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Bedoya MA, Iwasaka-Neder J, Tsai A, Bixby SD. Intra-articular Osteoid Osteomas: Imaging Manifestations and Mimics. Radiographics 2024; 44:e230208. [PMID: 38843097 DOI: 10.1148/rg.230208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Osteoid osteoma (OO) is the third most prevalent benign bone neoplasm in children. Although it predominantly affects the diaphysis of long bones, OO can assume an intra-articular location in the epiphysis or the intracapsular portions of bones. The most common location of intra-articular OO is the hip joint. The presentation of intra-articular OOs often poses a diagnostic enigma, both from clinical and radiologic perspectives. Initial symptoms are often vague and nonspecific, characterized by joint pain, stiffness, and limited range of motion, which frequently contributes to a delayed diagnosis. Radiographic findings range from normal to a subtle sclerotic focus, which may or may not have a lucent nidus. In contrast to their extra-articular counterparts, intra-articular lesions have distinct features at MRI, including synovitis, joint effusion, and bone marrow edema-like signal intensity. While CT remains the standard for identifying the nidus, even CT may be inadequate in visualizing it in some cases, necessitating the use of bone scintigraphy or fluorine 18-labeled sodium fluoride PET/CT for definitive diagnosis. Radiologists frequently play a pivotal role in suggesting this diagnosis. However, familiarity with the unique imaging attributes of intra-articular OO is key to this endeavor. Awareness of these distinctive imaging findings of intra-articular OO is crucial for avoiding diagnostic delay, ensuring timely intervention, and preventing unnecessary procedures or surgeries resulting from a misdiagnosis. The authors highlight and illustrate the different manifestations of intra-articular OO as compared with the more common extra-articular lesions with respect to clinical presentation and imaging findings. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- M Alejandra Bedoya
- From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Jade Iwasaka-Neder
- From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Andy Tsai
- From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Sarah D Bixby
- From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
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He Y, Li X, Tu ZX, Chen HW, Zeng H, Peng Q, Chen TZ. Arthroscopic treatment of osteoid osteoma in the posterior proximal tibia: A case report and literature review. Medicine (Baltimore) 2024; 103:e37076. [PMID: 38306554 PMCID: PMC10843490 DOI: 10.1097/md.0000000000037076] [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: 10/30/2023] [Accepted: 01/05/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Osteoid osteoma (OO) is a benign lesion characterized by an increased fibrous component in the bone marrow, presence of bone-like structures within the medullary cavity, and a surrounding sclerotic bone rim. Reports on OO located in the posterior proximal tibia are rare. CASE SUMMARY Herein, we report the case of an 18-year-old male, admitted for the evaluation of right knee pain. The right knee pain had started 6 months prior without any apparent cause, which was notably severe at night, affecting sleep, and was exacerbated while climbing stairs or bearing weight. The patient also experienced pain on flexion. Three-dimensional computed tomography and magnetic resonance imaging revealed a nodular lesion beneath the cortical bone of the posterior medial plateau of the right tibia and an abnormal signal focus on the posterior lateral aspect of the right tibial plateau associated with extensive bone marrow edema. A small amount of fluid was present in the right knee joint capsule. The patient subsequently underwent arthroscopic excision of the OO. Postoperatively, there was significant relief of pain, and the knee range of motion returned to normal. CONCLUSION Although OO in the posterior proximal tibia is a rare occurrence, it can be effectively excised through minimally invasive arthroscopic visualization.
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Affiliation(s)
- Yinhao He
- Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Xiaosheng Li
- Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Zhi-Xing Tu
- Fujian Medical University, Fuzhou, Fujian Province, China
| | - Hong-Wen Chen
- Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Hui Zeng
- Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Qiang Peng
- Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
| | - Tie-Zhu Chen
- Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China
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Chen C, Fu S, Su Y, Shi Z. Intra-articular Osteoid Osteoma of the Intermediate Cuneiform Bone Causing Articular Degeneration: A Rare Case and Literature Review. Orthop Surg 2023; 15:2471-2476. [PMID: 37431565 PMCID: PMC10475673 DOI: 10.1111/os.13805] [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: 03/04/2023] [Revised: 05/03/2023] [Accepted: 05/25/2023] [Indexed: 07/12/2023] Open
Abstract
Osteoid osteoma of the cuneiform bone is an exceedingly rare and easily missed cause of foot pain. The uncharacteristic and nonspecific radiographs of such intra-articular osteoid osteoma further increase difficulty in making the diagnosis. To date, there has been no description of intra-articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration in any published literatures. We present a case of intra-articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration, who underwent curettage, allograft bone graft, and navicular-cuneiform arthrodesis. The patient presented with radiographic bone union, full motor function recovery and pain-free at the 22-month follow-up. This report adds to the existing literature. Intra-articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration is an exceedingly rare and easily missed cause of foot pain. It proves a complicated and challenging task to identify intra-articular osteoid osteoma. Clinicians should be particularly careful not to exclude the possibility of arthritis and, thus, vigilant when choosing the surgical option.
