Is radiofrequency ablation safe and effective in treating osteoid osteomas? A prospective single-center study with atypical cases

Abstract

Purpose: Osteoid osteomas are benign and nonprogressive lesions. The clinical presentation of osteoid osteoma is typical with night pain responsive to nonsteroidal anti-inflammatory agents. The typical radiological appearance is lucent nidus and adjacent reactive sclerosis. The most traditional management of osteoid osteoma is surgical removal which is associated with significant morbidity. This article aims to demonstrate our single-center experience of 55 patients with osteoid osteoma treated with percutaneous radiofrequency ablation (RFA). Methods: Fifty-five symptomatic patients who were seen at our orthopedics outpatient clinics, diagnosed with osteoid osteoma, and referred to interventional radiology department between May 2015 and April 2019 were enrolled. The nidus size, pain numeric rating scale score, and intramedullary edema diameter before and after RFA were compared. Clinical and technical success, intervention-related complications, and need for subsequent ablation were recorded. Results: Of the 55 patients, including 12 pediatric cases, 6 had atypical locations such as metatarsal, vertebra, and scapula, while 1 case had osteoid osteoma with multiple nidus. The mean age was 18.5 ± 9.6 years. Preintervention maximum nidus diameter, pain score, and edema diameter were significantly lower in postintervention measurements ( p < 0.001). Technical success rate was 98.1%, and clinical success was 96.36%. Severe complication occurred in one patient with soft tissue burn and osteomyelitis. Conclusion: This is one of the largest series of osteoid osteoma treated with RFA done in a single center with atypical cases. In conclusion, RFA is safe and effective in both pediatric and adult patients with rare complications even in challenging cases with atypical locations.

Our experience with osteoid osteomas treated by percutaneous radiofrequency ablation

“…The clinical and technical success rate was 94% after primary ablation and after re ablation of the other 2 patients we finally achieved 100% clinical and technical success rate. Our study showed a favorable outcome compatible to other international studies [17][18][19][20][21][22][23][24][25][26][27][28] . Radiofrequency ablation technique is an effective, minimally invasive and economic method of treatment.…”

“…Computed tomography (CT) guided percutaneous radiofrequency ablation in the treatment of osteoid osteoma is safe, effective with minimally invasive procedure 28 compared to previous the surgical techniques which has the drawback of difficult localisation, incomplete excision and high rate of recurrence. Literature has proven RFA in the treatment of osteoid osteoma in unattained area have achieve a favourable success rate with minimal complications and morbidity.…”

“…Osteoid osteoma were treated by curettage and nidus excision previously. Currently CT guided percutaneous radiofrequency ablation is gaining popularity [17][18][19][20][21][22][23][24][25][26][27][28] .…”

Osteoid osteoma: which is the best mininvasive treatment option?

“…Data reported in the literature have demonstrated that in case of symptomatic recurrence after the first RFA treatment, re-ablation is almost always resolutive with complete disappearance of symptoms, as suggested by the revision of the literature proposed [ 10 , 16 – 20 , 23 – 25 , 36 , 39 , 42 44 , 46 , 48 50 28 – 43 , 92 , 44 – 51 , 54 – 56 ] (Table 2 ).…”

Osteoid Osteoma of the Proximal Femur: Pitfalls in Diagnosis and Performance of Open Surgical Resection

“…It is indeed an excellent choice for the treatment of OO with less trauma, quick recovery and excellent efficacy ( 15 , 16 ). However, there are still some controversies over the treatment of proximal femoral OO considering the particular location of the nidus ( 17 , 18 ). The nidus of the proximal femur is often adjacent to the femoral sheath, and there are the main feeding vessels of the femoral head on the inside of the articular capsule.…”