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Rajasekaran RB, Krishnamoorthy V, Kamashi J, Thippeswamy PB, Singh R, Rajasekaran S. Is Intraoperative CT Navigation feasible for excision of osteoid osteoma in the appendicular skeleton? - Retrospective analysis of 58 cases. J Orthop 2024; 47:28-34. [PMID: 38022841 PMCID: PMC10679521 DOI: 10.1016/j.jor.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background The use of intraoperative CT navigation to manage osteoid osteoma is not common. We report our experience managing osteoid osteoma in the appendicular skeleton using an intraoperative AIRO CT navigation system. Materials & methods Between May 2013 and December 2022, 59 patients underwent Navigation-assisted excision of osteoid osteoma in the appendicular skeleton. Our primary study outcome was to assess for recurrence of the tumour with recurrence of symptoms. For our secondary outcomes, we evaluated the complications associated with the procedure and evaluated the histological slides of all patients to see for the presence of nidus. Results Of the 58 patients available for review, no patient had a lesion recurrence, and all were symptom-free at an average follow-up of 45.6 months (6-100). Two patients (3.5%) had a superficial infection managed conservatively, and 43 patients (74.1%) had the presence of nidus in curetted samples. No patient developed a pathological fracture after the procedure. Conclusion Using intraoperative CT navigation to manage osteoid osteoma in the appendicular skeleton is safe, minimally invasive, and effective in completely removing the nidus with a negligible complication rate. The absence of nidus on histology should not be a concern to clinicians once thorough burring and verification of excision of nidus has been confirmed intra-operatively. Study design Retrospective Case Series. Level of evidence Level IV.
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Affiliation(s)
- Raja Bhaskara Rajasekaran
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Venkatadass Krishnamoorthy
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Jayanthi Kamashi
- Department of Pathology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Rithika Singh
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
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Tsuha Y, Oshiro H, Mizuta K, Aoki Y, Tamaki T, Wada N, Tome Y, Nishida K. Intraoperative cone-beam computed tomography-guided curettage for osteoid osteoma. Medicine (Baltimore) 2023; 102:e36747. [PMID: 38134085 PMCID: PMC10735135 DOI: 10.1097/md.0000000000036747] [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: 03/25/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Recently, cone-beam computed tomography (CBCT)-guided surgeries have been developed for bone and soft tissue tumors. The present study aimed to evaluate the efficacy of CBCT-guided curettage for osteoid osteoma. Our study population included 13 patients who underwent primary curettage for osteoid osteoma using intraoperative CBCT in a hybrid operating room between April 2019 and November 2022. We collected the following data: sex, age, follow-up period, symptom onset to time of surgery, tumor size and location, length of skin incision, operating time, radiation dose, recurrence, postoperative complications, and visual analog scale for pain during the last follow-up. There were 10 male and 3 female patients, and the mean age was 25.0 years (range, 9-49 years). The mean follow-up period was 10.6 months (range, 0.4-24.0 months). The locations of the tumors were the proximal femur in 6 patients, the acetabular region in 2 patients, and the ilium, tibial shaft, calcaneus, cuboid, and talus in 1 patient each. The mean time of symptoms onset to surgery was 18.7 months (range, 2.3-69.9 months). The mean maximum diameter of the tumor was 5.9 mm (range, 3.5-10.0 mm). The mean length of the skin incision was 2.2 cm (range, 1.5-3.5 cm). The mean operating time was 96.9 minutes (range, 64-157 minutes). The mean dose of radiation was 193.2 mGy (range, 16.3-484.0 mGy). No recurrences, postoperative complications, and reoperation were observed in this study. All the patients reported 0 mm on the visual analogue scale for pain on the last follow-up. CBCT-guided curettage for osteoid osteoma was minimally invasive and reliable. This procedure can be effective for the treatment of lesions found in deep locations such as the pelvic bone and proximal femur or an invisible lesion that cannot be detected by regular fluoroscopy.
