Case 2, presented by Thomas P. Sculco, MD, Surgeon-in-Chief and Korein-Wilson Professor of Orthopedic Surgery at Hospital for Special Surgery and Lazaros A. Poultsides, MD, MSc, PhD, Orthopaedic Surgery Fellow in Adult Reconstruction and Joint Replacement at HSS describes a 59-year-old male with a history of polyostotic fibrous dysplasia who presented to HSS for chronic and progressive left hip pain. He had multiple previous surgeries on his left femur for significant acquired deformity, and his disease had affected other skeletal areas including his left forearm. Upon presentation, he walked with a limp and used two axillary crutches for ambulation. He stood with a planovalgus deformity of both hindfeet. Plain radiographs demonstrated osteoarthritis in both hips, severe on the left side, and a Shepherd’s crook deformity with an associated varus alignment of the left femoral neck shaft angle. A Kuntscher nail was present transfixing a healed fracture deformity of the proximal left femur. CT scan of the pelvis showed diffuse expansile lytic lesions of the iliac wings, sacrum, acetabulum, femurs, findings consistent with bilateral polyostotic fibrous dysplasia, with bilateral coxa vara deformity, severe on the left side resulting in a leg-length discrepancy of 6.5cm. Because of the patient’s severe pain and disability left total hip arthroplasty (THA) was recommended.
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