Intra-Articular Osteoid Osteoma of the Hip: An Observation and the Review of the Literature

Case Report

Austin J Orthopade & Rheumatol. 2023; 10(1): 1118.

Intra-Articular Osteoid Osteoma of the Hip: An Observation and the Review of the Literature

El Maqrout Amine, MD¹*; Ghannam Abdelaziz, MD¹; Mekkaoui Jalal, PhD¹; Moncef Boufettal, PhD²; Bassir Reda Allah, PhD²; Kharmaz Mohammed, PhD¹; Lamrani Moulay Omar, PhD¹; Berrada Mohammed Saleh, PhD¹

¹Department of Trauma and Orthopedic Surgery, Ibn Sina University Hospital, Faculty of Medicine, Mohamed V University of Rabat, Rabat, Morocco

²Department of Anatomy, Faculty of Medicine, Mohamed V University of Rabat, Rabat, Morocco

*Corresponding author: El Maqrout Amine Department of Trauma and Orthopedic Surgery, Ibn Sina University Hospital, Faculty of Medicine, Mohamed V University of Rabat, Rabat, Morocco. Email: amineelmaqrout96@gmail.com

Received: March 04, 2023 Accepted: May 04, 2023 Published: May 11, 2023

Abstract

Osteoid osteoma is a common benign bone tumor that affects young adults and has a typical clinical and radiographic presentation in long bones. However, when it appears in unusual intra-articular locations, the clinical symptomatology is then atypical and can lead to misdiagnosis constituting a diagnostic challenge for clinicians and causing delay in management. We present the case of a girl of 16 years with an osteoma osteoid intra-articular right hip involving the femoral head. This unusual location was the cause of unexplained pain and a delay in diagnosis of 20 months after the onset of symptoms, as the initial Magnetic Resonance Imaging (MRI) examination could not identify the lesion. The tomodensitometry is in this indication the most specific examination which made it possible to evoke the diagnosis of osteoid osteoma. Once the diagnosis is made, given the complexity of the location, it makes it difficult to access radio-guided techniques. The open surgical excision allowed healing with complete disappearance of pain. After complete surgical excision of the tumor, histopathological examination confirmed the final diagnosis of intra-articular osteoid osteoma. No recurrence was observed.

Keywords: Osteoid osteoma; CT; Bone tumor

Introduction

Osteoid Osteoma (OO) is a relatively common benign osteoblastic tumor (2-3% of all bone tumors). It was described by Jaffé in 1935 [1] which mainly affects children [2] and young adults, affects men twice as often as women and generally occurs in the cortico-diaphyseal or metaphyseal region of the long bones (femur, tibia) [3,4]. Intra-articular localization is less frequent representing around 10% of cases [5,6], resulting in a more confused diagnosis [7,8] and producing nonspecific clinical symptoms which may mimic inflammatory monoarthritis [9,10]. Intra-articular OO is generally an atypical clinical condition that can delay diagnosis and treatment [7,11]. We report the case of an e daughter of 16 years presentant osteoma osteoid intra- articular and we try to describe the peculiarities clinical-radiologiques and terms Therapeutic this location knowing that this location is anatomically unreachable for treatment

Observation

A young girl of 16 years with no notable history was presented to our formation with intermittent right hip pain, with a nocturnal recurrence, which suggests cruralgia that appeared without triggers. These pains are slightly calmed by analgesics and non-steroidal anti-inflammatory drugs. It causes limping and limitation of the range of motion of the right hip. The clinical examination finds a significant and painful limitation of the movements of the right hip. This pain radiating along the front of the thigh. Lasegue's sign was negative and examination of the dorsolumbar spine and sacroiliac joints was normal.

Biological examinations showed: the sedimentation rate is normal and CRP<4mg/l, normal white blood cells. The white line and the immunological examinations were negative. The pelvic and lumbar spine x-rays were normal. The first radiographic examinations (x-rays of the pelvis and the right hip (Figure 1), Computed Tomography (CT-scan) of the dorsolumbar spine, MRI of the hip and thigh (Figure 2) did not reveal any abnormalities, with the exception of the presence of a misdirected benign osteocondensation located in the right femoral head, which could not be correlated with the patient's clinical picture as well as a gap with posterior hyper signal of the femoral head and synovial reaction has MRI.