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Affiliation(s)
- Yuichi Tsuha
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hiromichi Oshiro
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kohei Mizuta
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yusuke Aoki
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tomoko Tamaki
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Naoki Wada
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yasunori Tome
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kotaro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Mhana SAA, Diri D, Halloum W, Alhilal O, Alasaad H. Successful en-bloc excision for recurrent femoral osteoid osteoma: The use in modern era. Int J Surg Case Rep 2023; 106:108185. [PMID: 37062193 PMCID: PMC10130464 DOI: 10.1016/j.ijscr.2023.108185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/18/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Osteoid osteoma is a benign bone tumor that may resolve spontaneously and commonly affects adolescents in the proximal femur region and causes characteristic pain. Although benign, it can relapse and severely deteriorate function when juxta-articular. Its recurrence rate varies according to the treatment method used. CASE PRESENTATION This article presents a case of a 21-year-old male with a recurrent calcar osteoid osteoma that was successfully treated by surgical en bloc excision; Harris Hip Score of 97.00 %. The lesion was previously managed through an intralesional curettage and an autologous iliac crest bone graft. CLINICAL DISCUSSION The treatment of osteoid osteoma varies from medical therapy with NSAIDs or minimally invasive surgery to traditional open surgery. The surgical approach aims to excise the nidus, remove the pain, avoid growth disturbance in immature skeletons, and limit the side effects of long-term NSAID use. CONCLUSION Radiofrequency ablation is the standard therapy for osteoid osteoma nowadays; unfortunately, it is unavailable in some countries due to the high cost and lack of equipment and specialists. En bloc excision may be the ideal approach for recurrent cases after intralesional curettage.
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Affiliation(s)
| | - Doried Diri
- Damascus University Faculty of Medicine, Damascus, Syria
| | - Wael Halloum
- Damascus University Faculty of Medicine, Damascus, Syria
| | - Omar Alhilal
- Damascus University Faculty of Medicine, Damascus, Syria
| | - Hakam Alasaad
- Damascus University Faculty of Medicine, Damascus, Syria
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Zeng H, He H, Tong X, Wang Z, Luo R, Liu Q. Osteoid Osteoma of the Proximal Femur: Pitfalls in Diagnosis and Performance of Open Surgical Resection. Front Surg 2022; 9:922317. [PMID: 35836603 PMCID: PMC9273932 DOI: 10.3389/fsurg.2022.922317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Aims Proximal femoral osteoid osteoma (OO) is extremely easy to be misdiagnosed or missed. The purpose of this study was to retrospectively analyze the clinical data of patients with proximal femoral OO in order to determine the clinical manifestation and imaging characteristics of the disease, so as to provide help for the preoperative diagnosis and clinical treatment of proximal femoral OO. Methods This was a retrospective study involving 35 patients with proximal femoral OO admitted into our hospital from January 2015 to January 2021. The baseline characteristics of the participants included; 24 males and 11 females, aged between 13 and 25 (mean 16.2) years old, and the course of the disease was 1 to 14 (mean 6.3) months. We used previous medical experience records of the patients to analyze for the causes of misdiagnosis. Moreover, we compared the difference between preoperative and postoperative treatment practices in alleviating pain in OO patients and restoring hip function. Follow-ups were carried out regularly, and patients advised to avoid strenuous exercises for 3 months. Results We followed up 35 patients (25 intercortical, 4 sub-periosteal, and 6 medullary) for an average of 41.4 months. We found that 15 patients (42.9%) had been misdiagnosed of synovitis, perthes disease, osteomyelitis, intra-articular infection, joint tuberculosis and hip impingement syndrome, whose average time from symptoms to diagnosis were 6.3 months. Postoperative pain score and joint function score improved significantly compared with preoperative, and complications were rare. Conclusion Open surgical resection constitutes an effective treatment for proximal femoral OO by accurately and completely removing the nidus. Wrong choice of examination, and the complexity and diversity of clinical manifestations constitutes the main reasons for the misdiagnosis of proximal femoral OO.
