Osteoid osteoma of the hip in children

In 31 children with osteoid osteoma lesions about the hip ranging in age from 2 to 16 years, there was an inordinate frequency of diagnostic delay with 16 patients having symptoms for more than 12 months. The clinical features were dominated by pain, limp, restricted hip motion and thigh atrophy. Twelve patients did not have classical night pain. Errors in diagnosis occurred in 22 instances. The roentgenographic appearance of most lesions consisted of a radiolucent central nidus encircled by sclerotic bone. Twenty-nine of the 31 patients were operated upon utilizing intra-operative roentgenograms and the nidus fully excised, with histological confirmation in 24 cases. All were relieved of preoperative symptoms. Two patients, who did not have surgical treatment, had pain for about one year and thereafter became pain free for 2 and 12 years. The sequelae observed at follow-up were meralgia paresthetica in 12 patients and mild asymptomatic leg length discrepancies in 7 patients. In view of these findings and since the process of apparent regression is slow and characterized by pain, blocked surgical excision of the lesion is the procedure of choice.