Abstract:The authors report the case of an osteoid osteoma of the acetabular roof in a 17-year-old sportsgirl successfully treated by radiofrequency ablation, with a mid-term evidence of cartilage loss. Extra-articular access and exact positioning of the needle electrode exclude direct operative chondral damage. Intense physical activity could be an aggravating factor for the chondropathy. It is difficult to determine whether the acetabular cartilage joint was damaged only by thermo-ablation or if it had also been weak… Show more
“…In minimal invasive techniques like RF ablation (RFA), the nidus of the OO is usually heated to 90 °C for 4–9 min to achieve thermal coagulation necrosis which makes it impossible to perform histological examination [21–23]. Furthermore, the area of osteonecrosis might not be easy to control as RFA has been associated with occurring damage of the articular cartilage in the acetabulum [24]. Fig.…”
BackgroundThe 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.MethodsWe 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.ResultsOut 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.ConclusionsRarely, 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 materialThe online version of this article (doi:10.1186/s12891-016-1313-3) contains supplementary material, which is available to authorized users.
“…In minimal invasive techniques like RF ablation (RFA), the nidus of the OO is usually heated to 90 °C for 4–9 min to achieve thermal coagulation necrosis which makes it impossible to perform histological examination [21–23]. Furthermore, the area of osteonecrosis might not be easy to control as RFA has been associated with occurring damage of the articular cartilage in the acetabulum [24]. Fig.…”
BackgroundThe 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.MethodsWe 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.ResultsOut 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.ConclusionsRarely, 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 materialThe online version of this article (doi:10.1186/s12891-016-1313-3) contains supplementary material, which is available to authorized users.
“…Focal articular cartilage damage has been reported after addressing periarticular lesions in an athletic individual. 5 Challenging anatomic locations of lesions, such as deep in the pelvis, result in an increased risk of lesion recurrence due to incomplete resection or ablation. 6 Hip arthroscopy is an alternative treatment option for some of these lesions and provides direct visual confirmation of excision.…”
Minimally invasive percutaneous radiofrequency ablation (RFA) techniques are the standard of care for treating simple osteoid osteomas (OOs). Historically, OOs were treated with open en bloc resection or curettage of the nidus. RFA procedures have been linked to soft-tissue complications of varying severity. In addition, RFA may be a poor choice for periarticular OOs because of the potential for procedure-related articular cartilage damage. Hip arthroscopy is a widely accepted approach for the treatment of femoroacetabular impingement. We describe arthroscopic resection of an acetabular rimebased OO as part of a rim resection and labral repair. Early clinical follow-up suggests that arthroscopic resection of an OO in this unusual location is precise and predictable, allows for an additional evaluation of associated symptomatic pathology (i.e., femoroacetabular impingement), and results in prompt symptom resolution.
“…The acetabulum is an uncommon but painful location often associated with children [29]. There have been numerous reported cases of OO in the acetabulum [4,9,18,20,21,28,29,36,40,41,44,48,49,52,55,56,67]. Juxtaarticular and intraarticular localizations frequently are associated with a delayed diagnosis, as seen in our patient [24].…”
Section: Discussionmentioning
confidence: 85%
“…In addition, the healing rate is 76% to 100% [14,53], with a major complication rate of 0% to 5% [2,6,45]. However, using CT-guided RFA, there are reports of articular cartilage damage in weightbearing joints; one patient experienced articular cartilage damage to the talus [47], and another had damage to the acetabulum [9]. Direct observation and femoral head distraction during the arthroscopy may decrease the risk of cartilaginous thermal damage.…”
Background Osteoid osteomas consist of a nidus surrounded by reactive sclerotic bone. The diagnosis typically is based on imaging and clinical presentation involving nocturnal pain. Removal of the lesion is essential and currently is performed mainly with image-guided, minimally invasive techniques. We describe a case involving an osteoid osteoma of the acetabular fossa, treated with arthroscopy-assisted radiofrequency ablation. Case Description A 47-year-old woman presented with a 9-month history of right groin pain and limited motion. The CT and MR images showed synovitis around the ligamentum teres and a nidus of the acetabular fossa, surrounded by sclerotic bone and protruding from the inner part of the lamina quadrilateral. Synovectomy and debridement of the ligamentum teres were performed, followed by radiofrequency ablation of the osteoid osteoma under direct arthroscopic observation of the hip, avoiding resection of the normal bone around the nidus and preserving the integrity of the quadrilateral lamina and cartilage. The patient had complete pain relief the next day with minimal morbidity and rapid functional restoration. At the 22-month clinical followup, the patient was asymptomatic, and the CT and MR images obtained 1 year after surgery showed no pathologic signs or synovitis. Literature Review Our case was the fifth such case to be treated with hip arthroscopy and the first of these to our knowledge to be treated with the arthroscopy-assisted radiofrequency ablation technique. Purposes and Clinical Relevance Arthroscopy-assisted radiofrequency ablation is a combined treatment technique that may be used for intraarticular lesions of the hip that otherwise would require a difficult approach and jeopardize damage to cartilage and bone and also treat concomitant synovitis.
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