Intra-articular Osteoid Osteoma Research Articles

Intra-articular osteoid osteoma accompanied by extensive bone marrow edema. A clinical and micro-morphological analysis

Osteoid osteoma (OO) is a benign bone tumor producing non-mineralized bone matrix (i.e., osteoid). While peritumoral edema is commonly found in OO, extensive bone marrow edema has been reported less frequently. Furthermore, the micro-morphological characteristics of the nidus and its central calcification remain unclear. In this study, a consecutive series of four patients suffering from extensive bone marrow edema triggered by intra-articular osteoid osteoma underwent clinical examination, magnetic resonance imaging (MRI) and computed tomography (CT) as well as dual-energy X-ray absorptiometry (DXA) and laboratory bone turnover analyses. The obtained resection specimens were processed by undecalcified histology and were subsequently analyzed by light microscopy and quantitative backscattered electron imaging (qBEI). We report an entity of intra-articular osteoid osteoma in the knee and foot, in which an extensive and persistent bone marrow edema syndrome masked the correct diagnosis. While metabolic bone diseases were excluded in all cases, the reassessment of the patients’ clinical history including pain characteristics (nocturnal, aspirin sensitivity) led us to perform additional CT, where the tumor was diagnosed. The micro-morphological analysis of the OO biopsies revealed that the nidus was surrounded by hyperosteoidosis, while central mineralization was detected in all cases. This mineralized area showed a significantly higher mineralization heterogeneity than the surrounding trabecular bone and more disorganized collagen fibers detected by qBEI and polarized light microscopy, respectively. Taken together, our results indicate that osteoid osteoma should be considered when persistent and extensive, peri-articular bone marrow edema is diagnosed. The central calcification that is found inside the nidus in conventional imaging was mirrored by bone matrix with a heterogeneous mineralization pattern.

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

ABSTRACTIntra-articular osteoid osteoma (IAOO) of the hip is a relatively rare diagnosis, but one that can closely mimic symptomatic presentation of femoroacetabular impingement (FAI). Although there are multiple case reports of osteoid osteoma (OO) in the hip, we present the largest case series of hip IAOO treated with hip arthroscopy and discuss limited patient-reported outcomes after treatment with hip arthroscopy. We retrospectively identified patients diagnosed with IAOO of the hip with confirmatory computed tomography, magnetic resonance imaging or biopsy diagnoses of OO. We analyzed lesion location, main presenting symptoms, symptom duration and treatment undertaken. For the patients who underwent hip arthroscopy for treatment of their IAOO, we reviewed patient-reported outcome scores when available.Forty patients with confirmed IAOO were identified. Thirteen underwent excision with hip arthroscopy. The most common presenting symptom was groin pain. In limited patients who had pre- and post-operative outcome scores, we found significant improvements in modified Harris Hip Score (mHHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL) and international Hip Outcomes Tool (iHot33) scores. Compared with patients undergoing hip arthroscopy for FAI alone, baseline mHHS, HOS-ADL, Hip Outcome Score–Sport-Specific Subscale and iHot33 scores were almost identical. We found that the presenting symptoms of hip IAOO closely mimic symptomatic FAI, including groin pain and anterior hip pain, so it is important to keep IAOO of the hip in the differential diagnosis of hip pain. Based on our experience, arthroscopy can be an effective treatment option for excision of intra-articular OO and is especially effective in patients with concomitant FAI in treating both pathologies.

Arthroscopic excision of an intra-articular osteoid osteoma in the elbow joint

An osteoid osteoma is a rare, small, benign and painful tumour occurring in the extra-articular portion of long bones seen most commonly in the lower extremities. This is a case...

Computed tomography-guided radiofrequency ablation of intra-articular osteoid osteoma: a single centre’s experience

Objective: To evaluate safety and efficacy of radiofrequency ablation (RFA) in the treatment of painful intra-articular osteoid osteoma.Materials and methods: During the last 3 years, 15 patients underwent computed tomography (CT)-guided biopsy and RFA of symptomatic intra-articular osteoid osteoma. In order to assess and sample the nidus, a coaxial bone biopsy system was used. Biopsy was performed and followed by ablation session with osteoid osteoma protocol in all cases. Procedure time (i.e. drilling including local anaesthesia and ablation), amount of scans, the results of biopsy and pain reduction during follow-up period are reported.Results: Access to the nidus through normal bone, biopsy and electrode insertion was technically feasible in all cases. Median procedure time was 54 min. Histologic verification of osteoid osteoma was performed in all cases. Median amount CT scans, performed to control correct positioning of the drill and precise electrode placement within the nidus was 9. There were no complications or material failure reported in our study. There was no need for protective techniques of the articular cartilage. Pain reduction was significant from the first morning post ablation and complete at the one week and during the follow-up period. No recurrences were noted.Conclusions: RFA under CT guidance is a safe and efficient technique for the treatment of painful intra-articular osteoid osteoma. Imaging guidance, extra-articular access through normal bone and exact positioning of the needle-electrode inside the nidus facilitate safety of the technique and prevention of damage to the articular cartilage.