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Affiliation(s)
- Hao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Hongbo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Xiaopeng Tong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiwei Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Rongsheng Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
- Correspondence: Qing Liu ;
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Efthymiadis A, Tsikopoulos K, Uddin F, Kitridis D, Edwards N, Sidiropoulos K, Lavalette D. Which is the optimal minimally invasive treatment for osteoid osteoma of the hip? A systematic review and proportional meta-analysis. J Orthop Sci 2022; 27:456-462. [PMID: 33563522 DOI: 10.1016/j.jos.2020.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Osteoid osteomata comprise approximately 10% of benign bone tumours, with 20% of them being located in the proximal femur and 1-3% in the pelvis. In this meta-analysis, we sought to investigate positive and negative outcomes relating to minimally invasive surgery (MIS), which has superseded open resection and conservative measures over the last decades. METHODS We searched the PubMed, CENTRAL and grey literature for completed studies published until 10 August 2020. Articles with a minimum of ten patients diagnosed with osteoid osteomata of the proximal femur and/or acetabulum were included. Primary outcomes were success rates, complications and recurrences following treatment. Delays in diagnosis were also recorded. We conducted random effects meta-analysis of success rates for MIS modalities using MedCalc statistical software. Quality was assessed with a modified Delphi checklist. RESULTS Sixteen case-series were identified. Success rates for computed-tomography (CT)-guided radiofrequency ablation (RFA), CT-guided percutaneous resection drilling and arthroscopic resection were 98.2% (95% CI 95.8-99.5), p = 0.47; 91.5% (95% CI 81.1-97.9), p = 0.06; and 98% (95% CI 89.3-99.7), p = 0.95, respectively. Both RFA and percutaneous drilling resection were associated with two iatrogenic femoral fractures. Arthroscopic removal was not associated with any complications. Definitive diagnosis was established at least six months after symptom onset in up to 43% of patients. CONCLUSIONS RFA could be the most effective treatment options for patients suffering from osteoid osteomata of the hip. Arthroscopy could be potentially as effective as RFA as long as further large-scale studies confirm its efficacy and safety. Reported complications stemming from these modalities were sparse in nature. In order to avoid inordinate diagnostic delays, a high index of suspicion and low threshold for CT scan investigation is required.
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Affiliation(s)
| | | | - Farid Uddin
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | - Dimitrios Kitridis
- 1st Orthopaedic Department of Aristotle University G. Papanikolaou General Hospital, Exohi, Thessaloniki, Greece
| | - Nicholas Edwards
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | | | - David Lavalette
- Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
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6
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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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7
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Tepelenis K, Skandalakis GP, Papathanakos G, Kefala MA, Kitsouli A, Barbouti A, Tepelenis N, Varvarousis D, Vlachos K, Kanavaros P, Kitsoulis P. Osteoid Osteoma: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features, and Treatment Option. In Vivo 2021; 35:1929-1938. [PMID: 34182465 DOI: 10.21873/invivo.12459] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/12/2022]
Abstract
Osteoid osteoma, the third most common benign bone tumor, usually occurs in the cortex of long bones. It consists of a radiolucent nidus surrounded by reactive osteosclerosis. Generally, osteoid osteoma affects young males. Nocturnal pain that eases with salicylates or nonsteroidal anti-inflammatory drugs (NSAID) is the typical clinical presentation. Sometimes, it remains undiagnosed for a long time. Plain radiography and computed tomography are usually sufficient for the diagnosis of osteoid osteoma. Initial treatment includes salicylates and NSAID because the tumor often regresses spontaneously over 2-6 years. Surgical treatment is indicated in case of unresponsive pain to medical therapy, no tolerance of prolonged NSAID therapy due to side effects, and no willingness to activity limitations. Nowadays, minimally invasive techniques have replaced open surgery and are considered the gold standard of surgical treatment. Although cryoablation seems superior in terms of the nerve damage and immunotherapy effect, radiofrequency ablation is the preferred technique.
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Affiliation(s)
- Kostas Tepelenis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece;
| | - Georgios P Skandalakis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, NY, U.S.A
| | | | | | | | - Alexandra Barbouti
- Anatomy - Histology - Embryology, University of Ioannina, Ioannina, Greece
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Jain M, Doki S, Pradhan S, Panda S. Osteoid osteoma of calcar of femur in child: prophylactic fixation using PHILOS and excision. BMJ Case Rep 2020; 13:13/6/e235073. [PMID: 32601142 DOI: 10.1136/bcr-2020-235073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mantu Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Sunil Doki
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Siddharth Pradhan
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Sashikanta Panda
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
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Koch G, Cazzato RL, Gilkison A, Caudrelier J, Garnon J, Gangi A. Percutaneous Treatments of Benign Bone Tumors. Semin Intervent Radiol 2018; 35:324-332. [PMID: 30402015 DOI: 10.1055/s-0038-1673640] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Benign bone tumors consist of a wide variety of neoplasms that do not metastasize but can still cause local complications. Historical management of these tumors has included surgical treatment for lesion resection and possible mechanical stabilization. Initial percutaneous ablation techniques were described for osteoid osteoma management. The successful experience from these resulted in further percutaneous image-guided techniques being attempted, and in other benign bone tumor types. In this article, we present the most common benign bone tumors and describe the available results for the percutaneous treatment of these lesions.
