Successful surgery for 16-year-old female patient with rare disease

A 16-year-old female patient (in Cau Giay, Hanoi) has often suffered from pain and swelling in her left knee for a long time. During the episodes of pain and swelling in her knee, the patient visited many medical facilities, used internal medicine, and had joint fluid aspirated many times, but the disease still recurred and the level of pain and swelling increased. The pain became increasingly severe, affecting her daily activities. In the past few months, the patient experienced pain, swelling and effusion in her left knee, making it difficult to move around.

Through clinical examination and paraclinical results, the patient was diagnosed with pigmented villonodular synovitis by the doctor of the Department of Orthopedic Surgery, E Hospital.

Dr. Kieu Quoc Hien - Department of Orthopedic Surgery, E Hospital said that, based on the patient's medical history, the patient had pain and swelling in the left knee since the age of 8, with the diagnosis and treatment of juvenile arthritis. After that, the patient received medical treatment but still had frequent relapses and the disease became more severe. Through examination, Dr. Kieu Quoc Hien found that the patient's left knee was swollen, had a lot of effusion, was painful when flexing the knee, and had a thick synovial membrane.

Ultrasound results also showed that the patient had a lot of joint effusion, the synovial membrane was very thick, forming thick patches of fluid. Magnetic resonance imaging (MRI) showed inflammation and thickening of the synovial membrane in the quadriceps space, uneven cartilage surface of the left knee. When performing joint aspiration, the fluid was red like blood, not clotted. Combining clinical symptoms and paraclinical results, the patient was diagnosed with pigmented villonodular synovitis and the doctors indicated arthroscopic synovectomy to effectively treat the disease.

The endoscopic synovectomy surgery was successfully performed by the hospital's doctors in more than 1 hour. This modern surgical method allows the doctor to observe almost all the synovial membrane in every small corner of the joint, deeply intervene in the joint area to cut and filter the damaged synovial membrane; limit complications such as infection, bleeding, etc. compared to traditional open surgery.

Dr. Kieu Quoc Hien shared: When performing arthroscopic surgery on the knee joint, the doctors saw the joint fluid was red like blood and when they washed it, they found the synovial membrane was yellow due to hemosiderin deposition (also known as metallic pigment deposited in the knee joint) and the synovial membrane had congested patches concentrated in patches. The doctors decided to remove the entire synovial membrane in the patient's knee joint.

Dr. Kieu Quoc Hien affirmed: Arthroscopic surgery to cut the synovial membrane is the best treatment method in treating this synovial membrane disease. However, after surgery, it is necessary to monitor the progression of the disease. If the disease recurs quickly and the knee joint is completely damaged, the doctor will have to perform knee replacement surgery or local radiation therapy to help the patient avoid the risk of losing mobility at the damaged joint.

Dr. Kieu Quoc Hien explains that pigmented villonodular synovitis is a synovial membrane disease that can occur in all synovial joints but mainly in the knee joint. It is common after the age of 30, the damage causes swelling, pain, and the deposition of the metallic substance hemosiderin in the joint. Common clinical symptoms are pain and swelling of the joint. Patients may have limited joint movement, joint stiffness, and sometimes joint laxity.

It is worth mentioning that this disease is found in patients aged 30-50, with no gender factor. However, this patient has had this rare disease since the age of 8, which is too young and the cause and pathogenesis are unknown, especially in adolescence. The symptoms of the disease are easily confused with common diseases such as joint tuberculosis, synovitis, polyarthritis, and rheumatism. The disease recurs over time, the level of joint destruction increases, and the patient is at risk of losing mobility in the affected joint.

Therefore, early detection and treatment of pigmented villonodular synovitis will help patients reduce joint pain and swelling, and improve the quality of movement./.

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