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Affiliation(s)
- Cheng Chen
- Foot & Ankle Section, Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth Peoples HospitalShanghaiChina
| | - ShaoLing Fu
- Foot & Ankle Section, Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth Peoples HospitalShanghaiChina
| | - Yan Su
- Foot & Ankle Section, Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth Peoples HospitalShanghaiChina
| | - ZhongMin Shi
- Foot & Ankle Section, Department of OrthopaedicsShanghai Jiao Tong University Affiliated Sixth Peoples HospitalShanghaiChina
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Polat G, Bayram S, Altan M, Kocazeybek E, Salduz A, Aşık M. Midterm Clinical, Radiological, and Functional Results of Arthroscopic Excision of Osteoid Osteoma of the Hip Joint: a Case Series. Indian J Orthop 2023; 57:71-79. [PMID: 36660482 PMCID: PMC9789269 DOI: 10.1007/s43465-022-00772-8] [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: 03/31/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022]
Abstract
Purpose We aimed to evaluate the midterm functional and clinical outcomes of the patients who underwent arthroscopic excision of hip osteoid osteoma (OO). Methods We reviewed records of patients diagnosed with intra-articular hip OO, treated with hip arthroscopic excision procedure, and a minimum of 1-year postoperative between 2011 and 2020. Clinical outcomes were assessed range of motion (ROM) pre and postoperatively, and functional outcomes were evaluated with a modified Harris hip score (modified HHS) and Visual analog scale test. All patients were assessed by hip radiography, and three radiological measurements, including lateral center-edge angle (LCEA), alpha angle, and Tönnis angle, were measured. These parameters were compared with unaffected hips. Results Fifteen (5 female and 10 male) patients were included in the study, with a mean age of 32.6 ± 12.7 (range 12-53). The average postoperative follow-up period was 59.1 ± 28 (range 13-106) months. The functional and clinical scores were significantly improved at the final visit compared to the preoperative values. No differences were found between the operated and unaffected sides with respect to the radiological parameters. The preoperative alpha was significantly higher on the operated side than on the unaffected side (p = 0.007). Conclusion In this study, within an average of 5 years after surgery, hip arthroscopy provided successful clinical outcomes in the treatment of OO of the hip joint without recurrence. The modified HHS, VAS, and HOS values improved significantly at the final follow-up; 14 of 15 patients had satisfactory outcomes after hip arthroscopy for hip OO. Level of Evidence Prognostic Level IV study.
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Affiliation(s)
- Gökhan Polat
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Çapa Fatih, 34093 Istanbul, Turkey
| | - Serkan Bayram
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Çapa Fatih, 34093 Istanbul, Turkey
| | - Murat Altan
- Department of Orthopedics and Traumatology, Sarıkamış State Hospital, Kars, Turkey
| | - Emre Kocazeybek
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Çapa Fatih, 34093 Istanbul, Turkey
| | - Ahmet Salduz
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Çapa Fatih, 34093 Istanbul, Turkey
| | - Mehmet Aşık
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Çapa Fatih, 34093 Istanbul, Turkey
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Eberhardt O, von Kalle T, Matthis R, Doepner R, Wirth T, Fernandez F. A CT-free protocol to treat osteoid osteoma of the hip region in childhood and adolescence by percutaneous drilling and by hip arthroscopy. Hip Int 2022; 32:792-799. [PMID: 33656954 DOI: 10.1177/1120700021996269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION It is often difficult to clinically and radiologically diagnose intra-articular osteoid osteomas and osteoid osteomas of the hip joint. Treatment can also be difficult due to complex locational relationships. CT-guided radiofrequency ablation is currently the standard form of treatment.In this paper we report on a minimally-invasive concept for treating osteoid osteomas near the hip joint in children and adolescents which does not involve using computed tomography. MATERIAL AND METHOD 10 patients with an average age of 12.1 years underwent treatment for osteoid osteomas in the hip joint region. The diagnosis was made using a contrast-enhanced MRI. The osteoid osteomas were marked percutaneously using x-ray and MRI guidance. MRI-guided drilling/curettage was performed in 4 cases and arthroscopic resection in 6 cases. RESULTS All lesions were successfully treated using the MRI-guided method. All patients were free of pain after the treatment. There was no instance of recurrence during the follow-up period, which averaged 10 months. The effective dose for marking the lesion was between 0.0186 mSv and 0.342 mSV (mean 0.084 mSV). CONCLUSIONS Our MRI diagnostics protocol, the MRI-guided drilling and the minimally invasive hip arthroscopy represent an alternative to CT-guided radiofrequency ablation in the treatment of osteoid osteomas. Radiation exposure can thereby be significantly reduced. Hip arthroscopy can also be used to treat secondary pathologies such as femoroacetabular impingement.