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Affiliation(s)
- Guillaume Koch
- Interventional Imaging, Nouvel Hôpital Civil, 1 place de l'Hôpital, Strasbourg Cedex, France.,Department of Anatomy, University of Strasbourg, Strasbourg, France
| | - Roberto Luigi Cazzato
- Interventional Imaging, Nouvel Hôpital Civil, 1 place de l'Hôpital, Strasbourg Cedex, France
| | - Andrew Gilkison
- Radiology Department, Christchurch Public Hospital, Christchurch, New Zealand
| | - Jean Caudrelier
- Interventional Imaging, Nouvel Hôpital Civil, 1 place de l'Hôpital, Strasbourg Cedex, France
| | - Julien Garnon
- Interventional Imaging, Nouvel Hôpital Civil, 1 place de l'Hôpital, Strasbourg Cedex, France
| | - Afshin Gangi
- Interventional Imaging, Nouvel Hôpital Civil, 1 place de l'Hôpital, Strasbourg Cedex, France
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Noordin S, Allana S, Hilal K, Nadeem N, Lakdawala R, Sadruddin A, Uddin N. Osteoid osteoma: Contemporary management. Orthop Rev (Pavia) 2018; 10:7496. [PMID: 30370032 PMCID: PMC6187004 DOI: 10.4081/or.2018.7496] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/06/2018] [Accepted: 03/18/2018] [Indexed: 11/23/2022] Open
Abstract
Osteoid osteoma is a benign bone-forming tumor with hallmark of tumor cells directly forming mature bone. Osteoid osteoma accounts for around 5% of all bone tumors and 11% of benign bone tumors with a male predilection. It occurs predominantly in long bones of the appendicular skeleton. According to Musculoskeletal Tumor Society staging system for benign tumors, osteoid osteoma is a stage-2 lesion. It is classified based on location as cortical, cancellous, or subperiosteal. Nocturnal pain is the most common symptom that usually responds to salicyclates and non-steroidal anti-inflammatory medications. CT is the modality of choice not only for diagnosis but also for specifying location of the lesion, i.e. cortical vs sub periosteal or medullary. Non-operative treatment can be considered as an option since the natural history of osteoid osteoma is that of spontaneous healing. Surgical treatment is an option for patients with severe pain and those not responding to NSAIDs. Available surgical procedures include radiofrequency (RF) ablation, CT-guided percutaneous excision and en bloc resection.
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Affiliation(s)
| | - Salim Allana
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kiran Hilal
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Naila Nadeem
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Riaz Lakdawala
- Orthopaedic Surgery, Aga Khan University, Karachi, Pakistan
| | - Anum Sadruddin
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Nasir Uddin
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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11
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Percutaneous excision of difficult osteoid osteomas using intraoperative AIRO CT navigation: a preliminary report. J Pediatr Orthop B 2018; 27:456-460. [PMID: 29035938 DOI: 10.1097/bpb.0000000000000505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Osteoid osteomas are well known for intraoperative technical difficulties for localization and adequate excision, especially when they are not clearly visualized on plain radiographs or when they occur in difficult and inaccessible situations. Localization in the radiology suite and shifting the patient to the operating room can be cumbersome, and can result in errors because of lack of real-time imaging. In these scenarios, intraoperative navigation will be useful. We report a technique of intraoperative computed tomography (CT) navigation for localization and excision of osteoid osteomas of the long bones. Six patients (four femoral and two tibial lesions) with a radiological diagnosis of osteoid osteoma, in whom the nidus could not be visualized clearly on plain radiographs, were treated with this technique. Intraoperative CT navigation with AIRO was performed and the images were registered to the computer. The lesion was then localized and excised using a high-speed burr. All patients underwent postexcision on-table CT scans, which showed complete excision of the nidus. All patients became symptom free and are doing well at a minimum follow-up of 6 months. Intraoperative CT navigation helps to exactly localize the nidus and also helps to confirm complete excision of the nidus. This is a safe, effective and minimally invasive method to treat osteoid osteomas, particularly those that are not amenable to excision under C arm guidance.
