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

Abstract

AimsProximal femoral osteoid osteoma (OO) is extremely easy to be misdiagnosed or missed. The purpose of this study was to retrospectively analyze the clinical data of patients with proximal femoral OO in order to determine the clinical manifestation and imaging characteristics of the disease, so as to provide help for the preoperative diagnosis and clinical treatment of proximal femoral OO.MethodsThis was a retrospective study involving 35 patients with proximal femoral OO admitted into our hospital from January 2015 to January 2021. The baseline characteristics of the participants included; 24 males and 11 females, aged between 13 and 25 (mean 16.2) years old, and the course of the disease was 1 to 14 (mean 6.3) months. We used previous medical experience records of the patients to analyze for the causes of misdiagnosis. Moreover, we compared the difference between preoperative and postoperative treatment practices in alleviating pain in OO patients and restoring hip function. Follow-ups were carried out regularly, and patients advised to avoid strenuous exercises for 3 months.ResultsWe followed up 35 patients (25 intercortical, 4 sub-periosteal, and 6 medullary) for an average of 41.4 months. We found that 15 patients (42.9%) had been misdiagnosed of synovitis, perthes disease, osteomyelitis, intra-articular infection, joint tuberculosis and hip impingement syndrome, whose average time from symptoms to diagnosis were 6.3 months. Postoperative pain score and joint function score improved significantly compared with preoperative, and complications were rare.ConclusionOpen surgical resection constitutes an effective treatment for proximal femoral OO by accurately and completely removing the nidus. Wrong choice of examination, and the complexity and diversity of clinical manifestations constitutes the main reasons for the misdiagnosis of proximal femoral OO.

Osteoid Osteoma, a Diagnostic Problem: A Series of Atypical and Mimicking Presentations and Review of the Recent Literature

“…Intraarticular OO can often be confused with other causes causing synovitis [ 54 ]. It may also resemble intraarticular infection, joint tuberculosis, Legg–Calvé–Perthes disease, and hip impingement syndrome in its presentation [ 55 ]. It is particularly difficult to make a diagnosis when the patient has other joint pathology.…”

Rare coexistence of multiple osteochondromas and solitary osteoid osteoma: A case report

“…They can occur in any bone of the body. Osteoid osteomas frequently occur in males aged between 10 and 30 years and affect long bones, such as the femur and tibia ( 11 , 12 ). They generally occur in the long bones of the lower extremities, with the femoral neck as the most frequent site ( 13 ).…”

Intra- and Juxta-Articular Osteoid Osteoma Mimicking Arthritis: Case Series and Literature Review

“…Unusual location and an atypical clinical presentation may mimic other diseases, especially in the intra-or juxta-articular OOs, estimated to comprise 5.2-10% of all OOs [3,[8][9][10]. The most frequent misdiagnoses reported in small case series or case reports of intra-articular OOs in children and young adults include juvenile idiopathic arthritis (JIA), juvenile spondyloarthritis, hip synovitis, complex region pain syndrome, recurrent multifocal osteomyelitis, infection, traumatic lesion, "growing pains", soft tissue tumor, and hip impingement syndrome [9,[11][12][13][14]. A rheumatic misdiagnosis might lead to diagnostic delay and inappropriate therapy, such as intra-articular corticosteroid injection or immunosuppressive drugs [15][16][17].…”