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Affiliation(s)
- Oliver Eberhardt
- Orthopaedic Department, Klinikum Stuttgart Olga Hospital and Women's Clinic, Stuttgart, Germany
| | - Thekla von Kalle
- Department of Paediatric Radiology, Klinikum Stuttgart Olga Hospital and Women's Clinic, Stuttgart, Germany
| | - Rebecca Matthis
- Institute for Medical Physics, Klinikum Stuttgart Katharinenhospital, Stuttgart, Germany
| | - Richard Doepner
- Orthopaedic Department, Klinikum Stuttgart Olga Hospital and Women's Clinic, Stuttgart, Germany
| | - Thomas Wirth
- Orthopaedic Department, Klinikum Stuttgart Olga Hospital and Women's Clinic, Stuttgart, Germany
| | - Francisco Fernandez
- Orthopaedic Department, Klinikum Stuttgart Olga Hospital and Women's Clinic, Stuttgart, Germany
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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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Tripathy S, Varghese P, Sethy SS, Agrawal K. Safe surgical hip dislocation for acetabular osteoid osteoma excision. BMJ Case Rep 2022; 15:e246025. [PMID: 35228220 PMCID: PMC8886369 DOI: 10.1136/bcr-2021-246025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 02/05/2023] Open
Abstract
Excision of acetabular osteoid osteoma is technically difficult. We report osteoid osteoma of the quadrilateral plate in a 9-year-old girl who presented to us with persistent nocturnal pain, limp and restricted hip joint movement. The child was investigated with CT scan, MRI and triple-phase bone scan. The 0.7 cm nidus was located in the central portion of the cancellous bone in the quadrilateral plate, 1.94 cm inferior to the triradiate cartilage. The child was operated on through the safe surgical dislocation of the left hip. The location of the lesion was gauged from the preoperative CT scan measurement data and intraoperative fluoroscopic aid. The nidus with a sclerotic rim was burred down completely. Postoperative X-ray and CT scan revealed complete excision of the tumour, and the patient was pain-free. At 18 months follow-up, the patient is completely asymptomatic and walking normally.
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Affiliation(s)
- Sujit Tripathy
- Department of Orthopaedics, AIIMS, Bhubaneswar, Odisha, India
| | | | | | - Kanhaiyalal Agrawal
- Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Arriaza CR, Salguero EJ, Cobar Bustamante A. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac019. [PMID: 35145629 PMCID: PMC8826157 DOI: 10.1093/jscr/rjac019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Osteoid osteoma located on the hip joint presents with atypical symptoms that can be misdiagnosed or missed. Multiple image studies can be made for diagnosis but OO should be suspected to properly choose the right one. Percutaneous resection with CT guidance is a reproducible and accurate technique with the appropriate tools and a specialist team to obtain optimal results.
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Affiliation(s)
- Carlos R Arriaza
- Correspondence address. 6a Av. 7-39 Zona 10, Edificio Las Brisas Clinica 109. Guatemala City, Guatemala.
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Kuhaimi TA, Alenezi G, Alawaji A, Alshaikh M, Bauones S. Intra-articular hip joint osteoid osteoma: Challenging diagnosis and percutaneous radiofrequency ablation treatment. Radiol Case Rep 2021; 16:3315-3320. [PMID: 34484539 PMCID: PMC8403707 DOI: 10.1016/j.radcr.2021.07.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/24/2021] [Accepted: 07/25/2021] [Indexed: 01/03/2023] Open
Abstract
Atypical intra-articular osteoid osteoma can be difficult to diagnose and challenging to treat. We report a case of a right acetabular subchondral intra-articular osteoid osteoma in a young male patient which was initially diagnosed as femoroacetabular impingement due to its atypical clinical and radiological presentations. After fully working up the patient the lesion was successfully treated with percutaneous CT-guided low-power bipolar radiofrequency ablation using several per procedural articular cartilage thermal protective measures including intra-articular thermocouple, and continuous per procedural joint space cooling with Dextrose 5% solution. A precise RFA electrode placement, using the No-touch technique, and applying different passive and active thermal protective measures were helpful in avoiding collateral damage of the hip joint articular cartilages. atypical intra-articular osteoid osteomas necessitate pertinent correlation between the clinical and radiological presentations. As far as intra-articular or subchondral nidus ablation is concerned, thermal protective measures should be considered.