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12
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Santiago E, Pauly V, Brun G, Guenoun D, Champsaur P, Le Corroller T. Percutaneous cryoablation for the treatment of osteoid osteoma in the adult population. Eur Radiol 2018; 28:2336-2344. [DOI: 10.1007/s00330-017-5164-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/19/2017] [Accepted: 10/30/2017] [Indexed: 12/26/2022]
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13
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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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14
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Expanding the borders: Image-guided procedures for the treatment of musculoskeletal tumors. Diagn Interv Imaging 2017; 98:635-644. [DOI: 10.1016/j.diii.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
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15
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Yoon BH, Kim JG, Ha YC. Arthroscopic Excision of an Osteoid Osteoma of the Lesser Trochanter of the Femoral Neck. Arthrosc Tech 2017; 6:e1361-e1365. [PMID: 29354441 PMCID: PMC5622304 DOI: 10.1016/j.eats.2017.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/21/2017] [Indexed: 02/03/2023] Open
Abstract
Osteoid osteoma frequently requires surgical treatment, especially among young, active patients. However, surgeons are reluctant to perform open surgery for an osteoid osteoma of the femoral neck area because the conventional surgical approach requires a large incision in muscular patients, and percutaneous resection with a trephine has the attendant risk of subsequent fracture. Recently, arthroscopic excision of an osteoid osteoma has been reported as a less invasive, safer procedure than traditional open curettage. Hip arthroscopy using the burr-down technique under C-arm guidance to locate and remove the lesion of the femur neck has also shown promise. The presented technique minimizes muscle damage around the femur and enables surgeons to confirm complete resection of the lesion through direct, detailed visualization. Furthermore, early return to previous activity can be achieved after excising the lesion located at the calcar femorale, which is an area with a heavy weight-bearing load. The objective of this Technical Note was to describe our preferred technique for the surgical excision of osteoid osteoma located at the base of the femoral neck through the use of arthroscopy.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Republic of Korea,Address correspondence to Byung-Ho Yoon, M.D., Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Republic of Korea.Department of Orthopaedic SurgeryInje University College of MedicineSeoul Paik HospitalSeoulRepublic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Republic of Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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16
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Kobayashi H, Akiyama T, Okuma T, Shinoda Y, Oka H, Ito N, Fukumoto S, Tanaka S, Kawano H. Three-dimensional fluoroscopic navigation-assisted surgery for tumors in patients with tumor-induced osteomalacia in the bones. Comput Assist Surg (Abingdon) 2017; 22:14-19. [DOI: 10.1080/24699322.2017.1282044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Akiyama
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tomotake Okuma
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Shinoda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Ito
- Department of Nephrology and Endocrinology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Seiji Fukumoto
- Department of Nephrology and Endocrinology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Teikyo, Tokyo, Japan
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17
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Percutaneous Biopsy and Radiofrequency Ablation of Osteoid Osteoma with Excess Reactive New Bone Formation and Cortical Thickening Using a Battery-Powered Drill for Access: A Technical Note. Cardiovasc Intervent Radiol 2016; 39:1499-505. [PMID: 27230513 DOI: 10.1007/s00270-016-1366-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/11/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE To report our experience with the use of a battery-powered drill in biopsy and radiofrequency ablation of osteoid osteoma with excess reactive new bone formation. The battery-powered drill enables obtaining the sample while drilling. MATERIALS AND METHODS During the last 18 months, 14 patients suffering from painful osteoid osteoma with excess reactive new bone formation underwent CT-guided biopsy and radiofrequency ablation. In order to assess and sample the nidus of the osteoid osteoma, a battery-powered drill was used. Biopsy was performed in all cases. Then, coaxially, a radiofrequency electrode was inserted and ablation was performed with osteoid osteoma protocol. Procedure time (i.e., drilling including local anesthesia), amount of scans, technical and clinical success, and the results of biopsy are reported. RESULTS Access to the nidus through the excess reactive new bone formation was feasible in all cases. Median procedure time was 50.5 min. Histologic verification of osteoid osteoma was performed in all cases. Radiofrequency electrode was coaxially inserted within the nidus and ablation was successfully performed in all lesions. Median amount CT scans, performed to control correct positioning of the drill and precise electrode placement within the nidus was 11. There were no complications or material failure reported in our study. CONCLUSIONS The use of battery-powered drill facilitates access to the osteoid osteoma nidus in cases where excess reactive new bone formation is present. Biopsy needle can be used for channel creation during the access offering at the same time the possibility to extract bone samples.
