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Arthroscopic Excision of Intra-Articular Osteoid Osteoma of the Hip: A Case Series. Arthroscopy 2021; 37:3104-3112. [PMID: 33865934 DOI: 10.1016/j.arthro.2021.03.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify the clinical features of intra-articular osteoid osteoma (OO) of the hip, to evaluate the clinical effect of arthroscopic excision for intra-articular OO, and to summarize the characteristics of revision cases of hip OO and the revision surgery under arthroscopy in these cases. METHODS We retrospectively reviewed the data of 25 patients who underwent arthroscopic excision of hip OO. The case series included 10 patients who underwent revision surgery. Lesion location, presenting symptoms, and symptom duration were analyzed; postoperative improvement was assessed using the modified Harris Hip Score (mHHS) and International Hip Outcomes Tool (iHot-12) score. We examined the reasons for revision surgery and the characteristics of OO progression after the first surgery. RESULTS The most common presenting symptom was groin pain that was relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). Varying degrees of limitation of range of motion (ROM) were present in all patients. The osteosclerosis around the tumor nest on computed tomography (CT) scan is a characteristic radiographic feature in this disease. However, the classic radiographic feature was apparent on plain x-rays in only 2 of 25 patients. As a kind of efficient radiological method, magnetic resonance imaging (MRI) can help in distinguishing OO from femoroacetabular impingement (FAI), as the latter is characterized by a large effusion and bone marrow edema at the atypical site of impingement. For the patients who had only 1 arthroscopic resection, the mean (± standard deviation) mHHS and iHot-12 scores were 70.30 ± 9.06 (range 51 to 86) and 75.07 ± 7.69 (57 to 88), respectively. At last follow-up, the mean scores were 98.30 ± 2.15 (94 to 100) and 97.76 ± 2.04 (94 to 100). For revision cases, the mean mHHS and iHot-12 scores were 68.55 ± 3.77 (60 to 72) and 67.88 ± 5.39 (56 to 76). At last follow-up, the mean scores were 97.11 ± 2.47 (94 to 100) and 95.22 ± 1.78 (94 to 100). In the present study, 24 of 25 patients (96%) reached the minimal clinically important difference (MCID) of mHHS, and 21 of 22 patients (95.2%) reached the MCID of iHot-12. Among the revision patients, the most common misdiagnosis at first surgery was FAI. Another feature is that a wrong diagnosis or incomplete intra-articular OO resection can stimulate the tumor and cause an inflammatory reaction and rapidly progressive OA, necessitating prompt revision surgery for complete removal. The degree of joint degeneration was related to the time since the first operation. CONCLUSION OO of the hip joint typically presents with pain and limited joint activity. Misdiagnosis as FAI or synovitis is common, and CT scan is very helpful for accuracy diagnosis. Arthroscopic excision appears to be an effective method for the treatment of OO of the hip joint. LEVEL OF EVIDENCE IV, case series.
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Wacheul E, Leemrijse T, Galant C, Malghem J, Lecouvet FE. Soft tissue recurrence of an osteoid osteoma: an exceptional observation. Skeletal Radiol 2021; 50:827-833. [PMID: 32964242 DOI: 10.1007/s00256-020-03609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
We report the observation of the soft tissue recurrence of an osteoid osteoma (OO) in a 26-year-old man initially complaining of post-traumatic pain and swelling of the right ankle. A first arthroscopic resection was performed after the misdiagnosis of "bone irregularities" observed on computed tomography (CT) and magnetic resonance imaging (MRI). The diagnosis of OO was made by histological analysis of the resection material. The patient became asymptomatic for 5 years until the symptoms progressively recurred. Follow-up MRI and CT studies demonstrated a nodular bony focus within the periarticular soft tissues of the ankle. The lesion was removed, and histological analysis confirmed the diagnosis of a whole viable OO. This observation likely resulted from the displacement of the initial lesion during the initial arthroscopic procedure. This case report highlights the possibility of recurrence of OO in the soft tissues.
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Affiliation(s)
- Emilie Wacheul
- Department of Pathology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | | | - Christine Galant
- Department of Pathology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Jacques Malghem
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), 10 Avenue Hippocrate, 10/2942, 1200, Brussels, Belgium
| | - Frédéric E Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), 10 Avenue Hippocrate, 10/2942, 1200, Brussels, Belgium.
