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Solitary Osteochondroma Treatment & Management

  • Author: Ian D Dickey, MD, FRCSC; Chief Editor: Harris Gellman, MD  more...
 
Updated: May 05, 2015
 

Medical Therapy

No medical therapy currently exists for osteochondromas. The mainstay of nonoperative treatment is observation because most lesions are asymptomatic. Lesions found incidentally can be observed, and the patient can be reassured.

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Surgical Therapy

The treatment for symptomatic osteochondromas is resection. Care must be taken to ensure that none of the cartilage cap or perichondrium is left in the resection bed; otherwise, there may be a recurrence. Ideally, the line of resection should be through the base of the stalk; thus, the entire lesion is removed en bloc with its fibrous covering. Atypical or very large lesions should be investigated fully to exclude the remote possibility of malignancy. Magnetic resonance imaging (MRI) is useful in assessing cartilage cap thickness.

In skeletally immature patients, care must be taken to avoid damage to the growth plate during exposure and resection of the lesion. In a small study evaluating surgical outcomes of pediatric patients with digital osteochondroma (average age, 3.6 years), early surgical treatment was recommended for those with nonepiphyseal metaphysis of the bone to improve motion and prevent further finger deformity; tumor excision, potentially including part of the articular surface, was recommended for laterally oriented tumors that included less than one third of the joint surface.[28, 29]

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Preoperative Details

Local anatomic constraints must be considered carefully so that the approach and resection do not damage nearby structures. Computed tomography (CT) and MRI can be useful for lesions that arise from flat bones or that are located in difficult areas, such as lesions around the hip or scapula.[30]

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Intraoperative Details

Once the osteochondroma is exposed, dissection is limited to the base of the lesion so that an osteotome can be used to shear off the base at the level of the host bone cortex. Care is required to ensure that the resection neither violates normal host cortex by straying too deep nor leaves residual lesion by staying too shallow. The overlying bursa should be left intact, and the loose adhesive tissue should be dissected away so that the lesion and the bursa are removed en bloc.

The resected surface of the host bone can be rasped smooth, and if needed, bone wax can be packed on the cut surface to stop bleeding.

Once the specimen is removed and pathologic confirmation is received, the wound should be irrigated well. If needed, a surgical drain can be placed, ideally exiting in line with the wound.

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Postoperative Details

Most osteochondromas allow the patient to return to activity as tolerated. However, after resection of a large sessile lesion, restriction of activities should be considered because the stress riser created by the violation of the cortex may increase the risk of fracture.

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Follow-up

The local recurrence rate after resection of osteochondroma is about 1.8%.[31] Once the wound is healed, follow-up on an as-needed basis is reasonable if no associated bone deformity or potential growth-arrest concerns exist.

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Complications

Complications after surgical resection of osteochondromas are rare. Considerations include physeal disturbance or growth arrest, fracture, recurrence, incorrect diagnosis, and hematoma formation.

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Outcome and Prognosis

For solitary osteochondromas, the outcome and prognosis after surgery are excellent, with excellent local control and a local recurrence rate of less than 2%.[32, 33, 34, 35] The process is a benign one; thus, the prognosis is usually one of complete recovery. Poorer outcomes usually are related to the morbidity associated with the exposure required to remove the lesion or associated with secondary bone deformity, but the latter is usually observed in the multiple hereditary form of the disease.[36, 37, 38, 39, 40, 41, 42]

Florez et al performed a retrospective study of 113 solitary osteochondromas (most frequently located in the distal femur) that were treated between 1970 and 2002. Six patients had a recurrence after treatment, and in two patients, the lesions became malignant and developed into chondrosarcoma. The authors noted that relapse of the exostosis is rare, occurring in approximately 2% of resections, and that growth of an osteochondroma or the presence of pain in older patients suggests a possible malignancy.[33]

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Future and Controversies

Genetic karyotyping suggests that reproducible genetic abnormalities are associated with these benign growths and that they may represent a true neoplastic process, not a reactive one.[8, 9] Research is in the early stages, and further investigation is needed.[10, 11, 12, 13] Biologic therapies for osteochondromas may be possible in the future.

