CASE REPORT article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicAdvancing Orthopedic Surgery: unique Case Reports driving progressView all articles
A rare case report of prosthetic loosening secondary to diffuse non-pigmented villonodular synovitis after bilateral total knee arthroplasty
Provisionally accepted
- 1Shandong University of Traditional Chinese Medicine, Jinan, China
- 2Shandong Wendeng Osteopathic Hospital, Weihai, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background:Nonpigmented villonodular synovitis (non-PVNS) is a benign yet locally aggressive proliferative disorder affecting the synovium. The occurrence of non-PVNS following knee joint replacement is exceedingly rare. Case presentation:This study investigated synovial mechanisms driving aseptic loosening in bilateral total knee arthroplasty failure over a 14-year period. Radiographic and pathologic analysis tracked sequential failure progression bilaterally. Initial radiographs documented progressive left-knee loosening (2009-2016). Subsequent intraoperative and histologic evaluation (H&E staining) confirmed synovial hyperplasia without PVNS features as the primary mechanism. Post-revision imaging showed immediate left-knee stabilization. However, long-term follow-up revealed sustained left-knee stability (2019) but emergent right-knee loosening (2023), demonstrating interlimb heterogeneity and recurrence risk. Pathologic examination of the revised right knee identified an analogous synovial hyperplasia mechanism (non-PVNS). Conclusion:Final post-revision radiographs validated successful stabilization following both revisions. This longitudinal bilateral case uniquely demonstrates synovial hyperplasia as a replicable driver of aseptic loosening independent of PVNS, highlights heterogeneous progression kinetics and recurrence risk between limbs despite unilateral intervention, and confirms the consistent efficacy of revision arthroplasty for this specific pathology.
Keywords: Nonpigmented villonodular synovitis, Prosthesis loosening, Total knee arthroplasty, Synovial hyperplasia, Longitudinal outcomes, Revision arthroplasty
Received: 20 Sep 2025; Accepted: 19 Nov 2025.
Copyright: © 2025 Cai, Yan, Lin, Li, Yu, Jiang and jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: hongjiang jiang, jhjbone@163.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.