Abstract No. 212 - Percutaneous biopsy and radiofrequency ablation for diagnosis and treatment of intraarticular osteoid osteomas at a single pediatric institution

Abstract No. 212 - Percutaneous biopsy and radiofrequency ablation for diagnosis and treatment of intraarticular osteoid osteomas at a single pediatric institution

Intra-articular osteoid osteoma in the ischial spine of a 5-year-old child

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 1 fevrier 2017

Intra-articular osteoid osteoma as a differential diagnosis of diffuse mono-articular joint pain.

BackgroundThe aim of this retrospective study was to investigate the frequency of intra-articular osteoid osteoma (iaOO) in a large study cohort and to demonstrate its clinical relevance as an important differential diagnosis of non-specific mono-articular joint pain.MethodsWe searched the registry for bone tumours of the University Medical Centre Hamburg-Eppendorf for osteoid osteomas in the last 42 years. Herein, we present three selected iaOO which were detected in the three major weight-bearing joints. Computed tomography (CT) or magnetic resonance imaging (MRI) scans were performed for initial diagnosis.ResultsOut of a total of 367 osteoid osteomas, 19 (5.2 %) tumours were localized intra-articularly. In all three presented tumours, a history of severe mono-articular pain was reported; however, the mean time to correct diagnosis was delayed to 20.7 months. Clearly, the nidus seen in CT and MRI images in combination with inconsistent salicylate-responsive nocturnal pain led to the diagnosis of iaOO.ConclusionsRarely, osteoid osteoma can occur in an intra-articular location. In cases of diffuse mono-articular pain, iaOO should be considered both in large and smaller joints to avoid delays in diagnosis and therapy of this benign bone tumour.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1313-3) contains supplementary material, which is available to authorized users.

Intraarticular Osteoid Osteoma of the Hip with Lengthening of Limb Secondary to Proximal Femoral Hypertrophy: A Case Report

12-year-old boy presented with pain in the right hip since 1 1⁄2 years, with associated apparent lengthening of the limb and limp since 9 months. He was thoroughly examined and investigated clinically and radiologically. A diagnosis of a long standing osteoid osteoma (OO) in the neck of femur resulting in hypertrophy of the proximal femur and 1⁄2 an inch true lengthening of the limb was made. He underwent an En bloc excision of the tumour. The pain relief was noticed immediately after surgery and there was no sign of recurrence at one year follow-up. This case of intra articular OO is presented herewith because of a long standing and interesting presentation causing hypertrophic structural changes in the proximal femur, resulting in true limb lengthening and a limp which to our knowledge has not been reported so far.

Abstract No. 597 - CT-guided radiofrequency ablation of intra-articular osteoid osteoma:clinical experience and results

Abstract No. 597 - CT-guided radiofrequency ablation of intra-articular osteoid osteoma:clinical experience and results

Long-term Follow-up of an Osteoid Osteoma of the Femoral Neck Treated with Percutaneous Procedure Under Computed Tomography Guidance

Osteoid osteoma (OO) is a benign bone tumor, characteristic of both nocturnal pain alleviated by administration of non-steroid antiinflammatory drugs (NSAIDs) and a nidus which appears as a small, relatively radiolucent zone. X-ray finding of the nidus depends on the site of the lesion. Cortical OO is usually characterized by reactive sclerotic bone around the nidus. On the other hand, intramedullary or intra-articular OO may be difficult to identify because of less reactive sclerotic bone (Figures 1 and 2).

Arthroscopic Excision of Acetabular Osteoid Osteoma: Computer Tomography–Guided Approach

Osteoid osteoma is a benign osteoblastic tumor that occurs in the subcortical shaft and metaphysis of the long bones of the lower extremities; however, intra-articular lesions are also possible. Intra-articular osteoid osteomas are rare, and clinical symptoms are often less specific and, thereby, may lead to misdiagnosis. The definitive treatment for osteoid osteoma is the excision of the nidus. We present the case of a 23-year-old man with a 4-year history of right anterior hip pain, subsequently diagnosed with a subarticular osteoid osteoma located in the right anterior acetabulum. Hip arthroscopic excision of the juxta-articular osteoid osteoma is presented as an effective treatment, with the advantage of less potential damage to normal bone and cartilage, as well as the additional benefits available with hip arthroscopy.

