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Osteoid osteoma of the proximal femur: treatment by percutaneous bone resection and drilling (PBRD). A report of 44 cases.
INTRODUCTION: Osteoid osteoma is a benign osteogenic tumor that is mainly located in the lower limbs. According to Campanacci the proximal femur is involved in 25% of cases. We present a series of 44 cases of osteoid osteoma located in the neck of the femur or the lesser trochanter treated by the minimally invasive method, CT-guided percutaneous bone resection and drilling (PBRD).
MATERIALS AND METHODS: This series included 44 patients, 20 girls and 24 boys, treated between 1987 and 2012. The average age at surgery was 12.7 years old (range 4-34). The diagnosis was based on the "association" of scintigraphy (hyperfixation) - CT scan (nidus located on the femoral neck or near the lesser trochanter). These patients underwent CT-guided PBRD under general anesthesia. Specific ancillary material was used to reach and remove the nidus and a cylinder of bone was sent to the pathologist for assessment. A lateral or anterior approach was used in all cases except one in which a posterior incision was made. Histological confirmation was obtained in 23 cases (the bone fragment was damaged in 21 cases).
RESULTS: Forty-two patients were reviewed after a minimum follow-up of one year (12-56 months). Two patients were lost to follow-up. Results were evaluated clinically and on CT scan 1 year after surgery: there were 35 cures with complete and permanent pain relief. There were 5 failures and 1 case of recurrence requiring a second CT-guided PBRD procedure as well 2 complications involving femoral fracture (one associated with failure).
DISCUSSION: The proximal femur is a common location of osteoid osteoma. Treatment requires careful preoperative planning to determine the surgical approach for safe removal. PBRD is a minimally invasive technique, allowing complete resection with suitable ancillary equipment. This method should be compared with thermoablation, which is a similar technique.
CONCLUSION: CT-guided PBRD is a therapeutic option in case of osteoid osteoma of the proximal femur.
LEVEL OF EVIDENCE: Level IV.
MATERIALS AND METHODS: This series included 44 patients, 20 girls and 24 boys, treated between 1987 and 2012. The average age at surgery was 12.7 years old (range 4-34). The diagnosis was based on the "association" of scintigraphy (hyperfixation) - CT scan (nidus located on the femoral neck or near the lesser trochanter). These patients underwent CT-guided PBRD under general anesthesia. Specific ancillary material was used to reach and remove the nidus and a cylinder of bone was sent to the pathologist for assessment. A lateral or anterior approach was used in all cases except one in which a posterior incision was made. Histological confirmation was obtained in 23 cases (the bone fragment was damaged in 21 cases).
RESULTS: Forty-two patients were reviewed after a minimum follow-up of one year (12-56 months). Two patients were lost to follow-up. Results were evaluated clinically and on CT scan 1 year after surgery: there were 35 cures with complete and permanent pain relief. There were 5 failures and 1 case of recurrence requiring a second CT-guided PBRD procedure as well 2 complications involving femoral fracture (one associated with failure).
DISCUSSION: The proximal femur is a common location of osteoid osteoma. Treatment requires careful preoperative planning to determine the surgical approach for safe removal. PBRD is a minimally invasive technique, allowing complete resection with suitable ancillary equipment. This method should be compared with thermoablation, which is a similar technique.
CONCLUSION: CT-guided PBRD is a therapeutic option in case of osteoid osteoma of the proximal femur.
LEVEL OF EVIDENCE: Level IV.
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