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Contributor Information and Disclosures
Author

Ian D Dickey, MD, FRCSC Adjunct Professor, Department of Chemical and Biological Engineering, University of Maine; Consulting Staff, Adult Reconstruction, Orthopedic Oncology, Department of Orthopedics, Eastern Maine Medical Center

Ian D Dickey, MD, FRCSC is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Royal College of Physicians and Surgeons of Canada, British Columbia Medical Association, Canadian Medical Association

Disclosure: Received consulting fee from Stryker Orthopaedics for consulting; Received honoraria from Cadence for speaking and teaching; Received grant/research funds from Wright Medical for research; Received honoraria from Angiotech for speaking and teaching; Received honoraria from Ferring for speaking and teaching.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Sean P Scully, MD 

Sean P Scully, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, Society of Surgical Oncology

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

References
  1. Garrison RC, Unni KK, McLeod RA, Pritchard DJ, Dahlin DC. Chondrosarcoma arising in osteochondroma. Cancer. 1982 May 1. 49(9):1890-7. [Medline].

  2. Staals EL, Bacchini P, Mercuri M, Bertoni F. Dedifferentiated chondrosarcomas arising in preexisting osteochondromas. J Bone Joint Surg Am. 2007 May. 89(5):987-93. [Medline].

  3. Akahane T, Shimizu T, Isobe K, Yoshimura Y, Kato H. Dedifferentiated chondrosarcoma arising in a solitary osteochondroma with leiomyosarcomatous component: a case report. Arch Orthop Trauma Surg. 2008 Jan 12. [Medline].

  4. Mavrogenis AF, Papagelopoulos PJ, Soucacos PN. Skeletal osteochondromas revisited. Orthopedics. 2008 Oct. 31(10):[Medline].

  5. Nogier A, De Pinieux G, Hottya G, Anract P. Case reports: enlargement of a calcaneal osteochondroma after skeletal maturity. Clin Orthop Relat Res. 2006 Jun. 447:260-6. [Medline].

  6. Kitsoulis P, Galani V, Stefanaki K, Paraskevas G, Karatzias G, Agnantis NJ, et al. Osteochondromas: review of the clinical, radiological and pathological features. In Vivo. 2008 Sep-Oct. 22(5):633-46. [Medline].

  7. D'Ambrosia R, Ferguson AB Jr. The formation of osteochondroma by epiphyseal cartilage transplantation. Clin Orthop. 1968 Nov-Dec. 61:103-15. [Medline].

  8. Hameetman L, Szuhai K, Yavas A, Knijnenburg J, van Duin M, van Dekken H, et al. The role of EXT1 in nonhereditary osteochondroma: identification of homozygous deletions. J Natl Cancer Inst. 2007 Mar 7. 99(5):396-406. [Medline].

  9. Hecht JT, Hogue D, Strong LC, et al. Hereditary multiple exostosis and chondrosarcoma: linkage to chromosome II and loss of heterozygosity for EXT-linked markers on chromosomes II and 8. Am J Hum Genet. 1995 May. 56(5):1125-31. [Medline].

  10. Coughlan B, Feliz A, Ishida T, Czerniak B, Dorfman HD. p53 expression and DNA ploidy of cartilage lesions. Hum Pathol. 1995 Jun. 26(6):620-4. [Medline].

  11. Legeai-Mallet L, Margaritte-Jeannin P, Lemdani M, et al. An extension of the admixture test for the study of genetic heterogeneity in hereditary multiple exostoses. Hum Genet. 1997 Mar. 99(3):298-302. [Medline].

  12. Legeai-Mallet L, Munnich A, Maroteaux P, et al. Incomplete penetrance and expressivity skewing in hereditary multiple exostoses. Clin Genet. 1997 Jul. 52(1):12-6. [Medline].

