Hip arthroscopy for the management of osteoid osteoma of the acetabulum: a systematic review of the literature and case report

Abstract

BackgroundIntra-articular osteoid osteoma (OO) causes irreversible joint damage. Its treatment of choice is radiofrequency ablation (RFA); however, some areas of the acetabulum are hard to access. Therefore, hip arthroscopy was used to treat this tumor. We aim to systematically review the literature with regards to arthroscopic management of acetabular OO, and to report a further case in which hip arthroscopy was used for treatment.MethodsPubMed and EMBASE were searched for articles relevant to the arthroscopic management of acetabular OO on December 2, 2014. All articles published on and before that date were reviewed, and studies which met our pre-determined inclusion criteria were included. Articles screening and data abstraction were done by two reviewers independently. We also presented a 31-year-old man with acetabular OO who underwent hip arthroscopy for the management of his tumor after failing to respond to medications and computed tomography scan (CT)-guided RFA.ResultsThe initial search revealed 14 studies, of which ten met our inclusion criteria. A total of ten patients underwent hip arthroscopy for the management of acetabular OO. Only two patients were females, and the patients' age ranged from 7 to 47 years. Two patients underwent arthroscopic guided-RFA of the lesion, while the rest underwent excision. The follow-up period ranged from 6 months to 2 years. Success rate was 100 %, and no recurrence was reported. Minor complications (transient impotence and perineal numbness) developed in one patient (10 %). Arthroscopic-guided RFA failed to eliminate the tumor in our additional case. A second trial of CT-guided RFA was successful in treating the patient's condition.ConclusionsHip arthroscopy is an effective and safe option for the management of acetabular OO, with success rate exceeding 90 %. Studies of higher level of evidence are required.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0779-8) contains supplementary material, which is available to authorized users.

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

“…Diagnosis of this rare but treatable benign bone tumor is often delayed due to its atypical presentation [ 6 ], and based on our findings, its similarity with symptomatic presentation of FAI. Case reports in the literature have previously reported of the coexistence of OO and FAI [ 52 ] and described multiple treatment options, including hip arthroscopy [ 11 , 17 , 19 ]. We report the largest case series of hip IAOO treated with hip arthroscopy (13 patients), and discuss the clinical presentation of a total of 40 patients with confirmed diagnosis of IAOO of the hip.…”

“…Marwan et al [ 17 ] recently published a systematic review of all acetabular IAOO treated with hip arthroscopy. From this review of 11 cases, they reported a success rate of greater than 90% in treating acetabular OOs with hip arthroscopy and noted no recurrences of the lesion at last follow-up ranging between 6 months and 2 years, and one study not reporting follow-up duration [ 17 ]. Similarly, in our case series, none of our patients treated with hip arthroscopy had recurrence of the lesion after our treatment at an average 27-months follow-up (range 3–105 months).…”

“…While multiple case reports have described IAOOs in the acetabulum [ 9 , 10 , 17 , 19–21 , 30–44 ] and femoral neck [ 11 , 12 , 19 , 23 , 30 , 33–35 , 37 , 45–49 ], as well as the femoral head [ 35–37 , 50 , 51 ] ( Table I ), we report the largest case series of OOs of the intra-articular region of the hip treated with hip arthroscopy. We share limited pre- and post-surgical outcome scores after treatment with hip arthroscopy.…”

“…Prolonged administration of oral salicylates and NSAIDs has been reported to take 2–15 years for the OO pain to resolve [ 16 ]. Surgical treatment of OO lesions in the acetabulum has included open surgical hip dislocation [ 9 ], percutaneous radiofrequency ablation (RFA), hip arthroscopy [ 17 ], the use of an intra-articular laser with en block excision [ 18 ], burring the lesion [ 17 , 19 ] or using a curette to excise the lesion [ 20 ], arthroscopically assisted RFA [ 21 ], or intraoperative percutaneous RFA [ 22 ]. Surgical treatment of femoral neck OOs has included excision with the arthroscopic burr and electrosurgical instruments [ 11 , 19 ], a modified core decompression technique [ 8 ], excisional biopsy or intralesional curettage through an anterior hip approach [ 23 ], with internal fixation or cast immobilization [ 23 ], and a lateral approach and en bloc excision through the greater trochanter [ 24 ].…”

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].…”