Osteochondroma Treatment in Delhi, India

Osteochondroma is a common benign bone tumour characterised by the overgrowth of cartilage and bone near the end of a bone. It typically affects the long bones, such as the thigh bone (femur) or the shinbone (tibia), but can also occur in other bones. Osteochondromas are often discovered incidentally and may not cause any symptoms. However, they can sometimes lead to pain, limited range of motion, or pressure on nearby nerves or blood vessels if they grow large enough.

Solitary Osteochondroma

Solitary osteochondroma is the most common type, representing approximately 80% of all osteochondromas. It typically occurs as a single tumour in one bone. The tumour usually develops near the growth plate, which is the area of growing tissue near the ends of long bones during childhood and adolescence. This type of osteochondroma often becomes apparent during growth spurts in childhood or adolescence when bones are actively growing. Solitary osteochondromas are typically sporadic and not inherited, although they can occur in individuals with no family history of the condition.

Hereditary Multiple Exostoses (HME)

Hereditary multiple exostoses (HME), also known as multiple osteochondromatosis, is a genetic condition characterised by the development of multiple osteochondromas in various bones throughout the body. HME is inherited in an autosomal dominant pattern, meaning that a child only needs to inherit one copy of the mutated gene from either parent to develop the condition. Individuals with HME typically develop multiple osteochondromas, often appearing during childhood or adolescence. These tumours may continue to grow and develop throughout childhood and into early adulthood.HME can lead to various complications, including bone deformities, limb length discrepancies, joint problems, nerve compression, and restricted joint movement. Regular monitoring and management by healthcare professionals are essential for individuals with HME to monitor tumour growth, address complications, and optimise quality of life.

Both solitary osteochondromas and hereditary multiple exostoses require careful monitoring and, in some cases, intervention to manage symptoms, prevent complications, and address any malignant transformation that may occur, although this is rare.

The exact cause of osteochondroma, particularly solitary osteochondroma (the most common type), remains unknown. However, researchers suspect several contributing factors:

• Genetics: There's a suspected link to specific genes, particularly EXT1 and EXT2, which play a role in cartilage development. Mutations in these genes might disrupt growth plate function, leading to abnormal cartilage and bone overgrowth. However, solitary osteochondromas often occur without a family history, suggesting other factors might be involved.
• Random mutations: In solitary cases, the genetic mutation might occur sporadically during cell division, not necessarily inherited.

Here's a breakdown of causes based on the type of osteochondroma:

• Solitary osteochondroma: The exact cause is unknown, but it's likely a combination of genetic predisposition and possibly random mutations during cell division.
• Hereditary multiple exostoses (HME): This is a confirmed genetic condition. Mutations in the EXT1 or EXT2 genes are inherited from a parent with HME (autosomal dominant inheritance).

While the precise cause remains under investigation, researchers are actively exploring the role of genetics and other potential factors in osteochondroma development.

Osteochondromas often don't cause any symptoms at all, and sometimes go unnoticed for years. However, when symptoms do occur, they can vary depending on the size and location of the osteochondroma. Here's a breakdown of the potential symptoms:

Common symptoms

• Painless bump: This is the most common symptom. You might feel a hard lump near a joint, especially around the knee and shoulder.
• Pain with activity: If the osteochondroma rubs against a tendon or nerve during movement, it can cause pain.

Less common symptoms

• Numbness or tingling: A large osteochondroma pressing on a nerve can lead to numbness or tingling in the surrounding area.
• Limited movement: In rare cases, a large osteochondroma near a joint might restrict movement.
• Uneven growth: In children with HME (multiple osteochondromas), abnormal bone growth can cause bone deformities, shorter stature, or unequal leg lengths.

The absence of symptoms doesn't necessarily mean there's no osteochondroma. Those who notice a lump or experience unexplained pain near a joint, must consult a healthcare professional for proper diagnosis.

The diagnosis of Osteochondromas may involve one or more of the following procedures/tests.

Physical Examination: A healthcare professional will conduct a physical examination to assess any visible lumps or masses near the affected bone or joint. They may also evaluate the range of motion and any associated symptoms.

Imaging Studies

• X-ray: X-rays imaging is often the initial diagnostic tool used to visualize bony abnormalities. Osteochondromas typically appear as bony projections arising from the bone surface.
• MRI (Magnetic Resonance Imaging): Magnetic resonance imaging (MRI) may be recommended to obtain detailed images of soft tissues, nerves, and blood vessels surrounding the osteochondroma, especially if there are concerns about nerve or vascular compression.

Biopsy (if needed)

In rare cases where there is suspicion of malignant transformation or if the diagnosis is uncertain based on imaging studies alone, a biopsy may be performed. A small sample of tissue is collected and examined under a microscope to confirm the diagnosis.

Observation

If the osteochondroma is small, asymptomatic, and not causing any complications, it may be monitored regularly without immediate intervention. Routine follow-up appointments with a healthcare professional may be recommended to monitor for any changes in size or symptoms.

Surgical Removal (Excision)

Surgical removal of the osteochondroma may be recommended if it causes symptoms such as pain, restricted movement, nerve compression, vascular compression, or if there is a risk of fracture. During the surgical procedure, the osteochondroma is carefully excised from the bone while preserving surrounding tissues and structures. In some cases, additional procedures may be performed to address any complications or deformities caused by the tumour.

Physical Therapy

Physical therapy may be prescribed as part of the treatment plan to improve joint mobility, strength, and function following surgical removal of the osteochondroma. Physical therapist can provide customised exercises and rehabilitation techniques to help restore optimal movement and function.

