Osteoid osteoma of the acetabulum: diagnosis and medical treatment

Management and clinical-outcome of juxta-articular osteoid osteoma lesions

INTRODUCTION

Osteoid osteoma (OO) is a benign intra-osseous lesion. The lesion is painful and usually diagnosed by x-ray, computed tomography (CT) or magnetic resonance imaging (MRI). When the lesion is juxta-articular or intra-capsular, the symptoms may present differently than the typical OO lesion and make diagnosis more challenging. Proximity to articular cartilage may make the treatment with radiofrequency ablation more dangerous. This study presents an 11-year experience in managing juxta-articular osteoid osteoma (JAOO) including long-term follow-up, while using CT-guided radiofrequency ablation (CT-RFA).

METHODS

All patients diagnosed with OO and managed with CT-RFA between 2010 and 2020 were reviewed. Those with a lesion that was intra-capsular or less than 2 cm from the articular cartilage were included. Charts and all imaging studies were evaluated, and patients were interviewed by phone for any persistent or recurrent symptoms.

RESULTS

There were 168 patients with OO during this period and 59 met the criteria for inclusion. Forty-four (75%) were male and median age at the time of ablation was 20.7 years (range 3-59 years). Thirteen (22%) had active growth plates during ablation. Three patients (5%) required a repeat ablation for non-resolving pain. None of the 13 children with open physes had growth disturbance of the affected limb after ablation. In 3 patients, the typical OO pain resolved but an activity related pain persisted. One of them had articular damage that may be related to the CT-RFA.

CONCLUSION

JAOO may present challenges for diagnosis and treatment and CT-RFA is the current standard for treatment. Despite proximity to the cartilage and physis, careful attention to technique showed only one injury to these structures in this series of 59 patients.

An Atypical Presentation of an Osteoid Osteoma of the Lesser Trochanter Resected via the Ludloff Approach

Osteoid osteoma is a benign bone tumor that frequently affects young adults. The clinical presentation is variable, and the course can lead to spontaneous regression or persistence, necessitating medical or surgical treatment. We report the case of a young patient with an exceptional localization of an osteoid osteoma at the lesser trochanter, exhibiting atypical clinical and radiological features. The tumor was resected via the Ludloff approach. Here, we discuss our diagnostic and therapeutic approach in light of the literature.

Osteoid Osteoma: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features, and Treatment Option

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.

About a rare cause of a coxitis

OO of the acetabulum can clinically and radiologically mimic an ankylosing spondylitis (with coxitis and sacroiliitis). Management of OO include multidisciplinary approach including radiologist, rheumatologist, and orthopedist.

Osteoid osteoma of the hip: imaging features

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.

Osteoid Osteoma in Children Younger than 3 Years of Age

We present a case series of four children, younger than 3 years old, with osteoid osteoma of the lower limb. Pain and limping were the main symptoms. With careful clinical examination, we could localize the affected area. Radiological evaluation revealed cortical thickening in 3 children. On MRI examination, we found extensive edema, with normal bony cortices. The central nidus was found in 3 children. CT scan was the most accurate examination which revealed the central nidus with surrounding sclerosis. Bone scans had positive uptake in the affected area. Our patients were treated with an intralesional excision biopsy, with simultaneous radiofrequency ablation in those affected in the femur. Pathological specimens confirmed the diagnosis of osteoid osteoma. There was uneventful recovery of our patients. This case series contributes to the limited description of osteoid osteoma diagnosed and treated in very young children.