The following question was asked in the pvns is pants site "Open synovectomy or TKR?"
If I Had only Known
I was newly diagnosed with diffuse pigmented villonodular synovitis of the knee, in November of 2011. The game plan for removal of the tumor was to begin with arthroscopic surgery to confirm the pvns via intra operative biopsy. the tumor was extensiveness so my orthopedic oncologist surgeon reverted to an open synovectomy. this procedure gave me the best chance of a cure.
If I Had only Known
I was newly diagnosed with diffuse pigmented villonodular synovitis of the knee, in November of 2011. The game plan for removal of the tumor was to begin with arthroscopic surgery to confirm the pvns via intra operative biopsy. the tumor was extensiveness so my orthopedic oncologist surgeon reverted to an open synovectomy. this procedure gave me the best chance of a cure.
Per mri I wouldn’t need a knee replacement for several years if at all. Looking back, I feel that the surgeon must have known when doing the synovectomy, that I would be left with severe arthritis. I don’t believe the discovery that I needed a knee replacement was a surprise to the surgeon in December when she performed an arthroscope for possible pvns recurrence (which turned out to be scar tissue) and meniscus repair.
Prior to open knee surgery, this is where I wish that I had discussed knee replacement in the event that the synovectomy would leave me with little to no cartilage. If it had been determined that I would be left with severe arthritis, I would have had them fix the meniscus, excise the pvns that they could with the arthroscopic procedure and close me up. I still would have done radiation but then I would have had the open synovectomy and the knee replacement done as soon as I was healed.
This strategy would have save me from needing a manipulation 4-5 mo post op/starting me all over in the healing process. It also would have saved me from an additional arthroscopic surgery to fix the meniscus. Not to mention the financial hardship of being off work for over a year due to severe pain and the inability to do my job.
With all of the said I had a partial knee replacement two weeks ago and for the first time in over a year I am not taking narcotics or anything else for pain. Note; with a minimally invasive knee replacement, they don’t cut through the quad muscle like with a traditional tkr and open synovectomy. This cuts down on discomfort and increased rehab time.
TKR is not a cure for pvns although it does seem to show that it may decrease the recurrence rate. Again there are risks no matter what you choose. I found that the open synovectomy was by far a much longer, more difficult and painful recovery than the arthroscopy and the partial replacement. I would never choose an open syno knowing that I would shortly need a TKR. When I was in rehab from my open syno I was very slow in my recovery compared to the people who had TKR. There are many peeps on this site that have had TKR and could direct you better than myself. Best of luck and well wishes.
I am not a physician and the above is in no way to be taken as medical advise. This is my interpretation of what I have been told by my physicians and from what I have read. Always consult with a professional for case specific accurate information.
