Medical management of osteoid osteoma
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* Peter L. Munk
* Michael E. Huk

We read with interest the article by Ilyas and Younge that appeared in the December issue of the Journal on the subject of medical management of osteoid osteoma.1

As the authors point out, there are a number of different options currently available for the treatment of this condition, and although it has been known for some time that medical management is successful, it may take years for the condition to resolve. Most patients are unwilling to wait for medical resolution, so more invasive procedures have been utilized. Over the last 10 years, since the development of the radiofrequency ablation procedure by Rosenthal and colleagues,2 surgery for treatment of these lesions has been in rapid decline. Radiofrequency ablation is now considered the standard procedure for osteoid osteomas.3 Although the authors do make passing reference to this in their introduction, we believe it is important to emphasize that in most instances this is the ideal way of treating these lesions.

Radiofrequency ablation has the advantage of being a day-care procedure. 4 It is very much like that for a percutaneous bone biopsy and is becoming widely available in any centre that receives a large number of orthopedic referrals. Patients tolerate the procedure well, and with a success rate greater than 90% it is clearly highly efficacious.3 As only a tiny core of bone is removed, the risk of pathologic fracture is minimal.

Although medical management can be successful and is an option for those unwilling to undergo any surgical or interventional procedure, radiofrequency ablation should, in most instances, be the preferred treatment for osteoid osteoma.

## References

1.  Ilyas I, Younge DA. Medical management of osteoid osteoma. Can J Surg 2002;45: 435–7.
    
    

2.  Rosethal DI, Alexander A, Rosenberg AE, Springfield D. Ablation of osteoid osteomas with a percutaneously placed electrode: a new procedure. Radiology 1992;183:29–33.
    
    [CrossRef](http://canjsurg.ca/lookup/external-ref?access_num=10.1148/radiology.183.1.1549690&link_type=DOI) 
    
    [PubMed](http://canjsurg.ca/lookup/external-ref?access_num=1549690&link_type=MED&atom=%2Fcjs%2F46%2F1%2F60.atom) 
    
    [Web of Science](http://canjsurg.ca/lookup/external-ref?access_num=A1992HJ87400007&link_type=ISI) 

3.  Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ. Percutaneous radiofrequency coagulation of osteoid osteoma compared with operative treatment. J Bone Joint Surg Am 1998;80:815–21.
    
    [Abstract/FREE Full Text](http://canjsurg.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoiamJqc2FtIjtzOjU6InJlc2lkIjtzOjg6IjgwLzYvODE1IjtzOjQ6ImF0b20iO3M6MTc6Ii9janMvNDYvMS82MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

4.  Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ. Decreasing length of hospital stay in treatment of osteoid osteoma. Clin Orthop 1999;361:186–91.
    
    [CrossRef](http://canjsurg.ca/lookup/external-ref?access_num=10.1097/00003086-199904000-00024&link_type=DOI) 
    
    [PubMed](http://canjsurg.ca/lookup/external-ref?access_num=10212612&link_type=MED&atom=%2Fcjs%2F46%2F1%2F60.atom)