Radiofrequency Ablation of Osteoid Osteoma in Atypical Locations: A Case Series

Abstract

Background Osteoid osteoma has a nidus surrounded by sclerotic bone with a size usually less than 20 mm. Its diagnosis is made on typical presentation of nocturnal pain and imaging findings. Excision of the niduses, which are often small and difficult to precisely identify, sometimes may result in resection of surrounding normal bone. Minimally invasive percutaneous treatments have been used to try to minimize resection of normal bone. Although minimally invasive radiofrequency ablation generally relieves pain, its ability to relieve pain is less well known in locations other than lower extremity long bones. Questions/purposes We determined the pain relief and complication rates after radiofrequency ablation of osteoid osteomas presenting in atypical locations and followed patients to assess possible recurrence or late complications. Patients and MethodsWe retrospectively reviewed 21 patients with osteoid osteomas in unusual locations (eg, hip, radioulnar joint, and proximal phalanx) in whom we used radiofrequency ablation. Postoperative activities were not restricted for any of the patients. We assessed the time for patients to become symptom free, their activity status, and possible recurrence or complications. The minimum clinical followup was 12 months (mean, 27.8 months; range, 12-37 months).

Case Report: Osteoid Osteoma of the Acetabulum Treated With Arthroscopy-assisted Radiofrequency Ablation

“…CT-guided percutaneous resection has been commonly used for the past decade, especially for difficult locations like the acetabulum [43,56,62]. Other percutaneous techniques have been proposed, such as laser thermal therapy, cryotherapy, and ethanol therapy [1,2,26,27]. CT-guided RFA has become the preferred method owing to a low morbidity rate, minimal postoperative complications, minimal tissue exposure, rapid recovery, and no restriction of weightbearing activity [10,14,33,50,60,69].…”

“…CT-guided RFA has become the preferred method owing to a low morbidity rate, minimal postoperative complications, minimal tissue exposure, rapid recovery, and no restriction of weightbearing activity [10,14,33,50,60,69]. In addition, the healing rate is 76% to 100% [14,53], with a major complication rate of 0% to 5% [2,6,45]. However, using CT-guided RFA, there are reports of articular cartilage damage in weightbearing joints; one patient experienced articular cartilage damage to the talus [47], and another had damage to the acetabulum [9].…”

“…The CT-guided radiofrequency ablation (RFA) is a minimally invasive technique and considered the preferred treatment owing to a 91% success rate and low complications compared with an open surgical procedure [59]. This procedure is challenging, being near neurologic structures and juxtaarticular and intraarticular localizations [2,53].…”

Osteoid Osteoma of the Coracoid Process: Case Report With Literature Review

“…Although this type of tumor may appear throughout the skeleton, signifi cant predilection has been described for long bones of lower extremities, aff ecting femur and tibia with a prevalence of approximately 50% 1,7,8 . Vertebrae are aff ected in approximately 10% of all cases, while the humerus, acetabulum, talus, calcaneus, metacarpus and scapula, together with coracoid process (CP) represent atypical localizations 7,9,10 . OO of the scapula, and particularly of the CP, is a rarely seen condition, which is the reason it is often not included in the diff erential diagnosis of shoulder pain in younger individuals.…”

“…A great number of methods have been described in the treatment of OO including a wide spectrum ranging from seldom-used conservative approach with NSAIDs over minimally invasive percutaneous treatments (mechanical, chemical or thermal ablation) to open surgical methods (en bloc resections and curettage techniques) [9][10][11][12][13][14][15][16][17][18][19][20][21] . Th erapeutic approach merely depends on numerous factors, among which anatomical localization is one of the most important factors in decision-making.…”