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Affiliation(s)
- Talal Al Kuhaimi
- Department of Interventional Radiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Gaied Alenezi
- Department of Musculoskeletal Radiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Aliya Alawaji
- Department of Musculoskeletal Radiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alshaikh
- Department of Interventional Radiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Salem Bauones
- Department of Musculoskeletal and Intervention Radiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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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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Plečko M, Mahnik A, Dimnjaković D, Bojanić I. Arthroscopic removal as an effective treatment option for intra-articular osteoid osteoma of the knee. World J Orthop 2021; 12:505-514. [PMID: 34354938 PMCID: PMC8316839 DOI: 10.5312/wjo.v12.i7.505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/07/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intra-articular osteoid osteoma (iaOO) can be found in 5.2% up to 10% of cases. They may cause non-specific symptoms, mimicking degenerative or traumatic pathologies. If iaOO is left untreated, it may lead to severe muscle atrophy, tenderness, swelling, and limited range of motion. Therefore, surgical treatment is recommended. The main goal of surgical treatment is complete removal or destruction of iaOO.
AIM To evaluate the efficiency of arthroscopic removal of iaOO of the knee in our cases and cases available in the literature.
METHODS Analysis of available hospital records of four patients with iaOO of the knee treated by arthroscopic removal from August 2005 to December 2015 at our Department was performed. All patients had a diagnosis of iaOO confirmed by histopathologic analysis. Additional literature review of cases of iaOO of the knee available on PubMed and Google Scholar was made. All cases of iaOO of the knee treated by arthroscopic or arthroscopically assisted removal were reviewed in order to further evaluate the efficiency of the method.
RESULTS The average age of patients included in our study was 23.2 (range 16-37) years. The average duration of the symptoms prior to surgery was 14.2 (range 6-24) months. All of the patients had persistent knee pain. Three patients reported worsening of pain during the night, while two reported worsening of pain during activity. Three patients reported alleviation of pain on non-steroidal anti-inflammatory drugs (NSAIDs), while one patient reported partial alleviation of pain on NSAIDs. No intraoperative complications were noted, and the postoperative period was uneventful in all patients. The patients reported immediate pain relief in the postoperative period. No recurrence of the disease was noted in any of the patients during the follow-up period of at least 24 mo. The literature review revealed 14 cases with an average age of 27.6 (range 16-48) years and onset of symptoms 27.7 (range 6-108) months prior to surgery, with recurrence of the disease noted in a single case.
CONCLUSION Arthroscopic removal is an efficient treatment method that allows excision of iaOO that is neither insufficient nor excessive, thus avoiding disease recurrence while obtaining adequate material for histopathologic analysis.
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Affiliation(s)
- Mihovil Plečko
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Alan Mahnik
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Damjan Dimnjaković
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Ivan Bojanić
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
- Department of Orthopedic Surgery, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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Gao G, Wu R, Liu R, Ao Y, Wang J, Xu Y. Hip arthroscopy has good clinical outcomes in the treatment of osteoid osteoma of the acetabulum. BMC Musculoskelet Disord 2021; 22:491. [PMID: 34049517 PMCID: PMC8161943 DOI: 10.1186/s12891-021-04384-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoid osteoma (OO) of the acetabulum is a relatively rare disease. However, the the clinical outcomes of hip arthroscopy for treatment of OO of the acetabulum are still uncertain. METHODS We evaluated consecutive patients who were diagnosed with OO of the acetabulum and who underwent hip arthroscopy at our hospital between January 2013 and March 2020. All patients underwent a preoperative physical examination. Preoperative supine anteroposterior hip radiography, cross-table lateral radiographs, computed tomography (CT), and magnetic resonance imaging were performed in all patients. The alpha angle and lateral center-edge angle were measured before surgery. Supine anteroposterior hip radiography and CT were performed in all patients postoperatively. Preoperative patient-reported outcomes (PROs), including Visual Analog Scale (VAS), the International Hip Outcome Tool-12 (iHOT-12) and modified Harris Hip Score (mHHS), and PROs at final follow-up were evaluated. RESULTS A total of 6 patients (mean age, 18.7 years; age range, 6-31 years; 5 males and 1 females) were included in this study. The average follow-up period after surgery was 28.3 months (range, 6-90 months). Before surgery, the mean mHHS was 45.2 ± 10.5 (range, 33-56), the mean iHOT-12 was 33.3 ± 14.5 (range, 13-49), and mean VAS was 8.2 ± 1.0 (range, 7-9). At one month after surgery, mean mHHS was 78.7 ± 1.9 (range, 77-81), iHOT-12 was 71.0 ± 4.5 (range, 68-80), and mean VAS was 0. At the final post-operative follow-up, mean mHHS was 89.2 ± 2.1 (range, 86-91), iHOT-12 was 93.5 ± 5.0 (range, 88-98), and mean VAS was 0. All results, except VAS between one month after surgery and at final follow-up, demonstrated statistically significant improvement (P < 0.05). One patient underwent revision surgery. CONCLUSIONS Hip arthroscopy has good clinical outcomes in the treatment of OO of the acetabulum. Further study on the mechanism of secondary femoroacetabular impingement (FAI) caused by OO of the acetabulum is needed. More cases of arthroscopic excision and longer follow-up are also needed to better prove the clinical outcomes of hip arthroscopy for OO of the acetabulum.
