Radiofrequency ablation of osteoid osteoma using tissue impedance as a parameter of osteonecrosis

Comparison of arthroscopy versus percutaneous radiofrequency thermal ablation for the management of intra- and juxta-articular elbow osteoid osteoma: case series and a literature review

BACKGROUND

Today, intra-articular and juxta-articular osteoid osteomas are treated with arthroscopy and radiofrequency thermal ablation. However, for the case of an elbow joint, arguments are made for the use of a minimally invasive technique to be the optimal choice. This study aims to analyse our experiences of arthroscopically treated elbow osteoid osteomas and to compare it with the published results of both techniques.

METHODS

The retrospective study analyses the patients who underwent elbow arthroscopy ablation of an elbow osteoid osteoma at a single institution from January 2014 until March 2020. Clinical and diagnostic features, success and treatment failure rates, complications and tumour recurrence rates were all compared to 13 studies of intra-articular elbow osteoid osteoma arthroscopic ablation and 15 studies involving radiofrequency thermal ablation of intra-articular osteoid osteoma within different joints.

RESULTS

Four males and two females, with a mean age of 19.3 years, were encompassed. All the patients had immediate postoperative pain relief and improved range of motion. No tumour recurrences were observed during a median of 21.7 months. The literature review yielded 86.4% success rate, 68.2% successful biopsies, one minor complication and no recurrences following the arthroscopic ablation of an elbow osteoid osteoma; while radiofrequency thermal ablation of an intra-articular elbow osteoid osteoma yielded 96.3% success rate, 33.3% successful biopsies, no complications and 3.7% recurrence rate.

CONCLUSIONS

Our results are consistent with the published literature proving that arthroscopic ablation is an efficient method with low treatment failure rates and no recurrences in treating intra- and juxta-articular elbow osteoid osteomas. Advantages of arthroscopic ablation stem from the ability to visualise and safely deal with the lesion and the joint's reactive changes resulting in high biopsy rates, no recurrences and better postoperative elbow's range of motion. Still, the technique selection should be personalised considering the medical expertise of every institution.

Radiofrequency ablation vs microwave ablation for osteoid osteomas: long-term results

OBJECTIVE

Osteoid osteomas are benign bone tumors commonly treated using thermal ablation. We compare the technical success, complication rates, and long-term efficacy of the two most common ablation types: radiofrequency and microwave.

MATERIALS AND METHODS

A retrospective study was performed of all osteoid osteoma ablation procedures between 2007 and 2017. A ten-point numerical pain scale was used to quantify symptoms before and after the procedures with > 12-month follow-up. Complications were reported using the Society of Interventional Radiology Adverse Events reporting criteria.

RESULTS

Twenty-nine patients successfully underwent 15 radiofrequency ablations and 15 microwave ablations with a technical success rate of 83% for radiofrequency and 100% for microwave (p = 0.23). Long-term recurrence rates (p = 1.0) and complication rates (p = 0.60) were not significantly different for the groups. One patient developed a skin burn following microwave ablation and another developed 12 months of sciatic neuropathy following radiofrequency ablation.

CONCLUSION

Microwave and radiofrequency ablation are safe and effective methods for treating osteoid osteomas with similar long-term efficacies. Although radiofrequency ablation is more commonly reported to result in skin burns, this complication can arise during microwave ablation.

CT-guided radiofrequency ablation for osteoid osteomas: a systematic review

OBJECTIVES

CT-guided radiofrequency ablation (CT-RFA) is considered to be the gold standard for treatment of osteoid osteoma (OO) yet treatment failures (TFs) continue to be reported. This systematic review was conducted to evaluate factors associated with TF, such as ablation time, lesion location, and patient age as well as evaluating how TF has trended over time.

METHODS

Original studies reporting on patients undergoing CT-RFA of OO published between 2002 and 2019 were identified. TF was defined as patients with (1) recurrent or persistent pain +/- (2) imaging evidence of persistent OO. TFs were subdivided into those occurring after the index procedure (primary TF) or those occurring after repeat RFA (secondary TF). Subgroup analysis was performed for TF based on the study date (2002-2010 or 2010-2019), time duration of ablation at 90 °C (6 min or > 6 min), patient age, and tumor location (spinal vs. appendicular).

RESULTS

Sixty-nine studies were included for a total of 3023 patients. The global primary TF rate was 8.3% whereas the secondary TF rate was 3.1%. The TF rate reported in studies published after 2011(7%) was about half that during the earlier time period 2002-2010 (14%). There was no statistical difference in TF corrected for age, OO location, or duration of ablation (respectively p = 0.39, 0.13, and 0.23). The global complication rate was 3%, the most frequent being skin burns (n = 24; 0.7%).

