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Napora J, Wałejko S, Mazurek T. Osteoid Osteoma, a Diagnostic Problem: A Series of Atypical and Mimicking Presentations and Review of the Recent Literature. J Clin Med 2023; 12:jcm12072721. [PMID: 37048803 PMCID: PMC10095250 DOI: 10.3390/jcm12072721] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
Osteoid osteoma (OO) is a common benign bone tumour, usually affecting young people. Typically, it is localised to the diaphyses or metaphyses of long bones. The classical manifestation includes distinctive night pain, almost always present, responding well to non-steroidal anti-inflammatory drugs, sometimes accompanied by complaints due to physical activity, and a typical picture on additional tests. A characteristic of osteoid osteoma is the presence of a nidus, usually visible on imaging tests. The nidus generally presents as a single, round lytic lesion up to 1 cm in diameter, surrounded by an area of reactive ossification. However, OO is a multifaceted neoplasm, and its diagnosis can cause numerous difficulties. OO can mimic multiple diseases and vice versa, which often leads to a prolonged diagnostic and therapeutic path and associated complications. There are few literature reviews about the differentiation and diagnostic difficulties of osteoid osteoma. Very effective therapies for this tumour are known, such as ablation and resection. Enhanced detection of osteoid osteoma could result in faster diagnosis and less suffering for the patient, avoidance of complications, and reduced costs of incorrect and prolonged treatment.
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Affiliation(s)
- Justyna Napora
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Szymon Wałejko
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Tomasz Mazurek
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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Gudas R, Staskunas M, Smailys A, Rimkunas A. Arthroscopic treatment of intra-articular osteoid osteoma in the bicipital groove. A case report. Int J Surg Case Rep 2022; 101:107794. [PMID: 36434875 PMCID: PMC9691409 DOI: 10.1016/j.ijscr.2022.107794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/16/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Rare presence of intra-articular osteoid osteoma may be difficult to diagnose due to the lack of typical radiographic features and clinical appearance similar to other articular pathologies. Additionally traditional treatment choices for osteoid osteoma may not suit the given environment of the shoulder joint area. CASE PRESENTATION We presented a 50-year-old male with a prolonged history of anterior shoulder pain and shoulder stiffness after physical activity. Intra-articular joint pathology was suspected after initial clinical and radiographic assessment. Magnetic resonance imaging revealed an osteoid osteoma in the humeral bicipital groove. CLINICAL DISCUSSION The surgical goal is to resect the benign bony tumour. Though the established treatment by open surgery or radiological minimally invasive techniques may not be optimal since pathologies in the shoulder joint cannot be addressed without the risk of damage to articular structures and increased complications. In this case to avoid joint incision site morbidity and address adjacent pathology arthroscopic removal of the tumour with refixation of the biceps longus tendon was carried out. At follow up of 12 months post-surgery physical activity did not provoke stiffness and resting pain has subsided. CONCLUSION Arthroscopic intra-articular osteoma resection in shoulder joint was optimal to address adjacent osteoma induced pathology, achieve great visualization, reduce incision site complication rates and achieve good results. Additional synovectomy during arthroscopic treatment can be performed, due to concomitant synovitis causing joint stiffness in most reported intra-articular OO cases.
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Affiliation(s)
| | | | | | - Augustinas Rimkunas
- Corresponding author at: Lithuanian University of Health Sciences, Kaunas Clinics, Eivenių g. 2, LT-50161 Kaunas, Lithuania.
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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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Wang TL, Luo YP, Zhou ZF, Liu JF, Hou XD, Jia SH, Zheng LP. O-Arm-Navigated, Robot-Assisted Versus Conventional CT Guided Radiofrequency Ablation in Treatment of Osteoid Osteoma: A Retrospective Cohort Study. Front Surg 2022; 9:881852. [PMID: 35586510 PMCID: PMC9108172 DOI: 10.3389/fsurg.2022.881852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundOsteoid osteoma is a common benign bone tumor, and clinically there is severe local pain that typically worsens at night. The conventional CT-guided radiofrequency ablation (RFA) was widely used in the treatment of osteoid osteoma (OO), which could result in some radiation-related and imprecise complications due to the overdose of radiation exposure. This study aimed to compare the surgical effect of robot-assisted RFA with O-arm navigation and conventional CT-guided RFA in the treatment of OO.MethodsSixty-two patients who underwent robot-assisted RFA with O-arm navigation (Robot-RFA, n = 24) or CT-guided RFA (CT-RFA, n = 38) were included in this retrospective cohort study. The mean follow-up time was 23.3 months. The intra-operative data, primary technical success rate, visual analog scale (VAS), and post-operative complications were analyzed.ResultsPrimary technical success was obtained in 23 patients who had robot-assisted RFA, and 35 patients who had conventional CT-guided RFA. One patient in Robot-RFA group and three patients in CT-RFA group with pain recurrence received repeat-RFA and had a secondary success. Mean operation time and dose of radiation exposure were lower in Robot-RFA group than that in CT-RFA group. The Robot-RFA group took fewer K-wire adjustment times for each patient than the CT-RFA group. There was a statistically significant difference in the mean operation time, dose of radiation exposure, and K-wire adjustment times between the groups (p < 0.05). No complications associated with the procedure were reported in the two groups during the follow-up period.ConclusionRobot-assisted RFA with O-arm navigation is a safer and more precise strategy in the treatment of osteoid osteoma with less operation time and radiation exposure compared with the conventional CT-guided radiofrequency ablation.