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Stražar K, Slodnjak I, Zupanc O, Drobnič M. Arthroscopic removal of osteoid osteoma with gamma probe assistance in the hip joint. Hip Int 2019; 29:328-335. [PMID: 29932003 DOI: 10.1177/1120700018782274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM The aim was to present the surgical technique and clinical outcome in a series of patients treated with gamma-probe-assisted arthroscopic removal of osteoid osteoma in the hip joint. METHODS The case series consisted of 10 patients diagnosed with osteoid osteoma of the hip, who were treated by arthroscopic nidus removal. An endoscopic gamma probe was used intraoperatively to locate the nidus and to control the extent of its removal. Residual osteoma cavities were additionally treated with an arthroscopic radiofrequency ablator. Microfracturing was performed when the osteochondral defect was in the weight-bearing area and osteochondroplasty was done in cases of concomitant cam deformity. Nonarthritic Hip Score (NAHS), Tegner activity score, quality of life questionnaire (EQ-5D) and postoperative magnetic resonance imaging (MRI) were used for evaluation before and post-surgery, with a minimum follow-up of 2 years. RESULTS The relative reduction of the gamma irradiation count immediately after removal of the nidus was 44.9% (range 33.3-54.5%). Postoperatively, all patients experienced prompt pain relief and a significant improvement according to all patient reported outcomes. Control MRI revealed fibro-cartilaginous tissue repair of post-osteoma osteochondral defects in the weight-bearing area; 1 patient showed signs of early degeneration. CONCLUSIONS The results of this case series demonstrated the safety and high efficacy of gamma-probe-assisted arthroscopic removal of the osteoid osteoma from the hip joint. Endoscopic gamma probe was recognised as a very useful device for locating the nidus of the osteoid osteoma exactly and preventing incomplete or excessive removal of the bone.
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Affiliation(s)
- Klemen Stražar
- 1 Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, SI-1000 Ljubljana, Slovenia
| | - Ivan Slodnjak
- 2 Clinic for Nuclear Medicine, University Medical Centre Ljubljana, Zaloška 7, SI-1000 Ljubljana, Slovenia
| | - Oskar Zupanc
- 1 Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, SI-1000 Ljubljana, Slovenia
| | - Matej Drobnič
- 1 Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška 9, SI-1000 Ljubljana, Slovenia
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Spiker AM, Rotter BZ, Chang B, Mintz DN, Kelly BT. Clinical presentation of intra-articular osteoid osteoma of the hip and preliminary outcomes after arthroscopic resection: a case series. J Hip Preserv Surg 2017; 5:88-99. [PMID: 29423256 PMCID: PMC5798088 DOI: 10.1093/jhps/hnx042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/26/2017] [Indexed: 01/01/2023] Open
Abstract
Intra-articular osteoid osteoma (IAOO) of the hip is a relatively rare diagnosis, but one that can closely mimic symptomatic presentation of femoroacetabular impingement (FAI). Although there are multiple case reports of osteoid osteoma (OO) in the hip, we present the largest case series of hip IAOO treated with hip arthroscopy and discuss limited patient-reported outcomes after treatment with hip arthroscopy. We retrospectively identified patients diagnosed with IAOO of the hip with confirmatory computed tomography, magnetic resonance imaging or biopsy diagnoses of OO. We analyzed lesion location, main presenting symptoms, symptom duration and treatment undertaken. For the patients who underwent hip arthroscopy for treatment of their IAOO, we reviewed patient-reported outcome scores when available. Forty patients with confirmed IAOO were identified. Thirteen underwent excision with hip arthroscopy. The most common presenting symptom was groin pain. In limited patients who had pre- and post-operative outcome scores, we found significant improvements in modified Harris Hip Score (mHHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL) and international Hip Outcomes Tool (iHot33) scores. Compared with patients undergoing hip arthroscopy for FAI alone, baseline mHHS, HOS-ADL, Hip Outcome Score–Sport-Specific Subscale and iHot33 scores were almost identical. We found that the presenting symptoms of hip IAOO closely mimic symptomatic FAI, including groin pain and anterior hip pain, so it is important to keep IAOO of the hip in the differential diagnosis of hip pain. Based on our experience, arthroscopy can be an effective treatment option for excision of intra-articular OO and is especially effective in patients with concomitant FAI in treating both pathologies.
