A Narrative Review of Osteoid Osteomas and an Audit on the Practice of CT-Guided Radiofrequency Ablation in the Northern Irish Population: A First in the Literature

Abstract

Introduction Osteoid osteoma is a benign condition of the bone, usually affecting young males. This retrospective study explores the demographics of osteoid osteomas in the Northern Irish population. It also aims to audit the practice of CT-guided radiofrequency ablation of osteoid osteomas at a major orthopaedic centre in Belfast, Northern Ireland, and to investigate the possible causes of treatment failure. Methods Forty-seven osteoid osteoma patients, diagnosed based on clinico-radiologic features and treated with CT-guided radiofrequency ablation, were found eligible for inclusion and analysis. We collected data from electronic health records (March 2011 to May 2022) and reviewed the radiological images and associated reports. Information about demographics, clinical indices, operative technique, clinical outcomes, biopsy results, and follow-up were also gathered. Data were then analysed using IBM SPSS Statistics for Mac, version 28.0.1.1 (14) (IBM Corp., Armonk, NY). Results The average age of patients was 19.3 years, with a male-to-female predilection of 2.1:1. The proximal and mid-tibial shafts were the most frequently involved sites. On average, patients had symptoms for 15.6 months, while the mean treatment delay period was 6.9 months. Primary clinical success was observed in 37 patients (78.7%), while ten patients had a clinical failure. Two out of the 10 patients with treatment failure underwent subsequent successful ablations, raising the secondary clinical success rate to (83.0%). Chi-Square association tests found no correlation between primary treatment outcomes and other qualitative variables (gender, bone type, lesion location, and Kayser classification). Moreover, binary logistic regression tests found no predictability of age and treatment delay on treatment outcomes. The overall observed complication rate was 4%, with only one significant side effect reported (third-degree skin burn). Conclusion We concluded that the demographics of osteoid osteomas in the Northern Irish population are comparable to what is previously established in the literature. Furthermore, we reasoned that CT-guided radiofrequency ablation is an efficient, safe, and effective minimally invasive technique in the management of osteoid osteomas.

Keywords: belfast; ct-guided percutaneous thermal ablation; ct-guided radiofrequency ablation; minimally invasive interventional radiology; northern ireland; osteoid osteoma.

Figure 1. A flowchart illustrating the patient recruitment process

Figure 2. Scans showing CT-guided radiofrequency ablation of an osteoid osteoma in the neck of the talus bone of the left foot

A, a pre-ablation scan showing the overlying adhesive localizer grid. B, a peri-ablation scan showing the radiofrequency ablation probe tip positioned inside the nidus. This is a computed tomography (CT) image of one of the patients included in the study.

Figure 3. The distribution of osteoid osteomas in different age groups in our study

Figure 4. The skeletal distribution of osteoid osteomas in our study

The numbers indicate the total number of lesions at different sites within our patient population. (*) thoracic spine lesions involve the superior and inferior articular facets. The sketch is drawn by one of the authors, SK.