Review Question - QID 5955

Imaging of the hip are consistent with a osteoid osteoma. Radiofrequency ablation is the most appropriate treatment for osteoid osteoma of the hip after failed conservative management.

Osteoid osteomas are painful bone lesions that are commonly seen between the ages of 10 and 35. Symptoms often are worse at night and usually are not activity related. Radiographs reveal a dense sclerotic cortex surrounding a small radiolucency or nidus. Relief of the patients symptoms with NSAID therapy further supports this diagnosis. The next stage of symptomatic treatment would be percutaneous radiofrequency ablation.

Gibbs et al. reviewed techniques in the surgical management of benign bone tumors. They state that CT images should be ordered in all patients with suspected osteoid osteomas as Ct scans has better diagnostic accuracy compared with plain radiographs or magnetic resonance imaging to localizing the lesion.

Bourgault et al. reviewed 87 patients with osteoid osteoma treated with percutaneous CT-guided radiofrequency. The average patient age was 23 years old. The success rate for first-line treatment was 89.6% and it was 97.5% for second-line treatment. They concluded that the recurrence rate was 10.4% and tumor locations revealed no risk factors for recurrence.

Figure A and B show <1cm lesion in the lesser trochanter with a central nidus. This is consistent with osteoid osteoma. Illustration A (left) is a AP hip radiograph and (right) axial CT scan image showing percutaneous CT-guided radiofrequency ablation of an osteoid osteoma in the proximal femur.

Incorrect Answers:
Answers 1, 3, 4: No extensive workup is required for osteoid osteomas.
Answer 5: Patient presentation does not suggest septic or inflammatory arthritis. Hip aspiration is not indicated in the evaluation of osteoid osteoma.