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Gökalp MA, Gözen A, Ünsal SŞ, Önder H, Güner S. An Alternative Surgical Method for Treatment of Osteoid Osteoma. Med Sci Monit 2016; 22:580-6. [PMID: 26898923 PMCID: PMC4765535 DOI: 10.12659/msm.896988] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND An osteoid osteoma is a benign bone tumor that tends to be <1 cm in size. The tumor is characterized by night-time pain that may be relieved by aspirin or other non-steroidal anti-inflammatory drugs. Osteoid osteoma can be treated with various conservative and surgical methods, but these have some risks and difficulties. The purpose of the present study was to present an alternative treatment method for osteoid osteoma and the results we obtained. MATERIAL AND METHODS In the period from 2010 to 2014, 10 patients with osteoid osteoma underwent nidus excision by using a safe alternative method in an operating room (OR) with no computed tomography (CT). The localization of the tumor was determined by use of a CT-guided Kirschner wire in the radiology unit, then, in the OR the surgical intervention was performed without removing the Kirschner wire. RESULTS Following the alternative intervention, all the patients were completely relieved of pain. In the follow-up, no recurrence or complication occurred. CONCLUSIONS The presented alternative method for treating osteoid osteoma is an efficient and practical procedure for surgeons working in clinics that lack specialized equipment.
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Affiliation(s)
- Mehmet Ata Gökalp
- Department of Trauma and Orthopedic Surgery, Medical School of Yuzuncu Yil University, Van, Turkey
| | - Abdurrahim Gözen
- Department of Trauma and Orthopedic Surgery, Medical School of Yuzuncu Yil University, Van, Turkey
| | - Seyyid Şerif Ünsal
- Department of Trauma and Orthopedic Surgery, Medical School of Yuzuncu Yil University, Van, Turkey
| | - Haci Önder
- Department of Trauma and Orthopedic Surgery, Van Training and Research Hospital, Van, Turkey
| | - Savaş Güner
- Department of Trauma and Orthopedic Surgery, Medical School of Yuzuncu Yil University, Van, Turkey
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Alemdar C, Çaçan MA, Dusak A, Özkul E, Atiç R, Kapukaya A. A comparison of percutaneous trephine excision and open surgery in the treatment of osteoid osteoma. INTERNATIONAL ORTHOPAEDICS 2015; 40:1481-7. [PMID: 26572883 DOI: 10.1007/s00264-015-3044-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/02/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to compare CT-assisted percutaneous excision, which is a closed, economic method and a more cosmetic approach, and open surgery in the treatment of osteoid osteoma. MATERIALS AND METHODS Fifty-three patients (12 female and 41 male patients) who had percutaneous excision (n = 24) and open surgery (n = 29) were evaluated retrospectively. The mean age was 16.6 years and the mean duration of follow-up was 53.5 months. During percutaneous excision, a trephine was advanced through the labeling wire and the site, including the nidus, was excised en-bloc and the incision walls were curetted. During the open surgery, the localization of the nidus was marked using c-arm X-ray and the nidus was accessed by lifting the cortical bone, layer-by-layer, using burr. The nidus was excised and its cavity curetted. RESULTS The result was successful in 22 and a failure in three patients who had closed excision. The result was successful in 20 and a failure in nine patients who had open surgery. The mean duration of operation was 44.37 minutes in the percutaneous excision group and 80.6 minutes in the open surgery group. There was no difference in the pre-operative VAS values between the two groups, whereas the post-operative VAS values were statistically significantly different. There was also a statistically significant difference in the duration of the operation and the length of the hospital stay between the groups. CONCLUSION Percutaneous excision with trephine is a more successful, effective, minimally invasive, safe and a better cosmetic approach in the treatment of osteoid osteoma. This method is also a cheap method that does not require expensive equipment.
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Affiliation(s)
- Celil Alemdar
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey.
| | - Mehmet Akif Çaçan
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey
| | - Abdurrahim Dusak
- Department of Radiology, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Emin Özkul
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey
| | - Ramazan Atiç
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey
| | - Ahmet Kapukaya
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey
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Use of warm Ringer’s lactate solution in the management of locally advanced giant cell tumor of bone. Int J Clin Oncol 2015; 21:177-85. [DOI: 10.1007/s10147-015-0856-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
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