Clinical presentation of intra-articular osteoid osteoma of the hip and preliminary outcomes after arthroscopic resection: a case series

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.

Misdiagnosis and treatment of proximal femoral osteoid osteoma

“…This causes considerable physical suffering and nancial burden. Through comparative analysis, we found that the complex and diverse clinical manifestations of proximal femoral OO cause its objective misdiagnosis, whereas lack of clear understanding of the disease and selection of the wrong method of examination constitute the frequent subjective causes of misdiagnosis [6,25,[34][35][36]. OO is characterized by persistent pain, accompanied by nocturnal pain, which is relieved by oral use of NSAIDs.…”

Clinical outcomes and causes of arthroscopic hip revision surgery

“…It is important to note that misdiagnosis of osteoid osteoma is also a reason easily overlooked for revision surgery. Osteoid osteoma of the hip is a relatively rare diagnosis, which can closely mimic symptomatic presentation of FAI, and arthroscopic surgery can be especially effective in patients with concomitant FAI 15 . Osteoid osteoma can be diagnosed by MRI.…”

Magnetic resonance-guided focused ultrasound surgery treatment of non-spinal intra-articular osteoblastoma: feasibility, safety, and outcomes in a single-center retrospective analysis

“…The most diffuse surgical approaches for this pathology include arthroscopy and open techniques such as excisional biopsy, intra-regional curettage, and en bloc excision, which require prolonged hospitalization, and recovery times. The main complications are a risk of avascular necrosis, precocious onset of osteoarthritis, and synovial adhesion [16][17][18]. One case of coxa magna occurring after an excisional biopsy of an intra-articular OO has also been described [19].…”

“…Because of their lower invasiveness, IR techniques, and in particular, percutaneous ablation by needle under CT guidance, are currently considered the first-line treatment for benign bone lesions such as OO and OB. Nevertheless, damage to the cartilage of the intra-articular structures (probably related to thermal ablation rather than needles), infections, skin burns, bleeding, nerve injury, tendonitis, thrombosis, and pathological fractures have been described [9,16,20].…”