  13. Park KJ, Shin KH, Ku JL. Germline mutations in the EXT1 and EXT2 genes in Korean patients with hereditary multiple exostoses. J Hum Genet. 1999. 44(4):230-4. [Medline].

  14. Heinritz W, Hüffmeier U, Strenge S, Miterski B, Zweier C, Leinung S, et al. New mutations of EXT1 and EXT2 genes in German patients with Multiple Osteochondromas. Ann Hum Genet. 2009 May. 73:283-91. [Medline].

  15. Galasso O, Mariconda M, Milano C. An enlarging distal tibia osteochondroma in the adult patient. J Am Podiatr Med Assoc. 2009 Mar-Apr. 99(2):157-61. [Medline].

  16. Coenen L, Biltjes I. High radial nerve palsy caused by a humeral exostosis: a case report. J Hand Surg [Am]. 1992 Jul. 17(4):668-9. [Medline].

  17. Mnif H, Koubaa M, Zrig M, Zammel N, Abid A. Peroneal nerve palsy resulting from fibular head osteochondroma. Orthopedics. 2009 Jul. 32(7):528. [Medline].

  18. Karasick D, Schweitzer ME, Eschelman DJ. Symptomatic osteochondromas: imaging features. AJR Am J Roentgenol. 1997 Jun. 168(6):1507-12. [Medline].

  19. Murphey MD, Choi JJ, Kransdorf MJ, Flemming DJ, Gannon FH. Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation. Radiographics. 2000 Sep-Oct. 20(5):1407-34. [Medline].

  20. El-Khoury GY, Bassett GS. Symptomatic bursa formation with osteochondromas. AJR Am J Roentgenol. 1979 Nov. 133(5):895-8. [Medline].

  21. Day FN, Ruggieri C, Britton C. Recurrent osteochondroma. J Foot Ankle Surg. 1998 Mar-Apr. 37(2):162-4; discussion 173. [Medline].

  22. Rajappa S, Kumar MM, Shanmugapriya S. Recurrent solitary osteochondroma of the metacarpal: a case report. J Orthop Surg (Hong Kong). 2013 Apr. 21(1):129-31. [Medline].

  23. Robbin MR, Murphey MD. Benign chondroid neoplasms of bone. Semin Musculoskelet Radiol. 2000. 4(1):45-58. [Medline].

  24. Hudson TM, Springfield DS, Spanier SS, et al. Benign exostoses and exostotic chondrosarcomas: evaluation of cartilage thickness by CT. Radiology. 1984 Sep. 152(3):595-9. [Medline].

  25. Purandare NC, Rangarajan V, Agarwal M, Sharma AR, Shah S, Arora A, et al. Integrated PET/CT in evaluating sarcomatous transformation in osteochondromas. Clin Nucl Med. 2009 Jun. 34(6):350-4. [Medline].

  26. Lange RH, Lange TA, Rao BK. Correlative radiographic, scintigraphic, and histological evaluation of exostoses. J Bone Joint Surg Am. 1984 Dec. 66(9):1454-9. [Medline].

  27. Robinson D, Hasharoni A, Oganesian A, et al. Role of FGF9 and FGF receptor 3 in osteochondroma formation. Orthopedics. 2001 Aug. 24(8):783-7. [Medline].

  28. Ohnishi T, Horii E, Shukuki K, Hattori T. Surgical treatment for osteochondromas in pediatric digits. J Hand Surg Am. 2011 Mar. 36(3):432-8. [Medline].

  29. Kim JI, Kwon JH, Park YJ, D'Almeida VR, Soni SM, Nha KW. Arthroscopic Excision of Solitary Intra-articular Osteochondroma of the Knee. Knee Surg Relat Res. 2013 Mar. 25(1):36-9. [Medline]. [Full Text].

  30. Fageir MM, Edwards MR, Addison AK. The surgical management of osteochondroma on the ventral surface of the scapula. J Pediatr Orthop B. 2009 Sep 1. [Medline].

  31. Humbert ET, Mehlman C, Crawford AH. Two cases of osteochondroma recurrence after surgical resection. Am J Orthop. 2001 Jan. 30(1):62-4. [Medline].