T2 Mapping Magnetic Resonance Imaging Encourages an Arthroscopic Approach for Osteoid Osteoma in the Acetabulum

Intra-articular osteoid osteoma (OO) is uncommon, especially in the hip joint. Delayed treatment may cause early osteoarthritis; however, diagnosis and complete excision are often challenging. We describe the feasibility of the combination of T2 mapping magnetic resonance imaging evaluation and arthroscopic excision of OO in the acetabulum. A 12-year-old boy presented with a 6-month history of hip pain. An undifferentiated tumor of the medial wall of the acetabulum was suspected on radiographs and computed tomography. T2 mapping showed joint effusion, and the T2 value of the acetabular cartilage just above the tumor was significantly high. These findings suggested OO in the acetabulum. An arthroscopic excision was performed for biopsy and excision of the tumor to avoid damage to the normal cartilage and growth plate. Histologic examination confirmed the OO. At 16 months' follow-up, there was no evidence of recurrence. This is the first report to evaluate intra-articular OO by T2 mapping and to treat it arthroscopically. Arthroscopic treatment assisted by T2 mapping has excellent potential as a minimally invasive technique to enable us to approach the tumor from the area of discriminative abnormal cartilage with minimal damage to the normal cartilage and surrounding tissue.

Intra-articular Osteoid Osteoma of the Proximal Ulna

Osteoid osteoma is a common benign osteogenic bone neoplasm characterized histologically by increased osteoid tissue formation with an intracortical nidus surrounded by cortical thickening and vascular fibrous stroma and sclerosis. The clinical presentation classically includes severe nocturnal pain that is improved with nonsteroidal anti-inflammatory drugs. Younger men (second and third decades) have the highest incidence, with the most frequent sites of involvement being the long bones or axial skeleton. Osteoid osteoma may be missed due to the lesion occurring in an atypical location or due to failure to obtain advanced imaging studies such as computed tomography (CT). Intralesional or wide excision, or CT-guided radiofrequency ablation if available, leads to predictable and rapid pain relief. The authors report the case of a 24-year-old man who had a painful flexion contracture of his dominant right elbow for 1.5 years, secondary to an intra-articular osteoid osteoma. Attempted motion, passive or active, produced a marked exacerbation of pain. Previous surgeries, including an elbow synovectomy and an ulnar nerve transposition, had been unsuccessful in relieving his pain. Plain radiographs demonstrated a small area of periosteal thickening adjacent to the sublime tubercle. Fine-cut CT scan demonstrated an osteoid osteoma within the articular surface of the trochlear notch of the olecranon, adjacent to the sublime tubercle. Because of a perceived risk to the surrounding articular cartilage, CT-guided radiofrequency ablation was not performed. Wide en bloc surgical excision of the nidus was performed, with complete resolution of pain and rapid return to normal function.

An Intraarticular Osteoid Osteoma: A Case Report & Review of Literature

Osteoid osteoma (OO) is one of the common benign bone tumors but an uncommon cause of musculoskeletal pain. Its diagnosis is usually not difficult in classic clinical setup and in typical location in diaphyseal region. However, the diagnosis of juxta or intraarticular osteoid osteoma (IAOO) is challenging because of atypical clinical presentation responsible for delay in diagnosis and treatment. We report a rare case of IAOO as a cause of chronic shoulder pain to make clinician aware to help in its early diagnosis and management. A 28-year-old woman presented with chronic debilitating right shoulder pain. The diagnosis was established on CTscan after 2 years of onset of symptoms because of atypical clinical presentation as a chronic monoarthritis of the shoulder. CTscan demonstrated radiolucent nidus with central calcification with areas of surrounding sclerosis. The tumor was excised surgically and histopathologic examination confirmed the diagnosis of osteoid osteoma. So, in the scenario of an unexplained chronic monoarthritis, the possibility of intraarticular osteoid osteoma should also be kept in mind. CT-scan remains the investigation of choice for demonstrating the nidus and surgical exicision relieves the symptoms. DOI: http://dx.doi.org/10.3126/njr.v3i2.9615 Nepalese Journal of Radiology Vol.3(2)July-Dec, 2013: 77-80

Intra-articular osteoid osteoma mimicking juvenile arthritis.

In case of intra-articular osteoid osteoma, misdiagnosis as juvenile arthritis may occur, delaying adequate treatment. We report cases of intra-articular osteoid osteomas in children that were misdiagnosed and initially inappropriately treated with intra-articular corticoid injection. Diagnosis of osteoid osteoma was finally given by CT-scan and appropriate treatment by radiofrequency ablation or surgical ablation was performed. Clinicians and radiologists should be aware of the potentially confusing clinical and imaging findings associated with intra-articular osteoid osteoma.