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Affiliation(s)
- Guanying Gao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191, Beijing, China
| | - Ruiqi Wu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191, Beijing, China
| | - Rongge Liu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191, Beijing, China
| | - Yingfang Ao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191, Beijing, China
| | - Jianquan Wang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191, Beijing, China.
| | - Yan Xu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191, Beijing, China.
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Ischial osteoid osteoma: A cause of persistent hip pain in an adolescent patient with bilateral femoroacetabular impingement. Radiol Case Rep 2021; 16:1037-1041. [PMID: 33680272 PMCID: PMC7917454 DOI: 10.1016/j.radcr.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/20/2022] Open
Abstract
A 15-year-old boy presented with left-sided hip pain and imaging consistent with the diagnosis of femoroacetabular impingement. Following hip arthroscopy, which included an osteochondroplasty, labral repair, and capsular repair, the patient's anterior hip pain improved. However, his deep aching hip pain persisted until an ischial osteoid osteoma was identified and treated with radiofrequency ablation. At 3 years follow-up, the patient reports high satisfaction and minimal pain. We present this case to illustrate the importance of considering all potential causes of persistent hip pain following hip arthroscopy, including benign bone tumors which may be difficult to visualize on plain radiographs.
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Arrigoni F, Bruno F, Palumbo P, Zugaro L, Zoccali C, Barile A, Masciocchi C. Magnetic resonance-guided focused ultrasound surgery treatment of non-spinal intra-articular osteoblastoma: feasibility, safety, and outcomes in a single-center retrospective analysis. Int J Hyperthermia 2019; 36:768-775. [DOI: 10.1080/02656736.2019.1639833] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Francesco Arrigoni
- Department of Emergency and Interventional Radiology, San Salvatore Hospital, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Pierpaolo Palumbo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Department of Emergency and Interventional Radiology, San Salvatore Hospital, L'Aquila, Italy
| | - Carmine Zoccali
- Department of Oncological Orthopaedics, Muscular-skeletal Tissue Bank, IFO-Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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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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Clinical outcomes and causes of arthroscopic hip revision surgery. Sci Rep 2019; 9:1230. [PMID: 30718558 PMCID: PMC6362113 DOI: 10.1038/s41598-018-37708-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/12/2018] [Indexed: 11/08/2022] Open
Abstract
Hip arthroscopic surgery has become a common technique during the past decade, leading to an increased number of arthroscopic hip revision surgeries. This study aimed to evaluate the clinical outcomes in a series of revision hip arthroscopies to analyse the causes of reoperation in the short to medium-term follow-up. We retrospectively analysed 22 patients who underwent arthroscopic hip revision surgery in our institute. All patients accepted a detailed physical examination and obtained radiographs to measure the centre edge angle, the alpha angle and the offset. Three-dimensional computed tomography was used to evaluate the deformities. The modified Harris Hip Score, visual analogue scale and patient self-reported satisfaction were collected and analysed preoperatively and postoperatively. Our results demonstrated that the modified Harris Hip Score improved from 52.8 to 81.6, and the visual analogue scale decreased from 5.0 to 1.1. Patient self-reported satisfaction was 8.5. In conclusion, patients who underwent arthroscopic hip revision surgery exhibited significant improvement in patient-centred outcomes in the short- to medium-term follow-up, and the outcomes indicated the effectiveness of revision surgery. Residual femoroacetabular impingement and extra-articular impingement are common reasons for arthroscopic hip revision surgery. Misdiagnosis of osteoid osteoma and relapse of synovial chondromatosis are also important reasons for revision.
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