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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. BMC Musculoskelet Disord 2022; 23:287. [PMID: 35337326 PMCID: PMC8953134 DOI: 10.1186/s12891-022-05244-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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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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Calanna F, Maione A, Fioruzzi A, Randelli F. Hip arthroscopy for the treatment of osteoid osteoma of the acetabulum: a case report study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021114. [PMID: 34747382 PMCID: PMC10523051 DOI: 10.23750/abm.v92is1.11122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022]
Abstract
Osteoid osteoma (OO) of the acetabulum is a quite rare pathology, with an overall incidence of 0,5%. Frequently the diagnosis of OO may not be simple to obtain, because the clinical presentation can mimic other common hip pathologies. We present a case report of OO of the anterior/superior edge of the acetabular fossa associated with a degenerative lesion of the acetabular labrum and with a concomitant femoral neck cam. The patient was refractory to prior pharmacological therapy with NSAIDs so arthroscopic treatment was performed. As a rational strategy, we trimmed the region of the tumor and we finally excised the nidus of the OO. Finally a femoroplasty and a partial labrectomy were performed. At the last follow-up the patient was symptom-free and able to walk with full weight bearing. The nocturnal pain was gone and his ROM improved fully without pain. The arthroscopic procedure, being less invasive, represents a valid option in the treatment of OO, allowing to treat radically the tumor and concurrently diagnose and repair any chondral or soft tissue injuries.
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Affiliation(s)
- Filippo Calanna
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.
| | | | - Alberto Fioruzzi
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.
| | - Filippo Randelli
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.
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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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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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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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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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Newhouse AC, Wichman DM, Fu M, Nho SJ. Cartilage-Preserving Arthroscopic-Assisted Radiofrequency Ablation of Periacetabular Osteoid Osteoma in a Young Adult Hip. Arthrosc Tech 2020; 9:e1039-e1042. [PMID: 32714816 PMCID: PMC7372570 DOI: 10.1016/j.eats.2020.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/29/2020] [Indexed: 02/03/2023] Open
Abstract
Osteoid osteomas are benign bone lesions that commonly occur in the lower extremities and spine, with the radiographic evidence of a central nidus surrounded by circumferential reactive bone. Although nonsteroidal anti-inflammatory drugs can provide symptomatic relief and are used as an important diagnostic tool, surgical intervention is the definitive treatment. Arthroscopic-assisted radiofrequency ablation has been shown to be an effective technique to directly visualize and treat the lesion while minimizing damage to the articular cartilage.
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Affiliation(s)
| | | | | | - Shane J. Nho
- Address correspondence to Shane J Nho, M.D., M.S., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, U.S.A.
