Abstract
We present the case of an elderly lady who was treated surgically as an infant for osteomyelitis of the left distal femur. Throughout the whole of her adult life she describes episodes where the thigh has become more painful and warm followed by a watery discharge from a sinus on the upper medial aspect of the thigh. This sinus has discharged at least weekly up until the present day. No further surgery has been performed on the proximal femur since childhood.
Almost 10 years ago the patient presented with symptoms of osteoarthritis in the left hip. A total hip replacement was performed at that time without any further active measures aimed at eradication of the osteomyelitis.
Despite obvious concerns of the possibility of exacerbating the osteomyelitis and developing pan femoral disease this has not been the case. The hip replacement is symptom free, stable and there are no signs of infection clinically or radiologically.
Conclusions: Whilst we would not immediately recommend this course of action; the surgical treatment of long bone osteomyelitis if an arduous procedure for both patient and surgeon with high recurrence rates. This case demonstrates that in low demand elderly patients it may be possible to implant a hip replacement.
Editoral Secretary Mr Peter Howard. Correspondence should be addressed to BHS at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN.
