Clinical and radiological features and skeletal sequelae in childhood intra-/juxta-articular versus extra-articular osteoid osteoma

Abstract

BackgroundTo compare the clinical and radiological features of intra-/juxta-articular osteoid osteoma and extra-articular osteoid osteoma in skeletally immature patients, paying special attention to the skeletal complications.MethodsOsteoid osteoma in 34 children (22 boys and 12 girls, mean age 10.4 years) was dichotomized according to the location of the nidus as intra-/juxta-articular (11 children) or extra-articular (23 children). The following features were compared: diagnostic delay, typical symptoms, synovitis and limited range of joint motion, response to treatment, typical radiographic findings, and skeletal complications.ResultsEight of the 11 children with intra-/juxta-articular osteoid osteoma presented with synovitis in the involved joint, which led to a delayed diagnosis for a median 9.5 months. Pain disappeared in all children with surgical or medical interventions, but at the mean 4.9-year follow-up evaluation, skeletal abnormalities around the joint were noted in 5 children (4 proximal femur and 1 distal humerus) with intra-/juxta-articular osteoid osteoma, 2 of whom required subsequent surgeries for limited hip motion caused by femoroacetabular impingement and limited range of elbow motion, respectively. In contrast, typical clinical and radiological features were observed more often in extra-articular osteoid osteoma, and only 1 child showed overgrowth of the tibia, which did not have clinical significance.ConclusionsIntra-/juxta-articular osteoid osteomas in growing children exhibit different clinical and radiological features from extra-articular lesions. Skeletal abnormalities mainly develop in intra-/juxta-articular osteoid osteoma, and these may lead to permanent skeletal sequelae.

Intraarticular Osteoid Osteoma: MRI Characteristics and Clinical Presentation Before and After Radiofrequency Ablation Compared to Extraarticular Osteoid Osteoma

“…MRI can thus prevent delayed diagnosis and allow early treatment. This is particularly important in growing young patients since an intraarticular OO can lead to chronic damage to the articular cartilage and bony deformities [30]. CT-guided RFA is a safe and effective treatment for OO, resulting in a decrease in pathological MRI findings and excellent clinical results [16][17][18].…”

Benign Pediatric Tumors and Tumor-Like Conditions of the Hip

“…17 In a series by Song et al, 73% of the pediatric patients with intraarticular and juxtaarticular OOs presented with synovitis in the associated joint, confounding and delaying the correct diagnosis for a median of 9.5 months. 18 On plain radiographs, the lesion appears as an area of reactive bone surrounding a radiolucent nidus. OOs generally present with a single nidus; however, multicentric OOs have been described in the literature.…”

ESSR Consensus Document for Detection, Characterization, and Referral Pathway for Tumors and Tumorlike Lesions of Bone

“…Also, in selected cases, osteoid osteomas are juxta-articularly localized, reactive changes (cortical thickening, medullary sclerosis) are lacking, and a predominant synovitis may be present, which is preferentially appreciated using MRI. 37 The role of FDG-or NaF-PET/CT and PET/MRI in the initial diagnostic work-up of bone tumors is still not established. These investigations can show a number of incidentalomas that have no relevance to the patient's clinical condition.…”