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Singh DK, Katyan A, Kumar N, Nigam K, Jaiswal B, Misra RN. CT-guided radiofrequency ablation of osteoid osteoma: established concepts and new ideas. Br J Radiol 2020; 93:20200266. [PMID: 32520586 DOI: 10.1259/bjr.20200266] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Osteoid osteoma is a painful benign bone tumour of children and young adults with characteristic clinico-radiological features depending upon the location of the lesion. Intraoperative visualisation of the nidus is difficult and therefore curative surgery is often associated with excessive bone removal, significant perioperative morbidity and potential need of bone grafting procedures. With advancement in cross-sectional imaging and radiofrequency ablation (RFA) technology, CT-guided RFA has emerged as the treatment of choice for the osteoid osteoma. This procedure involves accurate cannulation of the nidus and subsequent thermocoagulation-induced necrosis.Multidisciplinary management approach is the standard of care for patients with osteoid osteoma. Appropriate patient selection, identification of imaging pitfalls, pre-anaesthetic evaluation and a protocol-based interventional approach are the cornerstone for a favourable outcome. Comprehensive patient preparation with proper patient position and insulation is important to prevent complications. Use of spinal needle-guided placement of introducer needle, namely, "rail-road technique" is associated with fewer needle trajectory modifications, reduced radiation dose and patient morbidity and less intervention time. Certain other procedural modifications are employed in special situations, for example, intra-articular osteoid osteoma and osteoid osteoma of the subcutaneous bone in order to reduce complications. Treatment follow-up generally includes radiographic assessment and evaluation of pain score. Dynamic contrast-enhanced MRI has been recently found useful for demonstrating post-RFA healing.
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Affiliation(s)
- Dharmendra Kumar Singh
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Amit Katyan
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Nishith Kumar
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Kanchan Nigam
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Binita Jaiswal
- Department of Anesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ritu Nair Misra
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Arthroscopic management of intra- and juxta-articular osteoid osteoma of the upper extremity: a systematic review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1333-1344. [PMID: 32504238 DOI: 10.1007/s00590-020-02710-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intra- and juxta-articular osteoid osteoma (OO) is rare and can result in irreversible joint damage. Recently, arthroscopic surgery is being used more and more to avoid complications associated with other treatment modalities. METHODS On October 13, 2019, we conducted a systematic review of the literature available in PubMed and EMBASE regarding the arthroscopic management of OO involving the joints of the upper extremity. Predetermined inclusion criteria were used to include any relevant article published on and before that date for further analysis. Treatment success rate and tumor recurrence rate were considered the primary outcomes in our analysis. RESULTS Out of 113 studies, 19 met our inclusion criteria. Of the 32 reported cases in these 19 articles, ten involved the shoulder joint, 19 involved the elbow joint and three involved the wrist joint. Overall treatment success rate was 93.8%. Tumor recurrence rate was 0.0%. No postoperative complications (0.0%) were reported among cases involving the shoulder joint. Two out of 24 (8.3%) patients with elbow OO failed arthroscopic treatment due to incomplete excision, and two (4%) experienced minor complications. Among the three cases of wrist OO, two (66.7%) patients had residual postoperative pain and decreased hand grip strength. CONCLUSION Arthroscopic management of OO of the upper extremity joints is highly successful and results in no tumor recurrence; however, there is a risk of incomplete resection in areas more difficult to access by arthroscopy.
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Abstract
Osteoid osteoma (OO), a small bone tumor relatively common in young subjects, frequently involves the hip. In addition to typical findings, we emphasize unsuspected clinical and imaging features including painless OO causing limping gait, non-visibility of totally mineralized nidus, absence of hyperostosis or adjacent edema, and recurrence at distance from the initial location. We also discuss the option of medical treatment for some cases of deep hip locations.
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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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Ge SM, Marwan Y, Addar A, Algarni N, Chaytor R, Turcotte RE. Arthroscopic Management of Osteoid Osteoma of the Ankle Joint: A Systematic Review of the Literature. J Foot Ankle Surg 2019; 58:550-554. [PMID: 30910487 DOI: 10.1053/j.jfas.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Indexed: 02/07/2023]
Abstract
Osteoid osteomas (OOs) are rare benign bone tumors that may occur in various joints including the ankle. These tumors are generally removed via open surgical excision or radiofrequency ablation. However, when they occur intra-articularly, these treatments are more difficult to perform because of more difficult access and the increased risk of damaging articular cartilage. Therefore, some have advocated for the use of arthroscopy to treat these cases. This systematic review aims to investigate the safety and efficacy of arthroscopic treatment for intra-articular OO of the ankle. Using Medline and Embase, we systematically reviewed the literature as of May 31, 2017. All articles published on and before that date were reviewed by 2 independent reviewers. Seventeen articles containing a total of 27 cases were included in the review. Most reported cases were in the talar neck, followed by the distal tibia. Of all the cases, only 2 recurrences were reported (in the same patient), and no complications were reported. Therefore, these cases demonstrate arthroscopic excision of intra-articular OO of the ankle as a safe and effective alternative to open surgical excision and radiofrequency ablation, with a success rate of 96%. However, all articles found were case studies or small case series owing to the rarity of this disease. In the future, analyses of case series with larger case collections should be performed.
