It is a rare benign tumour that forms within the synovium (the thin layer that lines the joints and tendons). It causes the affected tissue to thicken and overgrow. They are non-cancerous and do not spread to other areas of the body.
These can include; swelling in the joint, joint pain at rest and often worse on movement, decrease in range of movement, catching or locking and weakness.
Surgery is the current frontline treatment. It involves removal of the tumour and also the damaged portions of the synovium (joint lining), in a procedure that is called a synovectomy. There is a chance of recurrence and ongoing pain, the frequency of this depends on the type of PVNS/ TGCT you have.
It is normal for there to be some pain and discomfort post-operatively, but you will be offered suitable pain relief regularly throughout the day to help manage this.
It is normal for there to be some swelling post-operatively, this will reduce in time. There are things you can do to help this in the early stages
Elevation
You can lie with the foot of the bed raised, or with your leg on a pillow. Additionally if you are seated in a chair, you can have your leg positioned on a foot stool
Ice
You can ask for ice packs to help reduce swelling. Do not place this directly on your skin, have a towel as a barrier.
Depending on the time you return to the ward, the physiotherapist will aim to see you on the day of surgery or the 1st day post-operatively.
The Physiotherapist will provide you with exercises, these help in restoring a normal range of movement. If you are struggling they may use a machine called a CPM (continuous passive motion machine) which will passively bend and straighten your knee.
The aim will be to get you transferring out of bed and walking with an appropriate aid, this may be a frame or crutches, from the 1st day post op. Unless told otherwise, you should be fully weight bearing through the post-operative leg. The physiotherapist will aim to work on your walking daily until it is at an appropriate level for you to return home.
Prior to discharge you should:
- Be able to bend your knee to 90 degrees (Unless stated by your physiotherapist)
- Be independently transferring and walking with an appropriate aid
- Complete a stair assessment if you have stairs at home
- Exercises should start on the day of your operation
Lie on your back with your knees straight.
Pull your toes towards you and press the back of your knee down into the bed, squeeze your thigh/quadricep muscles for 3 seconds, then relax.
Repeat 8 - 10 times.
Lying on your back. Bend one leg and put your foot on the bed and put a cushion under the other knee.
Exercise your straight leg by pulling your foot and toes up, tightening your thigh muscle and straightening the knee (keep knee on the cushion). Hold approx. 5 secs. and slowly relax. Repeat 8 - 10 times.
Lying on your back with one leg straight and the other leg bent.
Exercise your straight leg by pulling the toes up, straightening the knee and lifting the leg 10 cm off the bed. Hold approx 5 secs. - slowly relax.
Repeat 8 - 10 times with both legs.
Lie on your back with your legs straight.
Slide your heel towards you, bending your knee, you can place something like a plastic bag under your heel to make this easier.
Repeat 8-10 times.
Sitting on a chair, slide your operated foot forwards and backwards, you can place it on a plastic bag to make it easier. Alternatively you can cross your non-operated leg in front to assist your operated leg to bend further. Hold 3 - 5 seconds.
Repeat 8 - 10 times.
With the lower part of your leg supported on a chair. Knee is straight and unsupported. Relax and let your knee straighten in this position.
Stay in this position for up to 30 minutes at a time.
In a standing position holding on to a solid support, keeping your knees together, bend your operated knee bringing your heel up behind you then lower.
Repeat 8-10 times.
- • Rest and elevate your leg.
- Continue to do your exercises regularly, otherwise the joint will become stiff and you will lose range of movement.
- Continue to increase walking. If you progress on to one crutch or stick you should hold it in the opposite hand to your operated leg. Once you can walk without a limp you may stop using your walking aid unless told otherwise.
- Scar care – massage can help soften the scar tissue and make it flatter, paler, cooler and smoother. This can be commenced when all stitches are removed and the wound is closed. Use an unperfumed moisturising cream or lotion such as such as Aveeno or Olive Oil. Massage for 5-10 minutes 2-3 times a day for optimum results.
- Full recovery generally takes up to 3-6 months, and will vary person to person. In general, most patients can return to their normal work, sports and activity within this timeframe.
For your own safety and that of other drivers, it is important that you do not drive until you have regained the ability to adequately perform an emergency stop. You should contact your insurance company and the DVLA to ensure that you are covered following your operation.
If you have a smaller excision you may feel able to return to work soon after your surgery dependent on your duties and job requirements. For larger excisions, it is advisable to discuss this with your Consultant at clinic or your GP. Your workplace Occupational Health department can help to guide a phased return to work if required.
All PVNS patients will be referred for outpatient physiotherapy, either at RNOH or at your local hospital depending on location/patient preference. This will be an urgent referral, however due to waiting times, it can be several weeks before you will be seen. If you have not been contacted about an appointment within 2 weeks, please contact your local hospital to chase this. If you are unable to contact them, you can contact us on the details below.
Hydrotherapy is recommended.
Page last updated: 04 March 2025