Monitoring and Follow-Up

After surgical removal or conservative management, regular monitoring and follow-up appointments with a healthcare professional are essential to assess healing, monitor for recurrence, and address any ongoing symptoms or complications.

Rare Cases of Malignant Transformation

If there is evidence of malignant transformation of the osteochondroma (secondary peripheral chondrosarcoma), additional treatment options such as chemotherapy, radiation therapy, or further surgical interventions may be considered in consultation with oncology specialists.

The specific treatment approach for osteochondroma depends on various factors, including the size and location of the tumour, the presence of symptoms or complications, and individual patient considerations. A multidisciplinary team of healthcare professionals, including orthopaedic surgeons, radiologists, and physical therapists, may collaborate to develop a personalised treatment plan tailored to each patient's needs and preferences.

The outlook for osteochondroma is generally positive, particularly for solitary cases. These benign bone tumours often remain asymptomatic and may not require treatment beyond regular monitoring. With appropriate management, many individuals with osteochondroma can lead normal, healthy lives. Surgical removal of symptomatic or complicated osteochondromas typically leads to resolution of symptoms and a good long-term outcome. However, individuals with hereditary multiple exostoses (HME) may face challenges due to multiple tumours in various bones, which may require ongoing monitoring and management to address symptoms and prevent complications. While rare, malignant transformation into secondary peripheral chondrosarcoma can occur, necessitating more aggressive treatment approaches and potentially impacting prognosis. Overall, early diagnosis, close medical supervision, and timely intervention are crucial in ensuring the best possible prognosis for individuals with osteochondroma.

Is osteochondroma a serious condition?

Osteochondroma is typically considered a benign condition. While it can lead to complications such as pain, restricted movement, or nerve compression, it is generally not considered life-threatening.

What is the difference between osteochondroma, chondrosarcoma, and osteosarcoma?

Osteochondroma is a benign bone tumour characterised by the overgrowth of cartilage and bone near the end of a bone.

Chondrosarcoma is a malignant tumour of cartilage cells. Unlike osteochondroma, chondrosarcoma is cancerous and has the potential to spread to other parts of the body.

Osteosarcoma is a malignant tumour of bone-forming cells. Like chondrosarcoma, osteosarcoma is cancerous and can metastasize.

Where does osteochondroma occur in the body?

Osteochondromas most commonly occur near the growth plates of long bones, such as the femur, tibia, and humerus. They can also develop in other bones, including the pelvis, ribs, and spine.

Is solitary osteochondroma genetic?

While solitary osteochondromas are typically sporadic and not inherited, there may be rare cases with a genetic predisposition. However, hereditary multiple exostoses (HME) is a genetic condition characterised by the development of multiple osteochondromas.

Can an osteochondroma become cancerous?

While most osteochondromas are benign, there is a rare risk of malignant transformation, particularly in cases of multiple or hereditary osteochondromas. Malignant transformation can lead to a condition known as secondary peripheral chondrosarcoma.

What parts of the body are usually affected by osteochondroma?

Osteochondromas typically affect the long bones of the body, such as the femur, tibia, and humerus. However, they can also occur in other bones, including the pelvis, ribs, and spine.

Do osteochondromas stop growing on their own?

Osteochondromas often stop growing once skeletal maturity is reached, typically during adolescence. However, in some cases, they may continue to grow into adulthood.

What complications can arise from osteochondromas?

Complications of osteochondromas can include pain, restricted movement, nerve compression, vascular compression, limb deformities, and fractures.

Can osteochondromas affect growth?

Osteochondromas near the growth plates of bones can potentially affect bone growth in children and adolescents, leading to limb length discrepancies or angular deformities.

Are osteochondromas more common in children?

Osteochondromas are more commonly diagnosed during childhood or adolescence when bones are actively growing. However, they can occur at any age.

Is surgery the only treatment option for osteochondromas?

Surgery is often recommended for symptomatic or complicated osteochondromas. However, conservative management, including observation and physical therapy, may be appropriate for asymptomatic cases.

Can osteochondromas recur after treatment?

While surgical removal of osteochondromas typically results in a good outcome, there is a potential risk of recurrence, especially in cases of hereditary multiple exostoses (HME).

Are there non-surgical treatments for osteochondromas?

Non-surgical treatments for osteochondromas may include pain management, physical therapy, and monitoring for potential complications.

Are there any alternative therapies for osteochondromas?

Alternative therapies for osteochondromas are not well-established. It's essential to consult with healthcare professionals for evidence-based treatment options.

Can osteochondromas cause arthritis?

Osteochondromas can potentially lead to secondary arthritis if they affect joint function or cause joint instability over time.

Can osteochondromas lead to bone fractures?

In some cases, osteochondromas may weaken the bone structure, increasing the risk of fractures or bone breakage, particularly if the tumour extends outward from the bone surface.

Can osteochondromas be prevented?

Osteochondromas typically cannot be prevented. However, early detection and appropriate management can help prevent complications and optimise outcomes.

Can osteochondromas be detected before birth?

Osteochondromas are typically not detectable before birth. They usually become apparent during childhood or adolescence when bones are actively growing.

How long does it take to recover after osteochondroma surgery?

Recovery time after osteochondroma surgery can vary depending on factors such as the size and location of the tumour, the surgical approach used, and individual healing abilities. Generally, patients may need several weeks to months to fully recover and regain normal function. Physical therapy may be recommended to aid in the rehabilitation process.

Reviewed By Dr. Ashish Jain, Director - Robotic Joint Replacements & Orthopaedics on 11 July 2024.