Six pathological dislocations of the hip in four patients with multiple sclerosis and in one patient with traumatic triplegia are presented. All occurred as a result of pyarthrosis caused by extension from a long-standing, infected trochanteric decubitus ulcer. In all, recognition of the serious infection affecting the hip joint was delayed greatly because of the patient's neurological disease with paralysis and lack of sensation.
Vigorous surgical treatment, antibiotic medication, and general supportive measures resulted in the healing of four of the wounds and residual osteomyelitis in one. One patient died of septicemia.
In four of the five patients there was an excellent local response to treatment, but all save one of these patients died within two years of the operation because of other complications of their neurological disease. Earlier recognition of the possible malignant nature of penetrating trochanteric decubitus ulcers should result in earlier surgical treatment and reduced morbidity and mortality. Closure of decubitus ulcers should be undertaken early, before the stage of invasion. If healing of these decubitus ulcers can be achieved after marked destruction of the
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hips joint, it is obvious that appropriate vigorous treatment will be successful at this early stage, when the patient is in better general condition.
Copyright 1960 by The Journal of Bone and Joint Surgery, Incorporated