Purpose
To identify the clinical features of intra-articular osteoid osteoma (OO) of the hip,
to evaluate the clinical effect of arthroscopic excision for intra-articular OO, and
to summarize the characteristics of revision cases of hip OO and the revision surgery
under arthroscopy in these cases.
Methods
We retrospectively reviewed the data of 25 patients who underwent arthroscopic excision
of hip OO. The case series included 10 patients who underwent revision surgery. Lesion
location, presenting symptoms, and symptom duration were analyzed; postoperative improvement
was assessed using the modified Harris Hip Score (mHHS) and International Hip Outcomes
Tool (iHot-12) score. We examined the reasons for revision surgery and the characteristics
of OO progression after the first surgery.
Results
The most common presenting symptom was groin pain that was relieved by nonsteroidal
anti-inflammatory drugs (NSAIDs). Varying degrees of limitation of range of motion
(ROM) were present in all patients. The osteosclerosis around the tumor nest on computed
tomography (CT) scan is a characteristic radiographic feature in this disease. However,
the classic radiographic feature was apparent on plain x-rays in only 2 of 25 patients.
As a kind of efficient radiological method, magnetic resonance imaging (MRI) can help
in distinguishing OO from femoroacetabular impingement (FAI), as the latter is characterized
by a large effusion and bone marrow edema at the atypical site of impingement. For
the patients who had only 1 arthroscopic resection, the mean (± standard deviation)
mHHS and iHot-12 scores were 70.30 ± 9.06 (range 51 to 86) and 75.07 ± 7.69 (57 to
88), respectively. At last follow-up, the mean scores were 98.30 ± 2.15 (94 to 100)
and 97.76 ± 2.04 (94 to 100). For revision cases, the mean mHHS and iHot-12 scores
were 68.55 ± 3.77 (60 to 72) and 67.88 ± 5.39 (56 to 76). At last follow-up, the mean
scores were 97.11 ± 2.47 (94 to 100) and 95.22 ± 1.78 (94 to 100). In the present
study, 24 of 25 patients (96%) reached the minimal clinically important difference
(MCID) of mHHS, and 21 of 22 patients (95.2%) reached the MCID of iHot-12. Among the
revision patients, the most common misdiagnosis at first surgery was FAI. Another
feature is that a wrong diagnosis or incomplete intra-articular OO resection can stimulate
the tumor and cause an inflammatory reaction and rapidly progressive OA, necessitating
prompt revision surgery for complete removal. The degree of joint degeneration was
related to the time since the first operation.
Conclusion
OO of the hip joint typically presents with pain and limited joint activity. Misdiagnosis
as FAI or synovitis is common, and CT scan is very helpful for accuracy diagnosis.
Arthroscopic excision appears to be an effective method for the treatment of OO of
the hip joint.
Level of Evidence
IV, case series.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Dahlin's bone tumors: General aspects and data on 10,165 cases.6th ed. Wollters Kluwer Health, Philadelphia2010
- Percutaneous radiofrequency ablation in osteoid osteoma.J Bone Joint Surg Br. 2001; 83: 391-396
- Severe growth disturbance with osteoid osteoma. A report of two cases involving the femoral neck.Radiology. 1970; 96: 285-288
- Subluxation of the hip from osteoid osteoma. Report of two intraarticular cases.Acta Orthop Scand. 1989; 60: 220-222
- Intra-articular osteoid osteoma of the hip misdiagnosed by MRI: An unusual cause of unexplained hip pain.Orthop Traumatol Surg Res. 2011; 97: 881-885
- Osteoid osteoma of the hip. Percutaneous resection guided by computed tomography.Clin Orthop Relat Res. 1995; : 170-175
- Osteoid osteoma of the acetabular fossa: five cases treated with percutaneous resection.Orthop Traumatol Surg Res. 2013; 99: 341-346
- Osteoid osteoma of the proximal femur: treatment by percutaneous bone resection and drilling (PBRD). A report of 44 cases.Orthop Traumatol Surg Res. 2014; 100: 641-645
- Acetabular osteoid osteoma treated by percutaneous radiofrequency ablation: Delayed articular cartilage damage.JBR-BTR. 2010; 93: 204-206
- Arthroscopic excision of acetabular osteoid osteoma in a 7-year-old patient.Knee Surg Sports Traumatol Arthrosc. 2015; 23: 3432-3435
- Radiofrequency ablation of intra-articular osteoid osteoma of the hip.J Int Med Res. 2006; 34: 537-544
- Clinical presentation of intra-articular osteoid osteoma of the hip and preliminary outcomes after arthroscopic resection: A case series.J Hip Preserv Surg. 2018; 5: 88-99
- Arthroscopically assisted excision of osteoid osteoma involving the hip.Arthroscopy. 2001; 17: 56-61
- Arthroscopic treatment of recurrent acetabulum osteoid osteoma.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 871-873
- Arthroscopic excision of acetabular osteoid osteoma: Computer tomography-guided approach.Arthrosc Tech. 2015; 4: e101-e105
- Minimal clinically important difference and substantial clinical benefit values for the 12-Item International Hip Outcome Tool.Arthroscopy. 2019; 35: 411-416
- Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery.Am J Sports Med. 2013; 41: 2065-2073
- Case report: Late subtrochanteric fracture post radiofrequency ablation of osteoid osteoma.Clin Cases Miner Bone Metab. 2014; 11: 145-148
- Arthroscopic excision of an intraarticular osteoid osteoma in the distal femur.Clin Orthop Surg. 2016; 8: 475-480
- Clinical outcome of arthrosopic excision of hip osteoid osteoma.Chin J Sports Med. 2014; 33: 10-16
- Osteoid osteoma of the hip stimulating an early onset of osteoarthritis.Radiology. 1986; 158: 417-420
- Osteoid osteoma associated with changes in adjacent joint; report of two cases.J Bone Joint Surg Am. 1947; 29: 483-490
- Therapeutic outcome of CT-guided radiofrequency ablation in patients with osteoid osteoma.Skeletal Radiol. 2017; 46: 949-956
Article info
Publication history
Published online: April 15, 2021
Accepted:
March 29,
2021
Received:
July 1,
2020
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