Ostéome ostéoïde du coude : un mode de révélation trompeur

Intra-articular osteoid osteoma (OO) is a rare and difficult diagnosis. We report the case of an 11-year-old boy who presented with inflammatory monoarticular arthritis in the left elbow. This monoarthritis was resistant to all types of treatment. He had an OO, diagnosed late because the first symptoms developed subsequent to the ablation of a wart in the same elbow and were suggestive of arthritis.

Osteoid Osteoma of the Intercondylar Notch: An Uncommon Cause of Knee Stiffness

The presence of an osteoid osteoma in a periarticular or intra-articular location about the knee is rare. Osteoid osteoma of the knee may be present with nonspecific complaints including knee pain, stiffness, effusions, and atrophy. Depending on the clinical setting, these symptoms could represent a variety of different diagnoses, including meniscal pathology, chondral pathology, synovitis, or Plica syndrome. In this article, we present the unique case of an osteoid osteoma within the intercondylar notch of the knee that underwent a significant delay in diagnosis and several unnecessary procedures due to misdiagnosis. Although intra-articular osteoid osteomas have been described, there remains a paucity of case reports discussing these lesions within and around the knee, and currently there are no reports available describing such a lesion located within the intercondylar notch. Although osteoid osteomas are relatively common, the intra-articular location of such lesions presents a diagnostic challenge. Vague, nonspecific symptoms including joint pain, swelling, and mechanical symptoms coupled with nonspecific radiographic findings in an otherwise healthy, young patient are more likely to guide the clinician toward a more common diagnosis of a sports-related injury as opposed to a benign bone tumor. This case represents an extremely rare presentation of osteoid osteoma within the intercondylar notch of the knee. The case presentation provides an excellent reminder of the need to consider rare diagnoses such as osteoid osteoma, especially in cases of chronic, unrelenting, localized pain in the absence of any other explicable pathology.

Collar-type osteophyte of the femur in young adults: is it a harbinger of intra-articular osteoid osteoma?

Variable clinical and radiological findings for intra-articular osteoid osteoma (OO) of the hip joint make its diagnosis difficult. Because radiographs commonly do not identify the nidus, MR imaging becomes the second line of study. However, because the appearance varies, findings on MR images can be confusing. We found "collar type osteophyte" of the femur i.e. an osteophyte rim around the femoral neck, to be a conspicuous finding of intra-articular OO. Here, this feature will be emphasized and intra-articular OOs will be discussed, with a review of the literature.

Osteoid Osteoma of the Distal Humerus Mimicking Sequela of Pediatric Supracondylar Fracture: Arthroscopic Resection—Case Report and A Literature Review

Osteoid osteoma (OO) is a small and painful benign osteoblastic tumour located preferentially in the shaft of long bones near the metaphyseal junctions, with a predilection for the lower limbs. Juxta- and intra-articular OOs are rare and even though hip, elbow, and talus are the most commonly reported locations, they may be found in any joint accounting for approximately 13% of all osteoid osteomas. There is usually a significant time delay between symptom initiation and diagnosis when the lesion is present in an uncommon location due to the diagnostic challenge it presents due to the lack of classical clinical signs and/or radiographic features found in the extra-articular lesions. A case of a distal humerus OO of a 15-year-old girl is presented to point out that a confounding factor, such as a previous paediatric supracondylar fracture, may further delay the already difficult diagnosis of a juxta- or intra-articular osteoid osteoma and also to emphasize the possibility of arthroscopic treatment of such lesions.

A Rare Case of Intra Articular Osteoid Osteoma of Hip Joint

Osteoid osteoma accounts for 10% of all benign bone tumours affecting young adults of age group 10-30 years. Intra articular osteiod osteoma accounts for approximately 13% of all osteoid osteoma cases and present as monoarthropathy. Clinical and radiological features of osteiod osteoma are atypical when located intra articularly and differ significantly from extra articular lesions. Intraarticular osteoid osteoma presents a diagnostic challenge and can cause a delay in diagnosis for years. We present a case of 39 year old female with a rare Intraarticular osteoid osteoma of hip involving femoral head diagnosed early with CT imaging and bone scintigraphy. Complete excision of the tumour with femoral head and hemiarthroplasty with modular bipolar prosthesis was done and diagnosis was confirmed by histopathological examination. Hence a high index of suspicion with correlation between clinical and appropriate radiological imaging is necessary for early diagnosis and effective management of the tumour.