The Destructive Power of Circumstance on Concurrent Poliomyelitis and Osteomyelitis.

INTRODUCTION: The current method in dealing with pediatric hip pathologies is to avoid joint replacement unless absolutely necessary. This decision is typically made on a scientific basis. However, this is not necessarily the correct approach in all cases as demonstrated in the following case report where social issues is an extremely important variable to be considered when deciding on surgical intervention.

CASE REPORT: This case report is the first of its kind to highlight the pathology mentioned and the social determinants that were a causative agent in its development. This case revolves around a 46-year-old Caucasian gentleman who presented in clinic enquiring about the possibility of a hip arthroplasty. He aimed to improve his ability to work after the cessation of state benefits. A retrospective look at his history indicated a number of social factors lead to poor outcomes and the resulting downward spiral causing his current presentation. The effect of social circumstances on the medical and surgical outcomes is highlighted in this report with a look into avascular necrosis and resulting natural arthrodesis. Both of these presentations were secondary to chronic and untreated childhood osteomyelitis of the right hip in conjunction with poliomyelitis development. The dual involvement of poliomyelitis and osteomyelitis to the hip joint no doubt had a massive impact on final pathology and is a rarely documented phenomenon. From an early age, this patient has faced difficulties integrating in society by factors that were out of his control. By the time he was old enough to lead an independent life, the damage had been inflicted both medically and psychologically through his earlier ordeals.

CONCLUSION: By writing this up, it is hoped that clinicians will recognize the debilitating holistic effect that mechanical joint pathologies and neurological deficiencies can have on patients' lives with the view to reopen the discussion on when it is appropriate to surgically intervene in hip pathologies in children and especially where osteomyelitis and poliomyelitis are involved.