  32. Chin KR, Kharrazi FD, Miller BS, Mankin HJ, Gebhardt MC. Osteochondromas of the distal aspect of the tibia or fibula. Natural history and treatment. J Bone Joint Surg Am. 2000 Sep. 82(9):1269-78. [Medline].

  33. Florez B, Mönckeberg J, Castillo G, Beguiristain J. Solitary osteochondroma long-term follow-up. J Pediatr Orthop B. 2008 Mar. 17(2):91-4. [Medline].

  34. Di Giorgio L, Lanzone R, Sodano L, Di Paola B, Touloupakis G, Mastantuono M. [Surgical treatment of osteochondromas: indication in "Strategic Exostosis"]. Clin Ter. 2015 Jan-Feb. 166(1):e27-e33. [Medline].

  35. Bakhshi H, Kushare I, Murphy MO, Gaynor JW, Dormans JP. Chest wall osteochondroma in children: a case series of surgical management. J Pediatr Orthop. 2014 Oct-Nov. 34(7):733-7. [Medline].

  36. Fogel GR, McElfresh EC, Peterson HA, Wicklund PT. Management of deformities of the forearm in multiple hereditary osteochondromas. J Bone Joint Surg Am. 1984 Jun. 66(5):670-80. [Medline].

  37. Govender S, Parbhoo AH. Osteochondroma with compression of the spinal cord. A report of two cases. J Bone Joint Surg Br. 1999 Jul. 81(4):667-9. [Medline].

  38. Peterson HA. Multiple hereditary osteochondromata. Clin Orthop. 1989 Feb. (239):222-30. [Medline].

  39. Porter DE, Benson MK, Hosney GA. The hip in hereditary multiple exostoses. J Bone Joint Surg Br. 2001 Sep. 83(7):988-95. [Medline].

  40. Snearly WN, Peterson HA. Management of ankle deformities in multiple hereditary osteochondromata. J Pediatr Orthop. 1989 Jul-Aug. 9(4):427-32. [Medline].

  41. Wuyts W, Ramlakhan S, Van Hul W. Refinement of the multiple exostoses locus (EXT2) to a 3-cM interval on chromosome 11. Am J Hum Genet. 1995 Aug. 57(2):382-7. [Medline].

  42. Wicklund CL, Pauli RM, Johnston D. Natural history study of hereditary multiple exostoses. Am J Med Genet. 1995 Jan 2. 55(1):43-6. [Medline].

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Solitary osteochondroma. Anteroposterior radiograph of a pedunculated osteochondroma of the distal femur.
Solitary osteochondroma. Lateral radiograph of a pedunculated osteochondroma of the distal femur. Orientation is away from the growth plate, and medullary continuity is clear.
Solitary osteochondroma. Lateral radiograph of a sessile osteochondroma of the distal femur.
Solitary osteochondroma. Anatomic and age distribution of solitary osteochondromas.
Solitary osteochondroma. CT scan of the pelvis depicting a massive solitary osteochondroma.
Solitary osteochondroma. Anteroposterior radiograph of sessile osteochondroma of the humerus.
Solitary osteochondroma. CT scan of the same sessile osteochondroma of the humerus as in Image 6.
Solitary osteochondroma. MRI of sessile osteochondroma of the femur demonstrating the thickness of the cartilage cap.
Solitary osteochondroma. Gross osteochondroma specimen at the time of resection. Bone stalk and overlying membrane on cartilage cap.
Solitary osteochondroma. Cut surface of surgical osteochondroma specimen. Cartilage cap and underlying bone with medullary continuity.
Solitary osteochondroma. Histology of cut osteochondroma specimen. Cartilage cap and orientation of enchondral bone formation.
Solitary osteochondroma. High-power view of benign cartilage cells arranged in vertical growth plate pattern.
Solitary osteochondroma. Radiograph demonstrating the deformation of the distal tibiofibular joint in a patient with a solitary osteochondroma.
 
 
 
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