Image guided radiofrequency thermo-ablation therapy of chondroblastomas: should it replace surgery?

Lalam, Radhesh; Cribb, G.L.; Tins, Bernhard; Cool, Paul; Singh, Jaspreet; Tyrrell, P. N. M.; Cassar‐Pullicino, Victor N.

doi:10.1007/s00256-014-1820-y

Cited by 40 publications

(41 citation statements)

References 15 publications

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“…However, they found radiographic severity and symptom levels as factors that predicted total joint arthroplasty. Because arthritis occurred in more than half of our patients with proximal femur lesions, one might consider alternative approaches such as radiofrequency ablation and grafting through a more limited approach [13,19]. Despite careful surgical dislocation with attention to preserving the epiphyseal vessels, the femoral head sphericity was not retained in many of our patients and that incongruence of the ball and socket resulted in symptomatic hips needing a second surgical procedure [2].…”

Section: Discussionmentioning

confidence: 93%

What Happens to the Articular Surface After Curettage for Epiphyseal Chondroblastoma? A Report on Functional Results, Arthritis, and Arthroplasty

Farfalli

Slullitel

Múscolo

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 93%

What Happens to the Articular Surface After Curettage for Epiphyseal Chondroblastoma? A Report on Functional Results, Arthritis, and Arthroplasty

Farfalli

Slullitel

Múscolo

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…There have been no reports of any complications following femoral head RFA in previous studies, although complications in larger case series of RFA in periarticular operations have been mentioned. Rybak et al 4 and Lalam et al 3 reported articular surface collapse with the two largest sized tumors in their series (2.5x2.0x2.1 cm and 4.6x4.8x1.8 cm). Recurrence following radiofrequency ablation was mentioned in 1 of 17 cases reported by Rybak et al 4 and in 1 of 3 cases of Rajalakshmi et al 9 Using an alternative method for larger lesions, Petsas et al 7 treated two femoral head chondroblastomas with a combination of curettage and RFA with multitine electrodes (average tumor size 2.7 cm).…”

Section: Discussionmentioning

confidence: 85%

“…Several case reports have demonstrated that RFA can be applied to the periarticular area, especially the femoral head, proximal humerus, femoral condyle and tibial plateau. [2][3][4]7,8 In difficult areas, such as the femoral head, several case reports and case series have shown that RFA has had excellent outcomes in terms of head preservation, no growth plate damage and no tumor recurrence ( Table 1). The decision to treat with RFA is based on skeletal maturity and size of the lesion.…”

Section: Discussionmentioning

confidence: 99%

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Radiofrequency Ablation in Chondroblastoma of the Femoral Head in Skeletally Immature Individuals: A Case Report

Pornwattanavate¹,

Arpornchayanon²,

Luevitoonvechkij³

et al. 2017

bkkmedj

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C hondroblastoma is rare, representing only 1-2% of all primary bone tumors and 5% of benign bone tumors. 1 Most patients are under 20 years old. Chondroblastoma is usually located in the epiphysis or apophysis of long bones but it can occur in flat bones and vertebrae as well. 1 Symptoms vary from mild to severe pain for periods followed by a decrease in range of motion. The standard treatment of chondroblastoma is tumor curettage with a bone graft. 1 Management of chondroblastoma in the femoral head, however, is challenging due to the difficulty of access and the potential risk of damage to the epiphyseal plate. Radiofrequenct ablation (RFA) is a minimally invasive option for chondroblastoma management. Reports of a small series using this technique have been reported to have had excellent outcomes, but there is limited data on long term follow up. 1-5 Case ReportA 13-year old boy presented to the Orthopedic Out-patient Clinic in January 2012 with left hip pain and reported limping for 1 year. He also had night pain but no history of trauma to the left hip. His mother had brought him to a primary hospital where he was initially treated with NSAIDs but the pain did not subside. Physical examination at the Orthopedic Clinic revealed a left antalgic gait and tenderness at left groin with slightly limited internal rotation of the left hip.Plain radiographs showed an eccentric well-circumscribed osteolytic lesion at the epiphysis of the left femoral head which measured 1.5x1.5 cm (Figure 1). Preoperative CT scans of the left hip showed a welldefined homogeneous osteolytic lesion 1.3x1.7x1.4 cm with a sclerotic border at the left femoral epiphysis (Figure 2). The inferior margin of the lesion was located on the epiphyseal plate of the femoral head while the superior margin was located beneath the articular surface.Based on the pathology report, chondroblastoma of the left femoral head was diagnosed. To avoid risk of growth plate injury following open surgery, we chose percutaneous radiofrequency abrasion. AbstractSurgical management of chondroblastoma of the femoral head in skeletal immaturity is challenging due to difficult access and a risk of epiphyseal plate injury. A 13-year old boy presented with left hip pain and limping for over 1 year. Based on imaging and pathology report, chondroblastoma was diagnosed. The size of the tumor was 1.7 cm in diameter. To avoid epiphyseal plate and articular damage, percutaneous radiofrequency ablation was performed under fluoscopic guidance with a 70 o Celsius monopolar probe for 3 minutes' duration repeated 3 times. The 2 nd ablation procedure was performed after 3 months to minimize risk of recurrence. The pain had subsided at the 3 months follow up. Over the 4 years follow up period, this case shows good functional outcome without deformity of the femoral head or tumor recurrence.

