A 26yr old lady treated for Pigmented Villonodular Synovitis and Dysplastic Trochlear with Total Synovectomy

Ms. Palak, a 26yr old lady came to MIOT on 22^nd Sep, 2016 with complaints of pain and dislocation of the left kneecap for the past 10yrs. She is a civil engineer by profession.

Her problem started from the age of 15. Initially her left kneecap gets dislocated which relocates back on its own. She dint have much pain. As years went by, the frequency of the dislocation started increasing. It started becoming like a practise to her that, once in 6months her knee will get dislocated. Post the dislocation, she will have swelling and mild pain for the next 2 days, which will also gradually subside.

She kept ignoring the problem, because it did not affect her daily activities. About 2 months ago she had another episode following which her pain did not settle down and her swelling had also not subsided completely with sporadic episodes of increased swelling. She felt something mobile inside her knee in the medial aspect which at times prevented her from fully flexing the knee. She even had struggle climbing down the stairs.

She went to a nearby hospital, where after all the tests the Doctors told that there is no abnormality and that it will get cured gradually. Having already ignored the problem for a very long time; Ms. Palak feared that if she does not take a step now, it will lead her into something major. One of her relative had referred her to MIOT and so her father had decided to take her there.

Treatment at MIOT:

In MIOT, she met the Arthroscopy specialist. She was thoroughly examined by the Doctor after which she was advised to take X-ray and MRI. Her results showed that she had Nodular Pigmented Villonodular Synovitis and Dysplastic Trochlea.

PIGMENTED VILLONODULAR SYNOVITIS (PVNS) is a joint disease characterized by inflammation and overgrowth of the joint lining. It usually affects the hip or knee. In PVNS the lining of the joint, called the synovium, becomes swollen and grows.

TROCHLEAR DYSPLASIA refers to a pathologic alteration in the shape of the femoral trochlea (the groove that holds the kneecap). Whereas a normal trochlea is sufficiently concave to guide and retain the patella (kneecap) throughout the normal range of movement, a dysplastic trochlea may be shallower than normal or even flat or convex, thus predisposing the patella to lateral subluxation or even dislocation.

The Doctor advised that initially they will do Total Synovectomy to control the PVNS and once that settles down they will reassess her and if the dislocation problem still persists, will advice for stabilization surgery. TOTAL SYNOVECTOMY is an operation performed to remove all the synovial membrane of a joint. On 23^rd Sep, 2016 she underwent the surgery.

Recovery:

Post-operatively she was stable and recovered well in the ICU. She was mobilized with the aid of a physiotherapist and was aided to walk with elbow crutches.  She showed good progress and so was discharged on 27th Sep, 2016. After 10days, she came for a review and to remove her stitches. She is walking comfortably. The swelling in her knee had reduced. She experienced mild stiffness and discomfort on standing for a prolonged time. Since the surgery, she did not have any dislocation episodes. This was mainly because she had undergone focussed rehabilitation to strengthen her muscles to prevent dislocation episodes.

Today:

She joined back work 3 weeks after surgery. She comes for regular review checkups. A review after 1yr of surgery revealed that she was able to walk comfortably, does not have any discomfort and has not had any dislocation episodes since then.