Dr Randall on One-stage Synovectomy in D-TGCT

R. Lor Randall, MD, FACS, The David Linn Endowed Chair for Orthopedic Surgery, chair, Department of Orthopedic Surgery, professor, UC Davis Comprehensive Cancer Center, discusses findings from a study of one-stage synovectomy in patients with diffuse-type tenosynovial giant cell tumor (D-TGCT) of the knee.

Patients with TGCT are often initially referred to orthopedic surgeons, including knee specialists and sports medicine clinicians, who typically treat these patients using arthroscopic methods or an open procedure, Randall says. If these patients have locally recurrent disease, often, they will then see a sarcoma specialist, as these experts treat patients with locally aggressive and locally malignant TGCT, Randall explains.

TGCT can appear at the front of the knee, such as in the patella, femur, or tibia articulation site, or in a pouch at the back of the knee, according to Randall. Synovectomy, a process which removes the lining of the knee joint, can be performed through arthroscopic or open procedures, Randall notes. Since surgery that starts at the front of the knee and moves to a tumor at the back of the knee can be challenging to perform, for patients requiring 2-side synovectomy, surgeons will sometimes conduct a one-stage complete synovectomy that addresses both the front and the back of the knee in the same surgical procedure. In contrast, surgeons will sometimes perform a two-stage synovectomy, which involves a recovery period for patients between the procedures at the front and back of their knees.

Nine sarcoma centers from around the world conducted a retrospective study that evaluated pooled data from 191 patients who had received either one- or two-stage arthroscopic synovectomy for knee D-TGCT. This study investigated whether synovectomy is best performed in 1 or 2 stages and found that patients who received one-stage synovectomy had equal or better outcomes, including range of motion and the incidence of complications, compared with those who had two-stage synovectomy. Although selection bias may have influenced these findings, this study ultimately found that one-stage synovectomy was optimal in patients with knee D-TGCT, Randall concludes.