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“…RFA and other ablation techniques have been used to treat a variety of bone and soft tissue lesions such as osteoid osteomas, chondroblastomas, metastases, phosphaturic mesenchymal tumour, chondromyxoid fibroma, intracortical chondromas, enchondromas, eosinophilic granuloma, epithelioid haemangioma and extra-abdominal desmoid/fibromatosis [53][54][55][56][57][58][59][60] ( Figure 14). Any type of normal or abnormal tissue can be destroyed by an increase of temperature .60°C.…”

Section: Tumour Ablationmentioning

confidence: 99%

Interventional articular and para-articular knee procedures

Lalam

Winn

Cassar‐Pullicino

2016

BJR

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The knee is a common area of the body to undergo interventional procedures. This article discusses image-guided interventional issues specific to the knee area. The soft tissues in and around the knee are frequently affected by sportrelated injuries and often need image-guided intervention. This article details the specific technical issues related to intervention in these soft tissues, including the iliotibial tract, fat pads, patellar tendon and other tendons, bursae and the meniscus. Most often, simple procedures such as injection and aspiration are performed without image guidance. Rarely image-guided diagnostic arthrography and therapeutic joint injections are necessary. The technique, indications and diagnostic considerations for arthrography are discussed in this article. Primary bone and softtissue tumours may involve the knee and adjacent soft tissues. Image-guided biopsies are frequently necessary for these lesions; this article details the technical issues related to image-guided biopsy around the knee. A number of newer ablation treatments are now available, including cryoablation, high-frequency ultrasound and microwave ablation. Radiofrequency ablation, however, still remains the most commonly employed ablation technique. The indications, technical and therapeutic considerations related to the application of this technique around the knee are discussed here. Finally, we briefly discuss some newer, but as of yet, unproven image-guided interventions for osteochondral lesions and Brodie's abscess. INTRODUCTIONThe knee is one of the commonest joints affected by osteoarthritis and other internal derangements, such as ligament and meniscal pathology, which may need imageguided and surgical management. The tissues around the knee are also a common site for bone tumours and intervention in the form of biopsy or ablation is often performed around the knee. Interventions such as injections are routinely performed in the knee and, in most instances, are performed in the outpatient setting without any image guidance. In this article, we discuss issues related to imageguided intervention specific to the knee joint. Detailed descriptions of the techniques and the merits of most of the procedures are described elsewhere in this issue. We also discuss newer techniques such as drainage of abscess and retrograde drilling of osteochondral lesions, even though there is sparse literature on these procedures and the evidence is limited currently.

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Image guided radiofrequency thermo-ablation therapy of chondroblastomas: should it replace surgery?

Cited by 40 publications

References 15 publications

What Happens to the Articular Surface After Curettage for Epiphyseal Chondroblastoma? A Report on Functional Results, Arthritis, and Arthroplasty

What Happens to the Articular Surface After Curettage for Epiphyseal Chondroblastoma? A Report on Functional Results, Arthritis, and Arthroplasty

Radiofrequency Ablation in Chondroblastoma of the Femoral Head in Skeletally Immature Individuals: A Case Report

Interventional articular and para-articular knee procedures

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