CONCLUSIONS

A decrease in TF observed between 2011-2019 compared to 2002-2010 may reflect improvements in operator technique or advancements in equipment. Duration of ablation, patient age, or location of OO failed to significantly correlate with TF.

KEY POINTS

• CT-guided radiofrequency ablation of osteoid osteomas is a safe technique with a low rate of treatment failure (8.3% failure rate after the primary radiofrequency reducing to 3.1% following a secondary treatment). • The treatment failure rate has decreased over time, possibly due to an improved understanding of the disease process, better technique, and advances in equipment. • Duration of ablation, patient age, or lesion location did not significantly correlate with treatment failure.

Percutaneous thermal ablation for treatment of osteoid osteoma: a systematic review and analysis

OBJECTIVE

Although radiofrequency ablation is well validated for treatment of osteoid osteoma, newer technologies, namely cryoablation, have been less thoroughly studied. The purpose is to perform a systematic review and pooled analysis of percutaneous ablation technologies for treatment of osteoid osteoma with subset analysis of intra-articular and spinal tumors.

MATERIAL AND METHODS

A total of 36 of 79 identified manuscripts met inclusion criteria, comprising 1863 ablations in 1798 patients. Inclusion criteria were (1) retrospective or prospective analysis of thermal ablation of osteoid osteomas in any location, (2) at least 6 months of clinical follow-up, (3) 10 or more patients, (4) patients not included in a second study included in this review, and (5) English language or English translation available. Success rate was defined as all ablations minus technical failures, clinical failures, and recurrences. Subset analysis of intra-articular and spinal tumors was performed.

RESULTS

Overall success rate was 91.9% (95% CI 91-93%). Technical failure, clinical failure, and recurrence rates were 0.3%, 2.1%, and 5.6% respectively. Complications were seen in 2.5% (95% CI 1.9-3.3%) patients. There was no significant difference when comparing radiofrequency ablation and cryoablation (p = 0.92). Success rates for intra-articular (radiofrequency ablation) and spinal tumors (radiofrequency and cryoablation) were 97% and 91.6% respectively.

CONCLUSION

Percutaneous ablation of osteoid osteomas was highly successful with low complication rates. Efficacy of radiofrequency ablation and cryoablation is similar, which is consequential because cryoablation is associated with decreased pain, predictable nerve regeneration, and theoretical immunotherapy benefits. Treatment of more challenging intra-articular and spinal lesions demonstrated similarly high success and low complication rates.

Radiofrequency ablation of osteoid osteoma: Aiming for excellent outcomes in an Australasian context

INTRODUCTION

To report a series of patients with osteoid osteoma treated by radiofrequency ablation in whom no complications or recurrences occurred.

METHODS

Over a 13-year period, 32 consecutive patients with osteoid osteoma were treated by radiofrequency ablation in an Australasian teaching centre.

RESULTS

All patients had resolution of symptoms with no complication or recurrence.

CONCLUSIONS

This series is further evidence for the use of radiofrequency ablation as the primary treatment for osteoid osteoma.

Radiofrequency ablation for osteoid osteoma - Recurrence rates and predictive factors

BACKGROUND AND PURPOSE

Osteoid osteoma is an infrequent but debilitating benign bone lesion which can be successfully managed by percutaneous radiofrequency ablation (RFA). There are few studies investigating the efficacy and follow-up of this treatment. An arbitrary upper limit of 15 mm has been used to differentiate between osteoid osteoma and osteoblastoma with surgery used for lesions above this limit. We aimed to analyse the cases identified from our prospectively maintained database over a ten year period since adoption of this technique in our unit. The primary objectives were to investigate factors which influenced recurrence and the time period at which patients are at risk of this.

BASIC PROCEDURES

Consecutive patients with confirmed osteoid osteoma were included. Patient demographics, complications, and recurrence were recorded and multiple regression analysis was performed to investigate causation.

MAIN FINDINGS

Within a minimum follow up of 21 months (mean 72), a recurrence rate of 16.3% was noted, higher than the published literature. Cox regression analysis to predict chance of recurrence revealed a relationship between larger lucent diameter and recurrence (p = 0.049, CI 95%, hazard ratio 1.33).

CONCLUSIONS

The traditional cut off between osteoid osteoma and osteoblastoma appears less rigidly defined than previously thought and probably represents a progressive scale with larger lesions responding less well to RFA. This study indicates that each millimetre increase represents a ×1.33 chance of recurrence. Clinicians should counsel patients accordingly with lesions approaching the larger limits of this diagnosis.

