandjoint.org.uk/doi/epub/10.1302/0301-620X.95B3.30192).

Typically patients are between the age of 20 and 50 years, although many examples have been reported involving infants, children and adolescents (https://online.boneandjoint.org.uk/doi/epub/10.1302/0301-620X.95B3.30192). As the diffuse-type insidiously infiltrates the synovial cavity lining leading to eventual osseous erosions and sub- chondral cysts, patients present with insidious swelling and/or pain which has been present for months or years.

The mainstay of treatment for diffuse PVNS remains radical surgical excision. The recurrence rate of diffuse PVNS of knee after attempted arthroscopic resection is very high, therefore open surgery is preferred as the recurrence rate is reported to be less than 30% after two years. (https://europepmc.org/article/PMC/2758986)

Readers will also find it useful to read Jonathan Stevensons complimentary technique Excision of synovial chondromatosis using a posterior approach to the knee

Author: Jonathan Stevenson FRCS (Tr & Orth)

Institution: Royal Orthopaedic Hospital, Birmingham, UK.

Feedback

  • Each operation and the questions associated become a named course in the CPD section
  • The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
  • You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
  • The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
  • There are four possible answers of which one is correct (or on occasion more correct) than the others.
  • There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
  • The course is completed once all the lessons are read and quizzes submitted and passed.
  • On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
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    The pass mark is 75%.
  • If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
  • Once these have been read you can re-do just the questions you failed on.
  • Once you have passed the quiz you can return at a future stage & resit .

CPD Points:

  • Operation Quiz – 1 CPD point
  • Surgical steps Quiz – 1/4 CPD point
  • Implants Quiz – 1/4 CPD point
  • Problem case Quiz – 1/2 CPD point

One CPD point equates to one hour of academic activity

COURSE

Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.

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