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Affiliation(s)
- Susan M Ge
- Resident, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada.
| | - Yousef Marwan
- Resident, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Abdullah Addar
- Resident, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Nizar Algarni
- Resident, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Ruth Chaytor
- Assistant Professor of Surgery, McGill University, Montreal, Canada; Staff Orthopaedic Surgeon and Chief of the Foot and Ankle Clinical Teaching Unit, Jewish General Hospital, Montreal, Canada
| | - Robert E Turcotte
- Professor of Surgery, McGill University, Montreal, Canada; Staff Orthopaedic Surgeon and Chief of Surgical Oncology, McGill University Health Centre, Montreal, Canada
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de Sa D, Lian J, Sheean AJ, Inman K, Drain N, Ayeni O, Mauro C. A Systematic Summary of Systematic Reviews on the Topic of Hip Arthroscopic Surgery. Orthop J Sports Med 2018; 6:2325967118796222. [PMID: 30320142 PMCID: PMC6154262 DOI: 10.1177/2325967118796222] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a rapidly growing body of literature on the topic of hip arthroscopic surgery. PURPOSE To provide an overall summary of systematic reviews published on the indications, complications, techniques, outcomes, and information related to hip arthroscopic surgery. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of all hip arthroscopic surgery-related systematic reviews published between January 2000 and May 2018 was performed using PubMed, MEDLINE, and the Cochrane Library. Narrative reviews and non-English articles were excluded. RESULTS A total of 837 articles were found, of which 85 met the inclusion criteria. Included articles were summarized and divided into 6 major categories based on the subject of the review: femoroacetabular impingement (FAI), non-FAI indications, surgical technique, outcomes, complications, and miscellaneous. CONCLUSION A summary of systematic reviews on hip arthroscopic surgery can provide surgeons with a single source for the most current synopsis of the available literature. As the prevalence of orthopaedic surgeons performing hip arthroscopic surgery increases, updated evidence-based guidelines must likewise be advanced and understood to ensure optimal patient management.
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Affiliation(s)
- Darren de Sa
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jayson Lian
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Albert Einstein College of Medicine, New York, New York, USA
| | - Andrew J Sheean
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathleen Inman
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicholas Drain
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Olufemi Ayeni
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Craig Mauro
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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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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Abstract
We describe the medical management of an acetabular osteoid osteoma in an 11-year-old girl. There was a 2-year delay until proper diagnosis of the patient's pathology was made. Accurate localization of the nidus in the subchondral bone, involving the cartilage, is difficult on the basis of plain radiographs. All imaging methods, including computed tomography, MRI, and bone scintigraphy, were used to confirm the diagnosis. We proposed medical treatment to avoid possible severe complications from surgical intervention. At the patient's latest follow-up visit, after 2 years of medical treatment with NSAIDs, there is complete healing of the osteoid osteoma and there is no sign of recurrence.
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Rolvien T, Zustin J, Mussawy H, Schmidt T, Pogoda P, Ueblacker P. Intra-articular osteoid osteoma as a differential diagnosis of diffuse mono-articular joint pain. BMC Musculoskelet Disord 2016; 17:455. [PMID: 27809832 PMCID: PMC5096000 DOI: 10.1186/s12891-016-1313-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/27/2016] [Indexed: 02/08/2023] Open
Abstract
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.
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Affiliation(s)
- Tim Rolvien
- Department of Osteology and Biomechanics, University Medical Centre Hamburg-Eppendorf, Lottestr. 59, Hamburg, 22529, Germany.
| | - Jozef Zustin
- Department of Osteology and Biomechanics, University Medical Centre Hamburg-Eppendorf, Lottestr. 59, Hamburg, 22529, Germany
| | - Haider Mussawy
- Department of Osteology and Biomechanics, University Medical Centre Hamburg-Eppendorf, Lottestr. 59, Hamburg, 22529, Germany
| | - Tobias Schmidt
- Department of Osteology and Biomechanics, University Medical Centre Hamburg-Eppendorf, Lottestr. 59, Hamburg, 22529, Germany
| | - Pia Pogoda
- Department of Osteology and Biomechanics, University Medical Centre Hamburg-Eppendorf, Lottestr. 59, Hamburg, 22529, Germany
| | - Peter Ueblacker
- Department of Osteology and Biomechanics, University Medical Centre Hamburg-Eppendorf, Lottestr. 59, Hamburg, 22529, Germany.,MW Centre for Orthopaedics and Sports Medicine, Munich, Germany
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