Intra-articular osteoid osteoma as a differential diagnosis of diffuse mono-articular joint pain

Background

The aim of this retrospective study was to investigate the frequency of intra-articular osteoid osteoma (iaOO) in a large study cohort and to demonstrate its clinical relevance as an important differential diagnosis of non-specific mono-articular joint pain.

Methods

We searched the registry for bone tumours of the University Medical Centre Hamburg-Eppendorf for osteoid osteomas in the last 42 years. Herein, we present three selected iaOO which were detected in the three major weight-bearing joints. Computed tomography (CT) or magnetic resonance imaging (MRI) scans were performed for initial diagnosis.

Results

Out of a total of 367 osteoid osteomas, 19 (5.2 %) tumours were localized intra-articularly. In all three presented tumours, a history of severe mono-articular pain was reported; however, the mean time to correct diagnosis was delayed to 20.7 months. Clearly, the nidus seen in CT and MRI images in combination with inconsistent salicylate-responsive nocturnal pain led to the diagnosis of iaOO.

Conclusions

Rarely, osteoid osteoma can occur in an intra-articular location. In cases of diffuse mono-articular pain, iaOO should be considered both in large and smaller joints to avoid delays in diagnosis and therapy of this benign bone tumour.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-1313-3) contains supplementary material, which is available to authorized users.

Bone targeted bipolar cooled radiofrequency ablation in a VX-2 rabbit femoral carcinoma model

To determine the effect of bipolar cooled radiofrequency ablation (BCRF) on bone and tumour in a lapine pathologic femoral model. Under institutional approval, twelve New Zealand white rabbits received a single femoral injection of VX2 carcinoma cells (day 0). The rabbit femora, (n = 24), were block-randomized into four experimental groups: tumour-bearing radiofrequency ablation (RFA) treated, healthy bone RFA treated, tumour-bearing shams and healthy bone shams (n = 6 per group). 15 min of thermally regulated (65 °C) BCRF was applied at day 14. Pre- and post-treatment MR imaging was performed and repeated at day 28 prior to euthanasia. Histologic evaluation was used to determine treatment effect on tumour and bone tissue. A thirteenth injected rabbit served as a histologic control (no BCRF electrode placement). Large volumes (12.9 ± 5.5 cm(3)) of thermal ablation were achieved. An eight-fold reduction in tumour growth resulted in RFA treated animals compared to tumour-bearing sham controls (p < 0.001). Osteolysis was controlled in the tumour-treated group. Therapeutic effects were best imaged using MR contrast-enhanced SPoiled Gradient Recalled (SPGR) sequences. Osteoclasts and osteoblasts were observed to be sensitive to BCRF but osteocytes were more resilient. A small number of tumour cells within BCRF treated regions appeared viable post treatment. New bone formation was stimulated in the periphery of the targeted BCRF treatment zone. Structurally large VX2 tumour volumes within bone were successfully ablated with BCRF, stimulating new bone formation in the treatment periphery, although viable appearing osteocytes and tumour cells were observed in some treated regions.

Osteoid osteoma treated by percutaneous thermal ablation: when do we fail? A systematic review and guidelines for future reporting

PURPOSE

Osteoid osteoma (OO) is a painful benign bone tumor of the young that is widely treated by percutaneous thermal ablation (PTA) with success rates close to 100%. Nevertheless, some patients have recurrences. We reviewed the literature to understand whether these are true recurrences or incomplete treatments; to analyze safety and efficacy during long-term follow-up in a extremely large cohort of patients; to detail best-practice suggestions from the largest clinical trials as well as report their complications; and to recommend standards for future reporting.

MATERIALS AND METHODS

This study followed the Cochrane's guidelines for Systematic Reviews of Interventions. Inclusion criteria were as follows: (1) prospective or retrospective cohort study for PTA of OO under computed tomography (CT) guidance; (2) CT or magnetic resonance diagnosis; (3) radiofrequency ablation or interstitial laser ablation technique; (4) English language; (5) population <10 patients; (6) follow-up ≥12 months; and (7) original research. Risk of bias was assessed with a modified Newcastle-Ottawa Scale.

RESULTS

Two hundred fourteen articles were initially found. After applying the criteria mentioned previously, 27 PTA articles concerning 1,772 patients were chosen for inclusion. No exclusions were made due to risk of bias.

CONCLUSION

The investigators proved the long-term efficacy and superiority of PTA for OO compared with other techniques. In 5% of patients, however, the technique failed, and the researchers did not offer detailed exhaustive explanations. Future clinical trials for OO ablation should consider reporting essential procedure details and follow-up findings to allow for a meta-analysis. We provide both recommended standards for future reporting and suggestions for the prevention of recurrence.