Aggressive Osteoblastoma of the Acetabulum in an 18-Year-Old Female Vol-leyball Player
Presentation Type
Poster Presentation
Abstract/Artist Statement
Background: The subject was an 18-year-old female volleyball player with an osteoblastoma of the acetabulum of the hip. She had a chief complaint of deep, aching pain from her outer right hip to upper groin. Despite conservative treatment, the frequency and severity of pain progressively worsened over the course of a year and a half. The subject’s primary care provider believed her pain was caused by a stress fracture in the lower spine, so further imaging was requested.
Differential Diagnosis: Differential diagnoses for the subject’s hip pain include a labral tear, femoroacetabular impingement, dysplasia, athletic pubalgia, acetabular fracture, hernia, soft tissue involvement.
Treatment: The radiologist discovered a 4.8x2.4x4.2 cm lesion in the medial right acetabulum, with internal high attenuation foci suggestive of calcium or chondroid matrix with abnormally increased radiotracer uptake. The lesion had completely eroded through the acetabulum, leaving the patient at risk for pathologic fracture. The subject underwent three biopsies, one drill biopsy and two open biopsies. Following the second open biopsy, the osteoblastoma was labeled as benign. The subject underwent a surgical resection and open reduction internal fixation (ORIF) to remove the osteoblastoma from her acetabulum. The athlete’s rehabilitation protocol has been guided largely by existing protocols from hip labral repair and ACL-reconstruction. Due to the uniqueness of the case, her surgeon did not have a predicted time for her to return to play.
Uniqueness: Osteoblastomas represent about 0.8% of all bone tumors and are more commonly seen in male adolescents. Osteoblastomas in the region of the hip are extremely rare, accounting for 3-8.8% of all osteoblastomas, especially an aggressive osteoblastoma of the acetabulum. The physical presentation of an aggressive osteoblastoma of the hip includes limited ROM, chronic pain, night pain, radiating pain, pain aggravated by weight bearing or walking, and pain alleviated by analgesic drugs. The clinical findings of an osteoblastoma may present similarly to other sport-related injuries, but a non-specific mechanism of injury is a red flag for clinicians to note. There is no specific osteoblastoma rehabilitation protocol, so the clinician is challenged to develop an individualized plan of care for the patient. However, literature infers that rehabilitation should be guided according to an acetabular fracture. There is no developed patient-rated outcome (PRO) for individuals following a surgical resection and ORIF, so clinicians should utilize a general hip PRO to track patient progress throughout rehabilitation.
Conclusion: An aggressive osteoblastoma of the acetabulum is a rare, unlikely pathology to encounter in a young, active population. It is important that clinicians working with this population recognize the signs and symptoms of an osteoblastoma, so they know when to refer for further evaluation. Diagnosing any hip pathology, whether it be sport-related or non-sport-related, requires a thorough patient history and objective assessment. For athletes suffering of worsening hip pain despite conservative treatment, an osteoblastoma should be treated as a differential diagnosis. Since current literature is lacking in return-to-play outcomes following a surgical resection of an aggressive osteoblastoma, the clinician is responsible for developing an individualized plan of care for an athlete.
Mentor Name
Valerie Moody
Aggressive Osteoblastoma of the Acetabulum in an 18-Year-Old Female Vol-leyball Player
UC North Ballroom
Background: The subject was an 18-year-old female volleyball player with an osteoblastoma of the acetabulum of the hip. She had a chief complaint of deep, aching pain from her outer right hip to upper groin. Despite conservative treatment, the frequency and severity of pain progressively worsened over the course of a year and a half. The subject’s primary care provider believed her pain was caused by a stress fracture in the lower spine, so further imaging was requested.
Differential Diagnosis: Differential diagnoses for the subject’s hip pain include a labral tear, femoroacetabular impingement, dysplasia, athletic pubalgia, acetabular fracture, hernia, soft tissue involvement.
Treatment: The radiologist discovered a 4.8x2.4x4.2 cm lesion in the medial right acetabulum, with internal high attenuation foci suggestive of calcium or chondroid matrix with abnormally increased radiotracer uptake. The lesion had completely eroded through the acetabulum, leaving the patient at risk for pathologic fracture. The subject underwent three biopsies, one drill biopsy and two open biopsies. Following the second open biopsy, the osteoblastoma was labeled as benign. The subject underwent a surgical resection and open reduction internal fixation (ORIF) to remove the osteoblastoma from her acetabulum. The athlete’s rehabilitation protocol has been guided largely by existing protocols from hip labral repair and ACL-reconstruction. Due to the uniqueness of the case, her surgeon did not have a predicted time for her to return to play.
Uniqueness: Osteoblastomas represent about 0.8% of all bone tumors and are more commonly seen in male adolescents. Osteoblastomas in the region of the hip are extremely rare, accounting for 3-8.8% of all osteoblastomas, especially an aggressive osteoblastoma of the acetabulum. The physical presentation of an aggressive osteoblastoma of the hip includes limited ROM, chronic pain, night pain, radiating pain, pain aggravated by weight bearing or walking, and pain alleviated by analgesic drugs. The clinical findings of an osteoblastoma may present similarly to other sport-related injuries, but a non-specific mechanism of injury is a red flag for clinicians to note. There is no specific osteoblastoma rehabilitation protocol, so the clinician is challenged to develop an individualized plan of care for the patient. However, literature infers that rehabilitation should be guided according to an acetabular fracture. There is no developed patient-rated outcome (PRO) for individuals following a surgical resection and ORIF, so clinicians should utilize a general hip PRO to track patient progress throughout rehabilitation.
Conclusion: An aggressive osteoblastoma of the acetabulum is a rare, unlikely pathology to encounter in a young, active population. It is important that clinicians working with this population recognize the signs and symptoms of an osteoblastoma, so they know when to refer for further evaluation. Diagnosing any hip pathology, whether it be sport-related or non-sport-related, requires a thorough patient history and objective assessment. For athletes suffering of worsening hip pain despite conservative treatment, an osteoblastoma should be treated as a differential diagnosis. Since current literature is lacking in return-to-play outcomes following a surgical resection of an aggressive osteoblastoma, the clinician is responsible for developing an individualized plan of care for an athlete.