Radiofrequency ablation of osteoid osteoma: outcomes from the West of Scotland

Femur Neck Osteoid Osteoma Managed with Radiofrequency Ablation - A Case Report

Introduction

Osteoid osteoma is a benign tumor of bones involving mainly the tubular bones and rarely axial skeletons. The patient mainly complains of night pain in the affected region or the joint nearby. Pain always subsides with analgesics and gradually increased over the period of time. It is mostly missed on the plain radiograph so magnetic resonance imaging or computed tomography (CT) scan are preferred for accurate and early diagnosis of the tumor.

Case Report

A 20-year-old male presented with pain in the left hip region which was gradually increased over the period of 6 months and was experiencing pain more in the night, used to relieve on medications. CT scan of the left hip showed the presence of osteoid osteoma of 0.5 cm diameter, which was managed with radiofrequency ablation. Moreover, the patient had pain relief immediately after the procedure. At present 1-year follow-up, the patient is symptomless with no recurrence.

Conclusion

The neck of femur osteoid osteomas is best managed with radiofrequency ablation as it causes less morbidity to the patient and helps in early return to normal activities with fewer complications as compared to open procedures.

Percutaneous Radiofrequency Ablation for the Treatment of Osteoid Osteoma in Children and Adults: A Comparative Analysis in 92 Patients

PURPOSE

To compare technical success, complications, and long-term clinical success following radiofrequency ablation of osteoid osteomas in pediatric and adult patients.

MATERIALS AND METHODS

Ninety-two patients underwent percutaneous computed tomography-guided radiofrequency ablation for osteoid osteomas including 54 pediatric (mean age 12.9 years) and 38 adult (mean age 24.1 years) patients. Presenting indication, osteoma location, ablation method, technical success, complications, visual analog score, radiographic follow-up, clinical success, reintervention rate, and total follow-up were reported. Technical success was defined as placement of the probe in the radiolucent nidus with ablation. Clinical success was defined as resolution of symptoms.

RESULTS

Ablation indications included: pain localized to the lesion, night pain, and an osteoma on imaging in all patients. Majority of osteoid osteomas were localized to the femur (pediatric [n = 22, 40.7%]; adult [n = 12, 34.2%]) and tibia (pediatric [n = 21, 38.9%]; adult [n = 10, 26.3%]). Mean lesion size was 9.6 mm in pediatric patients and 9.0 mm in adults. Technical success was achieved in all pediatric patients (100%) and 97.4% of adults. Two complications occurred. Primary clinical success was achieved in 49 (90.7%) pediatric and 35 (92.1%) adult patients. Five (9.3%) pediatric and 3 (7.9%) adult patients sought reintervention for residual symptoms, and all had secondary clinical success. Mean total follow-up was 95.2 ± 58.7 months in pediatric and 90.0 ± 61.6 months in adult patients. No differences in outcomes were identified between pediatric and adult patients.

CONCLUSION

Radiofrequency ablation of osteoid osteomas is safe with excellent technical and clinical success rates in pediatric and adult patients.

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.

Multifocal osteoid osteoma of tibia

Multifocal osteoid osteoma of the bone is extremely rare. We report a 25-year-old man who presented with pain in the left leg since 11 months which was partially relieved by over-the-counter analgesics. Radiograph demonstrated two lytic lesions with surrounding sclerosis along the anterior cortex of the left tibia. Three-phase Tc 99m bone and CT scans confirmed the diagnosis of multifocal osteoid osteoma. The patient underwent surgical excision followed by protected weight bearing. The patient was asymptomatic at 6 months postoperatively. Multifocal osteoid osteoma needs to be considered in the differential diagnosis of multiple lytic lesions in the bone.