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Abstract Objective To explore and summarize the best clinical treatment options for different types of pigmented villonodular synovitis on the knee.Methods A retrospective study of 31 patients with pigmented villonodular synovitis which were confirmed by postoperative pathology，were treated in our department from August 2004 to August 2015.The clinical manifestationin cluded knee repeated swelling，fluid and persistent pain，yellow brown joint puncture fluid，and rusty or old blood solution.The X-rays of showed articular cartilage had degenerative change or small-scale multi-section erosion change in some patients.There were 26 patients underwent of arthroscopy (ASR group) and 5 patients underwent of total knee arthroplasty(TKA group)，according to history，clinical manifestations，age，imaging performance and expectations of treatment.Results The Lysholm knee score in ASR group increased from preoperative (44.8±2.5) points to postoperative (85.8±2.8) points，the difference was significant(t＝55.695，P＝0.000)；the HSS in TKA group increased from preoperative (49.4±8.8) points to postoperative (85.4±11.6) points，the difference was significant(t＝5.529，P＝0.001).Conclusion For pigmented villonodular synovitis on the knee，should be individualized treated based on the patient age，clinical symptoms，and disease classification.Only in this way can the patient achieve satisfactory outcomes.
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