A CT-free protocol to treat osteoid osteoma of the hip region in childhood and adolescence by percutaneous drilling and by hip arthroscopy

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.

A comparative study assessing the efficacy and safety of radiofrequency ablation versus surgical treatment for osteoid osteoma: retrospective analysis in a single institution

“…These results do not reflect the diagnostic algorithm in the work-up of suspected OOs at our institution, but rather highlight the risk of higher ionising radiation exposure of patients in whom OO was initially diagnosed with CT, and one of the percutaneous ablative techniques was considered a viable treatment option. This observation supports the worldwide trend of engaging multiparametric MRI as the preferred imaging method of choice before treatment and during follow-up of OOs, especially in paediatric patients [18,24,[32][33][34].…”

Diagnosis and Management of Craniofacial Osteomas

“…88 Contrast-enhanced CT scans will demonstrate hyperintensity of the central portion of the osteoid due to hypervascularity. 89 Dynamic contrast studies demonstrate early enhancement of the lesion with rapid washout of the tumor, similar to other hypervascular tumors. 90,91 Occasionally, osteomas are discovered on x-ray or magnetic resonance imaging (MRI) ordered for other pathologies.…”

“…High attenuation on CT correlates with mineralized osteoid 88 . Contrast-enhanced CT scans will demonstrate hyperintensity of the central portion of the osteoid due to hypervascularity 89 . Dynamic contrast studies demonstrate early enhancement of the lesion with rapid washout of the tumor, similar to other hypervascular tumors 90,91 …”

Intra- and juxta-articular osteoid osteoma in children and adolescents

“…Recently, a literature review reported that arthroscopic management of OO of the upper extremity joints is highly successful and results in no tumor recurrence ( 23 ). As for the hip lesion, arthroscopic management appears to be an effective method ( 37 ), but has a high revision rate (10/25) ( 38 ). There is a risk of incomplete resection in areas more difficult to access by minimally invasive procedures, such as arthroscopy, and may also lead to neurovascular injuries in areas that are near important anatomic structures ( 39 ).…”