Arthroscopic Excision of an Osteoid Osteoma of the Lesser Trochanter of the Femoral Neck

Abstract

Osteoid osteoma frequently requires surgical treatment, especially among young, active patients. However, surgeons are reluctant to perform open surgery for an osteoid osteoma of the femoral neck area because the conventional surgical approach requires a large incision in muscular patients, and percutaneous resection with a trephine has the attendant risk of subsequent fracture. Recently, arthroscopic excision of an osteoid osteoma has been reported as a less invasive, safer procedure than traditional open curettage. Hip arthroscopy using the burr-down technique under C-arm guidance to locate and remove the lesion of the femur neck has also shown promise. The presented technique minimizes muscle damage around the femur and enables surgeons to confirm complete resection of the lesion through direct, detailed visualization. Furthermore, early return to previous activity can be achieved after excising the lesion located at the calcar femorale, which is an area with a heavy weight-bearing load. The objective of this Technical Note was to describe our preferred technique for the surgical excision of osteoid osteoma located at the base of the femoral neck through the use of arthroscopy.

Arthroscopic removal of osteoid osteoma with gamma probe assistance in the hip joint

“…1,6 Several case reports on arthroscopic removal of osteoid osteomas from the hip joint have been published to-date. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] A 70-degree scope, curved instruments and fluoroscopic control enable a nidus located in various parts of the peripheral and central compartment of the hip joint to be reached and removed, with the posteroinferior part of the acetabulum reported to be most challenging. 21,25 To the best of our knowledge, our case series of arthroscopically treated osteoid osteoma of the hip is the second largest reported to-date.…”

“…37,51 Osteoid osteoma was histologically verified in 27 (79%) out of the 34 cases of arthroscopically treated osteoid osteomas of the hip previously reported in literature in English available to the authors. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] To ensure the osteoid osteoma has been cured, followup of at least 7 months is recommended. 52 No recurrence of the tumour was noted in any of our cases at a minimum 24 months.…”

“…[13][14][15][16][17] However, there have been an increasing number of reports regarding arthroscopic treatment of articular cases, including in the hip joint. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Surgical treatment of osteoid osteoma may be associated with incomplete or excessive removal of the bone involved. The gamma probe has been introduced to prevent this concern during open excision or CT guided percutaneous ablation of the nidus.…”

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

“…4,8,[11][12][13] Arthroscopic resections of superficial osteoid osteomas near the hip joint are usually only described in case reports, even with respect to adults. [14][15][16][17][18][19] In this paper we report on our experience using an MRIguided, minimally-invasive protocol for treating osteoid osteomas of the hip region in children and adolescents. Different procedures will be presented depending on the location of the osteoid osteomas, including percutaneous MRI-guided drilling and arthroscopic resection.…”

“…4,8,11–13 Arthroscopic resections of superficial osteoid osteomas near the hip joint are usually only described in case reports, even with respect to adults. 14–19…”