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Affiliation(s)
- Andrea M Spiker
- Department of Orthopedic Surgery, Sports Medicine and Hip Preservation, University of Wisconsin-Madison, Madison, WI, USA
| | - Ben-Zion Rotter
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA and
| | - Brenda Chang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA and
| | - Douglas N Mintz
- Department of Radiology, Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Bryan T Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA and
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Marwan YA, Abatzoglou S, Esmaeel AA, Alqahtani SM, Alsulaimani SA, Tanzer M, Turcotte RE. Hip arthroscopy for the management of osteoid osteoma of the acetabulum: a systematic review of the literature and case report. BMC Musculoskelet Disord 2015; 16:318. [PMID: 26497395 PMCID: PMC4620000 DOI: 10.1186/s12891-015-0779-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/16/2015] [Indexed: 01/12/2023] Open
Abstract
Background Intra-articular osteoid osteoma (OO) causes irreversible joint damage. Its treatment of choice is radiofrequency ablation (RFA); however, some areas of the acetabulum are hard to access. Therefore, hip arthroscopy was used to treat this tumor. We aim to systematically review the literature with regards to arthroscopic management of acetabular OO, and to report a further case in which hip arthroscopy was used for treatment. Methods PubMed and EMBASE were searched for articles relevant to the arthroscopic management of acetabular OO on December 2, 2014. All articles published on and before that date were reviewed, and studies which met our pre-determined inclusion criteria were included. Articles screening and data abstraction were done by two reviewers independently. We also presented a 31-year-old man with acetabular OO who underwent hip arthroscopy for the management of his tumor after failing to respond to medications and computed tomography scan (CT)-guided RFA. Results The initial search revealed 14 studies, of which ten met our inclusion criteria. A total of ten patients underwent hip arthroscopy for the management of acetabular OO. Only two patients were females, and the patients' age ranged from 7 to 47 years. Two patients underwent arthroscopic guided-RFA of the lesion, while the rest underwent excision. The follow-up period ranged from 6 months to 2 years. Success rate was 100 %, and no recurrence was reported. Minor complications (transient impotence and perineal numbness) developed in one patient (10 %). Arthroscopic-guided RFA failed to eliminate the tumor in our additional case. A second trial of CT-guided RFA was successful in treating the patient's condition. Conclusions Hip arthroscopy is an effective and safe option for the management of acetabular OO, with success rate exceeding 90 %. Studies of higher level of evidence are required. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0779-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yousef A Marwan
- Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait. .,Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Sarantis Abatzoglou
- Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Ali A Esmaeel
- Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait. .,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait.
| | - Saad M Alqahtani
- Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada. .,Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia.
| | - Saleh A Alsulaimani
- Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Michael Tanzer
- Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Robert E Turcotte
- Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada.
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Tamam C, Howse EA, Tamam M, Barnes RH, Kelsey TJ, Perry B, Stubbs AJ. Arthroscopic Excision of Acetabular Osteoid Osteoma: Computer Tomography-Guided Approach. Arthrosc Tech 2015; 4:e101-5. [PMID: 26052484 PMCID: PMC4454822 DOI: 10.1016/j.eats.2014.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/24/2014] [Indexed: 02/03/2023] Open
Abstract
Osteoid osteoma is a benign osteoblastic tumor that occurs in the subcortical shaft and metaphysis of the long bones of the lower extremities; however, intra-articular lesions are also possible. Intra-articular osteoid osteomas are rare, and clinical symptoms are often less specific and, thereby, may lead to misdiagnosis. The definitive treatment for osteoid osteoma is the excision of the nidus. We present the case of a 23-year-old man with a 4-year history of right anterior hip pain, subsequently diagnosed with a subarticular osteoid osteoma located in the right anterior acetabulum. Hip arthroscopic excision of the juxta-articular osteoid osteoma is presented as an effective treatment, with the advantage of less potential damage to normal bone and cartilage, as well as the additional benefits available with hip arthroscopy.
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Affiliation(s)
- Cüneyt Tamam
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Elizabeth A. Howse
- Department of Emergency Medicine, Long Island Jewish Medical Center, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, U.S.A
| | - Muge Tamam
- Department of Radiology, Division of Nuclear Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Ryan H. Barnes
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Thomas J. Kelsey
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Brad Perry
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Allston J. Stubbs
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A.,Address correspondence to Allston J. Stubbs, M.D., M.B.A., Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, U.S.A.
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